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Home My WebLink AboutPR17-1737c C r - 0 CITY OF DIAMOND BAR { I i ' } DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES s 21810 Cople;-.7"iveiiamond Bar, CA 91765 �•. PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection mine (909) 839-7027 FIRMLY `' R9 BUILDING PERMIT APPLICATION www.city0fdiamondbar.com building@diamondbarca.gov lye JOB SITE ADDRESS -n / "-5�—` Al 0r14,&OT TRACT OWNER 111W--1 ADDRESS4"' �Y CITY _"'tr� :�s_ ,g;4 .C4ZIP 1.-71 TEL '�, APPLICANT CONTRACTOR w71 -`y"- ADDRESS /f s e` ' CITY / , r i.3 6A ZIP f• 461TEJ. 'V B�% �. —11 ARCH/ENG/r DESIGNER SY ° ADDRESS `" CITYZIP LXsr - TELA s OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(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 pursuant to the provisions of the Contractor's State License Law (Chapter9) 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 cr Section 7031.5 by any applicant for a permit subjects the spoil a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole 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 properly who, through employeesor personal effort, builds or improves the property, provided thatthe improvements are not intended or offered for sale. If however, the building or improvement is so€d within one year of completion, the Owner -Builder will have the burden of proving that t was not built 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 Code: The Contractors' State License Law does not apply to an owner of property who builds orimproves thereon, and who contracts forthe projects with a licensed Contractor pursnantlothe Contractors' State License Law.). U i am exempt from licensure under the Contractor's State License law for the following reasons}: Oate" Sign! By my naturs ! acicnovrleC9e 1Fai, except fur my persoral -asidaace ii 1 must have te6h.16d fur at "east ori, year prior to completion of the improvements covered by this permif,l cannot legally sell a structure that I have buift as an owner -builder if it has not heen constructed in fis entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web site: httplwww.laginto.ca.gov/calaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm order penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Cade, and my license is in full force and effect. LICENSE CLASS: LIC. NO.: ®S— , l -Z EXP, DATE; �-O CONTRACTOR: Z4 C4 r c WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for to 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 workfor which tihis permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT RE COMPLETED IF THE PERMI IS FOR ONE HUNDRED DOLLARS $1 DO OR LESS). I certfythatin the performance of the workforwhich this permit is Issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that it I should become subjoct to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall torthwth comply with these provisions. DATE: APPLICANT: i WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal i penalties and civil fines up to one hundred thousand dollars ($900,000), in addition to the cost of the compensation, damages as provided for 15 section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY i 1 hereby affirm under penalty of perjury that Were Is a Construction Landing 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 s county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to j enter upon the above-mentioned property for inspection purposes. i PER E NAME (PRINT) �� { SIGNATURE OF PERMITTEE DATE APPLICATION DATE: 5/21J/1 --y P/C# ISSUF DATE: PERMIT# : TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFH/ADD E I Garage/Carport rn U Patio/Deck Lu rr Pool/Spa ZRe -Roof Commercial Valuation: Add Area: QUANTITY DESCRIPTION FEE ® is v w J a � fir' ss z x U CONSTRUCTION: PLAN REVIEW: 0 Cp ZS 71 ELECTRIC: 1� . PLUMBING: 67 ep MECHANICAL: INSPECTION FEE: ISSUANCE: pp S SMTP: 41,55 ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: 4.10 BASF: ®® PLOT P] AN: ZONING CLEARANCE: TOTAL FEES COMMENTS: /-179,57 PIC: 2"t "1�� PAID BY: �j RECRPTPAID BY: @� VALIDATION: VALIDATION: Y® WHITE— Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy .-I COMMENTS: