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Home My WebLink About18-34003CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax (909) 861-3117 Budding Inspedurn Hotline (909) 839.70274wFIRMLY PERMIT APPLICATION wwwatyofilAamondbart:om budding@deandondbarcagov AOBSITEADDRESS22-6 eeyici;k ^, APN L T T T OWNER ADDRESS CITY APPLICANT CONTRACTOR ADDRESS CITY ZIP TEL A,RCHIENGY DESIGNER ADDRESS 0TY ZIP TEL OWNB-BULMMtaT"TIW I hereby aehm Uwe( omot d I" and I w esma hm , to Cootwers We later taw w der re"s) miceted mte by am dwwavas), I pare placed am b We epdmade lamest EBeaaon MIA SWnme end Phase eCede Any dp^W comm, am rmadma Wntto$"MA dlm. nature, deAeaOa, W wplr, ed, ae¢pbrdin nAOmCwaPp�abare DWaWMnmdnamOwlMm a a,wPWmemimothe LeevemeWN DawadnMOBeu"r Twafat &+win 3 dIM BumlmexmmeMtmw hY1 w mel M w ww 0 esmgt ham keroua arW ew 8adstor ttwategeaarenMbn AmYwomiMd 7Ost5PY inn epolmd AaapWdaifefts em eppApm ma dwpwMty d�MmWeaanlhe wnWad dines F� LJIwowmrdmapopeetYm�wWgemwa wOAAamWebEOa WaeneMpA.MPtlaudlWwupwbn6 d red work and Tw arraw Ie ade Mended or blared for wo (Woon mi smas and p Code m �dmdwA'SaWtamme taw dam ocLq* to eno mar dWMMNwm, m,mp empbYaes brpayWx dMl. aWtls w. mw s ew pm My WW'IWdOmI Pw XnpmemnWa Wb am AWreedm aflame wide eMmrer tin etiaeor nnpiWamma tltlraOW om YmrdmmpkeW,. ma Ounfer-SuiMor wa twre me Nudandgwmg MuiKwaa rotoua I. arlmPmwaT Now prPma dpi l U I, mowar dine moms, win Am Commaaetr 0aPUmrbe0 woototodbn TM 7dN alaaeae WW RWassbns Coda The Sale tlrsnse taw min mta{ggben armerm PropeAywM Code a aMwhemnpflcaaedwpidadsMmellceremCamactwaas�enitrmeWmaeforsS Liam Lew)mmeewbn {)temamm Ilwryl�p{uum antlmim t�aenai9 Stain fW w6emal We t,ytji Sl n_ By my smadwr dom I schmewur W. "UPI Der my Pwapdwwd meia9Moaflmud Awx maOedhrml�tone year mbr idw craw. dine Wipm ovema creme by mapWeuU ly wA esmetme NMI here buaea an p ,4tAtler P A two w omn wIW Wad In Is mleay by Wood mmem s I onhodadw ad a mor UI tlw upAmoO aw Semm 7W8 d to Bonham ad Prpfaasaww Cam 0 voluble t ai toast eat thin eppmean Is mbmNadwdawklbwae Wei aio rdpynA'wlaBAdp eaeoWeaaw M1Ml Middle KINTRACTIRSDECLARATION I lwasim WWerpnary of KIM GM Ism arum, praraaa+mGwPIWS{tanumncNM war RecWn7005 d WNetm3d Cm SaamW eme PmhwMpw Caea aitl wry Ppnse m m NA hap arW elect uCBFSEGhSS _. UC ND .. RATE EV COMPACTM YW INEA'S=PERSATMVAU AATION '.I IHERESYAFFAMUNOea PE WOFPUWAYONEOFTIEFWOWAOkDAMIIONS _I nwa and al M. a Careepa of Omwwd le Sef-hwm WWooers 0onvondoev, mDrWdM Iry same TM of ew Iewr Com, forft wamoo, off INe ire wNch maWHO b Awed I here wW ww main Wwkne Imerufflon Memw.e is who by Swabn 370D of to Dale Cade by .meprbrmamudewwwkbr wtWh Pdspemdls09ued My Walker§ ImUtmm Cadeereltl PbbY FA.mbaram WNER POM Whom SECtImYNCONOT CDMIE IF THE PGraf IS FOR (M RM" DRIARS 510Q OR LEER t{wmymdln emdadaamKad AmwlPAbwtinM1tlm PawYtUffitaed Io�notBnabyanYPawm aaeYnwmWwm,ma baCana ap0�0Ay ace Wttkf4 Demp�eal lam wCaNwde ArWepae dM d I amain bumrwsW{ad tram WakBYe Q,npll&lrbl Atandam d Samm a7Do d Ow lebd Oo W, I B� a,Aa»h naipY wMl Puwo W W main DATE _ APftlfl ._ WNINM F WH6 a a mr, WmYx's ComweAm water IS u*,M, BM Voi MOW 0 ropIter b Cdeau pmllms W of an Up to me named thoumd diners (SIOO 00%, In addedw to em inn W Aw wmmmilm Wro mos mimed by a SKIN UM Oft hawmde I*= and mwmrs tam CONSTRUCTMI IfImwDAMOY Ifwmy uffim m6of Pamir of palsy W"a O a Comtmmloo laeaip ACM axme pwmnwmo C Ve wPW# MiltedG prmd a lisuetl {Sac 3097, Cb CF LEADEH S NAME LEWER'SADDREM Iw* Out I tore me are aoamtlm awl sww min dw Wald tAameemm mood I acme M comply Min aN my and coined, oreloina*0 s mIm r&adne It Made wooddW are Worry atom raiweaftelm C4 M madytr nwumnoo dwapMarapa9on itt,101 DATE IA !��rr TYPE el III I PElll� # GROUP `DC Ilr�l ''''♦'E, ia'.'�� Swpe of Work �TORIES If BODR0.e IIIIIIIIIIIIIIIIIIIIIII,— �.�}"+.�'�:�/ q��+iTiIIif4�lj1'urINllllllll�' II �� _- IMIIIIII �''I �IIIIII�IIIII��_ ��_� IIIIIIIII�IIIIII�IIIIII�IIIIIII�� 11111111�I�IIIICIII �IIIIOPLAN �'I • l�y1 REVIEWII IIII��IIIIIIIII ELECTRIC IIIII�IIIIII�IIIII�IIIIIIIIIIIIIIVI��II�IIIIII IIIIIIIIIIIIIIIIIIIII PLUMBING IIIIII�IIIIIIIIIIII MECHANICAL INSPECTION FEE ISSUANCE ENERGY PERMIT RFTENT1e E PRE-ALT FEE .�� r�v BASF e / ■ w , L TOTAL - COMMENTS I fill ; c'• w - �it., a RECEIPT 0 I WHITE—QepwamfCapp YELLOW—Rnmmxae Copy FNNK—Assassw CUe, ,I u', W � lil�lf1ti111 t - Building & Safety Division 21810 Copley Drive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861-3117 Job Address r s i& 2►. DO/L�'Iw�i.� aOE 00 An application for a building permit has been submitted in your name stating yourself as the builder of the property improvements specified For your protection, you should be aware that as'owner-builder" 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 d 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 $500 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 if 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" building permit, erroneously implying that the property owner is providing his or her own labor and materials personalty 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 cslb ca aov or at (800) 321-CSLB (2752) Please complete and return the enclosed "Owner -Budder" venfication form so that we can confirm that you are aware of these matters The budding permit will not be issued until the verification is returned Building & Safety Division 21825 Copley Drive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861,3117 Attention Property Owner An 'Owner -Builder" building permit has been applied for in your name and bearing your signature Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your budding 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 for construction of the proposed property improvement (yes or no); 2 1 (havethave not) �C signed an application for a budding permit for the proposed work I have contracted with the following person (firm) to provide the proposed construction Name Address Coy Phone Contractors License No I 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 Signed Property Owner NOTICE TO PROPERTY OWNER Dear Property Owner An application for a budding permit has been submitted in your name listing yourself as the builder of the property improvements specified at 9t-S Pe)irc 3 D121 r& t:3d4~ 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 -Budder We will not issue a budding 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 `(Q� I understand a frequent practice of unlicensed persons is to have the property owner obtain an '"Owner - Budder" budding permit that erroneously implies that the property owner is providing his or her aim labor and material personally I, as an Owner -Budder, 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 homeowner's insurance may not provide coverage for those injuries I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property 0__2 1 understand budding permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility 43 1 understand as an "Owner -Budder' l am the responsible party of record on the permit I understand that I may pr ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own VGA I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts 5 1 understand if I employ or othermse engage any persons, other than California licensed Contractors, and the total value of my construction is at least fire hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law 8 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 Y_@ 7 1 understand under California Contractors' State License Law, an Owner -Budder who builds single-family residential structures cannot legally build them with the intent to offer them for sate, 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 budding Contractor W'8 1 understand as an Owner -Budder d I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials u r &g' I understand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue Service, 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 gov for more information about licensed contractors _�0 I am aware of and consent to an Owner -Builder budding permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address Al 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable Yaws and requirements that govern Owner -Builders as well as employers _ 12 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public If you contract with someone who does not have 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 property licensed and the status of their workers' compensation insurance coverage Before a budding 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 verb the property owners signature Signature of Property Owner Date -- s iR 1:411 1