HomeMy WebLinkAboutPR17-11241LL
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D%l�►IOSTD BAR
CITY OF DIAMOND TSAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov
JOB SITE ADDRESS 2 l I g t4 (21 d l de rSDr
n s
APN 5-263-cK6-1U3 LOT TRACT
OWNER tnraj7Gl' /YF 614,r g� 51?t11c4,-d �!
ADDRESS l f `7'71 "'' UYC'e ftG )�daic7', f� 2_01i: -
CITY L -C-5 ^7 le; ZIP '100'I R TEL
APPLICANT icJ`-6lsnr° 15CI-P TEL.
CONTRACTOR fM.4. L s
ADDRESS
CITY'I ZIP ''EL.
ARCH/ENG/ j\
DESIGNER �%1 '� rrA eeli
ADDRESS 2j94-5;-9 I 'Ek -1
CITYl�-i-ur,res� ZIP 9 _"�G TEL q4-9 44�
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 hems) [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 perm€ll file a signed statementthat he or she
is licensed pursuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Seotian
7000 of Divlslon 3 of the Business and Professions Cede] orthat he or she Is exemptfrom licensure and the basis for
the alleged exempton. Any violation of Section 7931.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than flue hundred dollars ($500),
U I, as owner of the property, or my employees with wages as thelrso€e compensation, will do U all of or U portions
of the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Protesslons Code: The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
or improves the properly, 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-Bullder will have the burden of proving that It was not built
or Improved forthe purpose of sale.).
U I, as owner of the property, an exclusively contracting with licensed Contractors to construct the project (Section
7644, Business and Professions Code; The Contractors' State License Law does not apply to an owner of property who
builds or Improves thereon, and who contractsfor the projects with a licensed Contractor pursuant 1c the Contractors' State
License Law.).
U I am exempt from Ilcensure under the Contractor's State License law for the following reason(s):
Date: Sign:
By my signature below I acknowledge that, exceptfor my personal residence In which I must have resided for at least ane
year prl0rte completion ofthe Improvements covered by this permlt,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 matractors. I understand that a copy of the
applicable law, Section 7044 of the Business and Professions Code le available upon request when this appllcatlon Is
submitted or at the following Web site: http/wvvw.leglnfa.ca.gov/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 of the Business and Profe�sslons Code, and my license Is In f
ull force and effect
LICENSE CLASS: GIGS) iJC. NO.:
EXP. DATE: CONTRACTOR
WORKER'S COMPENSATION DECLARATION �
I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I have and will maintain a Certificate of Consent to Self -Insure far Worker's Compensation, as provided by
1 Section 3700 of the Labor Cade, for the performance of the work for which this permlt 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 this permit Is Issued. My Worker's Compensatlon Insurance Carrier end
Policy Number ar�
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS).
I certlythatin the performance of the werkfor which this permitls Issued, I shall not employ any person In any manner se as to
become subject to Me Worker's Compensatlon Laws of Califomla. And agree that if I sheul etyma subject to the Worker's
Compensallnngmvlslons of Section 3700 of th or Code, I shall forthw r hose pkovlslons.
OATE� APPLICANT: r T
WARNING: Falun to secure Worker's Comrl coverage Is unlawful, and shall subject an employer to criminal
penalties and civil flnes up to one hundred thousand dollars ($1 C0,000), In addition to Me cost of the compensation,
damages as provided for In section 3708 of the labor code, Interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury Mat there Is a Construction Lending Agency for the performance of the work for
which this permlt Is Issued (Sec. 3097, Civ, C.),
LENDER'S NAME:
LENDER'S ADDRESS:
ertliythat I have read this appllcation and state that the above Information Is correct. I agree to comply with oil city and
county ordinances and state laws relating to building constmctloa, and hereby authorize representatives of this county to
enteropen the above-mentioned property for Inspectlon purposes.
PEf3polA�ET 1 NAME (FR��
SfG kCF PERMITTEE DATE
(PJlC#
APPLICATION DATE: 31,5//-y 'Il
ISSUE DATE: III,L �l'a PERMIT# : l 1I tl
TYPE CONST. V-9 OCC GROUP:
/I YY
Scope of Work g� t, � ^'I T,&A""iS
C 242- L4A:,// US ocrgleGf
eq C, ot2enf
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION $Q. FT. FACTOR PSP ADJ. AREA/VALUATION
SFFVADD/REM
Garage/Carport
E3
Pat€c/Deck
W
PoolfSpa
2
Re -Roof
Commerclal
CD
Valuation: d Adj. Area:
QUANTITY DESCRIPTION FEE
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CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE: y
SMIP; O
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES (o 2. %%
COMMENTS:
P/C: l7Fi Q_..._T ?AD eY: J 10:2 L1 5 VALIDATION: LC
RECEIPT#-- PAID BY. Q VAUDATIOI
WHITE — Deparlment Copy, YELLOW — Finance Copy, PINK — Assessor Copy