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Home My WebLink AboutPR17-834 (7)~ _ CITY OF DIAMOND BAR IIS 1 I i ` DEPARTMENT OF COMMUNITY & DEVEIt) I':TT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection klotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiarnondbar.com building@diamondbarill r 4 �/ j JOBSITEADDRESSG APN LOT TRACT OWNER d ✓ a ADDRESS ✓� ' �". ` " _ CITY APPLICANT r CONTRACTOR ✓A�? !.� - ,�;t .m kV« ADORES CITY l LI P Gi - ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from this Contractor's State License Law for the reaso(s) Indicated below by the checkmark(s), I have placed next to the applicable Items) [Section 7031.5, Rosiness and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she I. licensed pursuantte the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Codej or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfor a permit subjects the applicantto a civil penalty of not more than five hundred dollars ($500). ( j I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or{_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not applyto an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or mprovenni is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved forthe purpose at sale.). (-)1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law forthe following reason(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an own er-bullder if it has not been constructed in its entirely by licensed contractors. I understand that a copy of the appllcable law, Section 7044 of the Business and Professions Code is available upon request when this application Is submitted or at the fallowing Web site: httplwwwleginfo.ca.govlcalaw.hlml. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force andloffect. LICENSE CLASS: LIC. NO.., !" 7 �..r EXP. DATE: % CONTRACTOR: P ' WORKER'SCOMPENNJAnfl ECLAU TI)31 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE Of THE FOLLOWING RATION& I have and will maltain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued: I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BEt GMM1TED`7rThEARMff IS FOR ONE HUMORED DOLLARS $100 OR LESS). I certify that in the performance of the; vJork for which this pumlit is issued, lIshall n�emplcy any person in any manner so m to . become subj, to the orker's Compensation Lalws of Cahfumia. And agree Shat if I should become subject 1n the Worker's Compens n prouist hs of Section 3700 onKe Labor Cod i iprihwrth cumplywith those proviAp DATE�.sP�r �APPLICtANr i WARruII�G: Falb"re tp'secure Workff''s Compensation c erage,,i5 unlawful, and shall subject an employer to criminal penalties and civil<'fines up to one hundrariAhousand ollars,(510p;000), in addition to the cost of the compensation, damages as provided for in section 37p the labor code, inures[; and attorney's fees. CONSTRUCTION LONUINGAGENCY I hereUy affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec, 3097, Civ. C.) LENDER'S NAME: LENDER'S ADDRESS: i I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to bullding construction, and hereby authorize representatives of this county to i enter uponit2.abve-meritlonedproperty for lityctionpurposes. S1GNA RE'�FP.ERMITT DATE APPLICATION DATE_ k_1 P/C# ISSUF DATE: �l PERMIT# : \'I TYPE CONST. OCC GROUP: Scope of Work -,729' # DWEL. UNITS /r' # STORIES z BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD7REiN Garage/Carport B Patio/ eck ri Pool Re -Roof Commercial m � Valuation: Cry Adj. Area: QUANTITY DESCRIPTION FEE co s� m J d U_ w v CONSTRUCTION: PLAN REVI EW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: -1 Q, _ SMIP: T r ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: ° PLOT PLAN: ZONING CLEARANCE: — TOTAL FEES COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT# PAID BY: VALIDATION: WHITE Department Copy, YELLOW — FTnance Copy, PINK — Assessor Copy CIT'v IF t BAR INSPL 'TION RECORD COMMENTS: