The URL can be used to link to this page

Home My WebLink AboutPR17-0680CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810C pley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamoodbar.com building@diamondbarea.gov ZIP ADDRESS CITY ZIP OWNER -BUILDER DECLARATION I hereby athnn under penalty at perjury that I am exempt from the Contractor's State License Law for the raason(s) Indicated below by the checkmark(e, I have placed next to the applicable items) [Section 7D31.5, Business and Professions Code: Any city or county that requires a permit to construct, after, Improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to fife a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] 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 applicant to a civil penalty of not more than five hundred dollars ($500). (_)1, as owner of the property, or my employees with wages as their sole compensation, will do U all at or (-j portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Coda: The Contractors' State License Law does not apply to 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 improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not buck or improved for the purpose of sale.}. U 1, as owner of the property, am exclusively contracting with licensed Contractors 10 construct the project (Section 7044, Business and Professions Coda: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts fortheprojects with alicensed Contractor pursuar the Contractors'State License Law), U I am exemptfrom licensure under the Contractor's State License law forthe following reason(s). By my signature below I acknowledge that, excel my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permlt,i cannot legally sell a structure that I have built as an owner builder it it has not been constructed in its entirety by licensed contractors. I understand that a copy of the app€icahle law, Section 7044 of the Business and Professions Code Is available upon request when this application is submitted or at the following Web she: httplwww.Iegiufo.ca.gav/calaw.html. 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 ofthe Business and Professions Code, and my license is in full force and effect. LICENSE CLASSLIC. NO EXP.DATE;."-. CONTRACTOR' L. �.: " WORKER'S COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and wM maintaln 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 whlch 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 ofthe workfor which this Perlis issued. My Worker's Compensation Insurance Carrier and Policy Numb : _ L--- - CARRIER POLICY NUMBER I cerlffythat in the performance ofthe work forwhich this permit issued, I shall not employ any person in any mannerso become subject to To Worker's Compensation Laws of California. Angree that if shpold bee a ' kject to the W% Comoeusallonnrovisions of Section 3700 ofihatatror Code, Fshall folhwith compl41TOse pro%cions, ✓ WARNING: Failure to secure Worker's Compensation c69rage is unlawful, and steal€ suhjec;ye employer to criminal penalties and civil tries up to one hundred thousand dollars ($100,0001, in addition to cost f the compensation, damages as provided ferric section 3788 orthe €abor code, interest, and attorney's fees �..,..� CONSTRUCTION LENDING AGENCY I hereby 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 certify that I have read this application and state thatthe above information Is correct- I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize represeniathes of this county to enW,Vpon the abovomentioned i5drtyforinspDdAn-purposes,, ; 'n DATE PRESS FIRMLY APPLICATION DATE:) P/C#� ISSUE DATE: PERMIT# :TM ""6 50 TYPE CONST. X J OCC GROUP: Scope of Work `'j li, i : 5 _ w # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/AE7D7PEM JOB SITE ADDRESS') Garage/Carport w Patio/Deck L 0 Pool/Spa APN LOT of TRACT Z) m a OWNER Valuation: Adj. Area: ADDRESS 7 OUANTITY DESCRIPTION FEE 4 rv` �— CITY u Z�f� -t� TEL. w APPLICANT .f " TEL. J CONTRACTOR... T U Z ZIP ADDRESS CITY ZIP OWNER -BUILDER DECLARATION I hereby athnn under penalty at perjury that I am exempt from the Contractor's State License Law for the raason(s) Indicated below by the checkmark(e, I have placed next to the applicable items) [Section 7D31.5, Business and Professions Code: Any city or county that requires a permit to construct, after, Improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to fife a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] 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 applicant to a civil penalty of not more than five hundred dollars ($500). (_)1, as owner of the property, or my employees with wages as their sole compensation, will do U all at or (-j portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Coda: The Contractors' State License Law does not apply to 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 improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not buck or improved for the purpose of sale.}. U 1, as owner of the property, am exclusively contracting with licensed Contractors 10 construct the project (Section 7044, Business and Professions Coda: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts fortheprojects with alicensed Contractor pursuar the Contractors'State License Law), U I am exemptfrom licensure under the Contractor's State License law forthe following reason(s). By my signature below I acknowledge that, excel my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permlt,i cannot legally sell a structure that I have built as an owner builder it it has not been constructed in its entirety by licensed contractors. I understand that a copy of the app€icahle law, Section 7044 of the Business and Professions Code Is available upon request when this application is submitted or at the following Web she: httplwww.Iegiufo.ca.gav/calaw.html. 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 ofthe Business and Professions Code, and my license is in full force and effect. LICENSE CLASSLIC. NO EXP.DATE;."-. CONTRACTOR' L. �.: " WORKER'S COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and wM maintaln 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 whlch 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 ofthe workfor which this Perlis issued. My Worker's Compensation Insurance Carrier and Policy Numb : _ L--- - CARRIER POLICY NUMBER I cerlffythat in the performance ofthe work forwhich this permit issued, I shall not employ any person in any mannerso become subject to To Worker's Compensation Laws of California. Angree that if shpold bee a ' kject to the W% Comoeusallonnrovisions of Section 3700 ofihatatror Code, Fshall folhwith compl41TOse pro%cions, ✓ WARNING: Failure to secure Worker's Compensation c69rage is unlawful, and steal€ suhjec;ye employer to criminal penalties and civil tries up to one hundred thousand dollars ($100,0001, in addition to cost f the compensation, damages as provided ferric section 3788 orthe €abor code, interest, and attorney's fees �..,..� CONSTRUCTION LENDING AGENCY I hereby 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 certify that I have read this application and state thatthe above information Is correct- I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize represeniathes of this county to enW,Vpon the abovomentioned i5drtyforinspDdAn-purposes,, ; 'n DATE PRESS FIRMLY APPLICATION DATE:) P/C#� ISSUE DATE: PERMIT# :TM ""6 50 TYPE CONST. X J OCC GROUP: Scope of Work `'j li, i : 5 _ w # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/AE7D7PEM Garage/Carport w Patio/Deck L 0 Pool/Spa zRe -Roof of Commercial Z) m Valuation: Adj. Area: OUANTITY DESCRIPTION FEE J U w w cv z m J a U Z C) C) CONSTRUCTION:, e� -- PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: , 2 - Sl SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: - PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: PIC: � PAIL) BY: VALIDATION: RECEIPT PAiDBY: VALIDATION: WHITE —Department Copy, YELLOW —Finance Copy, PINK—Assessor Copy 4 Z '0. COMMENTS: