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Home My WebLink AboutPR17-5619CITY OF DIAMOND BAR M '�'ITY &DEVELOPENT SERVICES _.iI DEPARTMENT OF COMMUN _ - PRESS { =- 21810 Copley Drive, Diamond Bar, CA 9 1 q (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityoldiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS APN _ OWNER ZIP DESIGNER ADDRESS CITY ZIP TFL. OWNER -BUILDER DECLARATION i hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasor(s) indicated below by the checkmark(s), I have placed next to the applicable Items) [Section 7031.5, Business 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 is licensed pursuantto 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 applicantfora permit subjects the appiicantto a civil penalty of not more than five hundred dollars ($500), U I, as owner ofthe property, or my employeeswith wages as theirsole compensation, will do (_) all of or U 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 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 net built or improv for the purpose of sale.). 01, as owner of the property, am exclusively conmeoting with licensed Contractors to construct the project (Section 11'7044, Buslness and Professions Code: The Contractors' State License Law does riot apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law torthe following mason(s): By my signature below I acknowledge that, exmptfor 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 owner builder If it has not been constructed In its entirety by licensed contractors. I understand that a copy of the applicable law, Sectlom 7044 of the Bui rind Professions Coda is available upon request when this application is submitted or at the following Web site: httplwww.leginfe.ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that i am licensed under provisions of Chapter 9 (oommendng with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE C LIC. 10.. .Aair : EXP.DAT. CONTRACTOR WORKER' - ;01 DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Seii-Insure for Worker's Compensation, as provided by rr ection 0 of the Labor Code, for the performance of the work for which this permit is issued ave and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the wcrkior which this permit is issued. My Worker's Compensation Insurance Carrier and PolicyNumherare: CARRIER POLICY NUMBER (PHIS SECTION NEEP NOT DE COMPLETED IFTH PERMIT IS FOR=UNDREDOLL DARS $100 OR LE55]. 1 certty that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so alto become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions of Sectlon 3790 ofthe Labor Cede, I shall forthwith comply with those provislons. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensator coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to ane hundred thousand dollars ($100,000), In addblon to the cost of the compensation, damages as provided for in section 3708 a1 the labor 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.). LENOEA'S NAME: LENDER'S ADDRESS: 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 building construction, and hereby authorize representatives of this county to enter upon-ihe above-mentioned prcpe"_, r 1 spe'ban purposes. y APPLICATION DATE: �-r h PIC# FIRMLY ISSUE DATE: il I +'i PERMIT# : VP R it ` S(42 k 4 - TYPE CONST Scope of Work OCC GROUP: # DWEL. UNITS # STORIFS # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUAI IUN SFR/ADDii Garage/Carport Patio/Reck Pool/Spa Re -Roof Commercial Valuati Adj. Area: CONSTRUCTION: REVIEW: QUANTITY DESCRIPTION ttt PLAN ELECTRIC: r u� SMTP: z m ENERGY ENERGY PERMIT: RETENTION FEE: PRE FFE:J a PLOT PLAN: ZONING CLEARANCE: �d v 9 —}MENTS: rTOTALFEES CONSTRUCTION: REVIEW: PLAN ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: P/C: ENERGY ENERGY PERMIT: RETENTION FEE: PRE FFE:J -ALT BAS F: PLOT PLAN: ZONING CLEARANCE: 9 —}MENTS: rTOTALFEES PIC: PAID BY: VALIDATION: - RECEIPT# PA11BY, VALIDATION: C/) DATE -SIGN R PERMITTEE H WHITE — Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy CITY OF DIAMOND BAR y INSPECTION RECORD VV[VIIVII=IV I 'D: