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HomeMy WebLinkAbout18-34004i CITY OF AMOND RAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fox (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION wwvvcetyoidixmondbarcomm buddmga@daamondbareagov JOB SITE ADDRESS —IZ APN LOT TRACT OWNER © G-1— _ ADDR SSy 7�,r,...-... CITY ZIP_ ..% TEL4". APPLICANT a7,�.�r6.Ii. CONTRACTOR ADDRESS CITY 21P TEL ARCWENGI DESIGNER ADDRESS CITY ZIP TEL ONNOWPAMUMLVATM I herar atmm tart won a Palely any i w "man {lam fie onwayes sey, i.amw taw ar Cw nababraw hdzftd bB'mw by A, dadmado. 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DATEOF ODWWTae COYRBUTINCEMAPATIN i IS%9Y AEEdia IxLDEn PENNTY � PEFiNRti Ota � PtE FOIlAWPNE DECtAMikx15 _I nave am will a~a isokm of Cwwmd m Sin( banns any Wasa's Dammam,by mWeal by SOOM 3Nm of as Leda 0D a. or Pw Pew of N work Pa wNdi law Mara is Rmm _ I nave MvA amen afmar'A manna, a nab" by SeWn 37M of bin Isar Can& tin dwP aPwwixkmwNMdw DamA6lwued yAPVmdwt4Oanal®mnilmavati Canaram FYACy NnrAOr Ore Daiwa LOLAi.YMibw SCCIAR{al{DN,7f�WNPLElEOr71EP(flR%ta PoapEnrnl®OIXIAfS qi 1 wimeiabeeswbwwaa atw wulkMMCnm4Pmmtkka�al.isimisnobSaTpLymsM any man W nb cmv mgmmtinaof$Dew 3=01 *talon aCaamla Hd apwranIsaAm bomnl0 swamlama WalOye famaWdbrpmbYema Same 9yma0nta0a Cab IMamrPwddrmna%aCsmme PrOA^bla DATE APK041T WARlal6 Cahn m sa ae WdYAr a CmlmwMm "Mod o UNAWM, as MBA subject an Bmplbmr m pdmkd names, watl pmpFNadeflantepar In wmcmpmn 3 Mbasb01 00 anew may, INne(Swt COP �I b addNan b tlw ma d non eanpematlm, ad anrlwys law CaN&TR MM LBmna Abany I**v Bann uft NYaly, (9 mRuly Aa bona N a Cavinawn Leading Ayemr term peramnm[Bannw ma aYCb 045 mmA mlmryd Fan 3 w ON C) SENDERSaWIL, SEMDERSAODAM I wrbp ma I reaa read me arum are and On, and ttn am, Inhnmmn Is camoI spas m away wdh el pry and m+ady mmanms ad lam am ala hm m bdamP mauden am nanbr Mbabe mmmwnmdawa Pa muajm Fnny upon Oaabov5m0 bpmpalYMhspemim drPd3Ba WMRPe OF F£PnOig MAfg RnNi} /� PRESS FIRMLY ISSUEDATE TYPE CONSTIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIM° , GROUP DWEL UNITS a STORIESBEDROOMS �_�a�.['l/✓r��fi'iai EL_. -+ice—_ cc)NsTRu '�a PLAN REVIEW PLUMBING INSPECTION FEE ISSUANCE fs��Jr SMtP ENERGY PIC ENERGY PERMIT RETENTIONPRE-ALT FEE BASF PLOT PLAN ZONNG CLEARANCE I TOTAL- Building $s Safety Division 21810 Copley hive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861-3117 Job Address aa'1716 tgi-`G- D;19~ck .&1 c6 0 Dear Property Owner An application for a budding permit has been submitted in your name stating yourself as the budder of the property improvements specified For your protection, you should be aware that as "owner -budder' you are the responsible party of record on such a permit Budding permits are not required to be signed by property owners unless they are personally performing their own work If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City of County They are also required bylaw to put their license number on all permits for which they apply If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $600 00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions There may be financial risks for you d you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance For more specific information about your obligations under the federal law, contact the internal Review Service (and if you wish, the U S Small Business Administration) For more specific information about your obligations under State law, contact the Department of Benefit -Payments and the Division of Industrial Accidents If the structure is intended for sale, the property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions A frequent practice of unlicensed persons professing to be contractors is to secure an 'owner -builder" budding permit, erroneously implying that the property owner is providing his or her own labor and materials personally Budding permits are not required to be signed by the property owners unless they are performing their own work personally Information about licensed contractors may be obtained by contacting the Contractors State License Board at 9821 Business Park Drive, Sacramento, CA 95827, www crib ca aov or at (800) 321-CSLB (2752) Please complete and return the enclosed "Owner -Budder verification form so that we can confirm that you are aware of these matters The building permit will not be issued until the verification is returned issuing your building permit No building permit will be issued until this verification is received by us 1 1 personally plan to provide the major labor and Materials Tor construction of the proposed property improvement (yes or xj�-5 2 1 (havelhave not) �e— igned an application for a building permit for the proposed work 3 1 have contracted with the following person (firm) to provide the proposed construction Name Address City Phone Contractors License No 4 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work Name Address City Phone Contractors License No 5 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated Name Address Phone Type of Work a. Date—�^frs NOTICE TO PROPERTY OWNER Dear Property Owner An application for a budding mind has been submitted iny ur name listing yourself as the builder of the property improvements specified at '� L c" a � ` fi & We are providing you with an Owner -Budder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority OWNER'S ACKNOWLEDGEMENT AND VERIFICATION DIRECTIONS Read and initial each statement below to signify you understand or verify this information d I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - udder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property My homeowners insurance may not provide coverage for those injuries I am willfully acting as an Owner -Budder and am aware of the limits of my insurance coverage for injuries to workers on my property 2 1 understand building permits are not required to be signed by property owners unless they are responsible for he construction and are not hiring a licensed Contractor to assume this responsibility _ A i understand as an "Owner -Budder' I am the responsible party of record on the permit I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own I understand Contractors are required by law to be licensed and bonded in Calforria and to list their license n mbers on permits and contracts JW 5 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law I understand if I am considered an "employer' under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee " I also understand my failure to abide by these laws may subject me to serious financial risk 2jg7 I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor fI understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for ny financial or personal injuries sustained by any subsequent owner(s) that result from any intent construction defects in the workmanship or materials fe1 understand I may obtain more information regarding my obligations as an "employer" from the Internet ue Seance, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of industrial Accidents I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www cslb ca aov for more information about licensed contractors 4 1 am aware of and consent to an owner -Builder budding permit applied for in my name, and understand that I a the party legally and financially responsible for proposed construction activity at the following address R1 I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide yallby all applicable laws and requirements that govern Owner -Builders as well as employers ' f, 2 I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the nformat n 1 have provided on this form Licensed contractors are regulated by laws designed to protect the public If you contract with someone who does not he" a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil court it is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages If you obtain a permit as Owner -Budder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit Note A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature Qtgnature of Property Owner Datz