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Home My WebLink AboutPR14-2923CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax; (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOB SITE ADDRESS !(P 1 N LOT OWNERJ ADDRESS CITY +'� IP TEL. APPLICANT TEL. CONTRACTORX�'"IC".?Pry ADDRESSr,. CITY '? ZIP 4'r! r TEL € C :>V' ARCH/ENGlDESIGNER ADDRESS CITY ZIP TEL. OWNER-RUILDER DECLARATION I hereby affirm under penalty of perjury that I are exempt from the Contractor's State License Law for the reason(s) indiealed below by the chackmmk(s), I have placed next to the applicable tlem(s) [Section 7031.5, Business and Pralessiens Code: Any City or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prierto its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provislons of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 at the Business and Professions Code] or that he or she is exempt from t(censure and the basis for the alleged exemption.Any violation of Section 7031.5 byany applicant for a permit subjects the applicant to acivil penally of net more than five hundred dollars ($500). U I, as owner of the properly, or my employees with wages as their sale compensation, will do () all of or () 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 oraffered for sale. It however, the building or improvement is sold within one year of completion, the Owner-Builderwill have the burden of proving that It was notbuilt or improved for the purpose of sale.). (j I, as owner of We property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cale:The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and wha contracts for the projects with a licensed Contractor pursuant to the Contractors' Slate License Law.). (� I am exempt fsum Ilcensure under the Contractor's State License law for the following reason(s): By my signature below I acknowledge that, except for my pemonal residence in which I must have resided for at least one year priorto completion of the improvements covered by this permit,) cannot legally sell a structure theft have butt as an owner -builder if it has riot been constructed In its entirety by licensed contractors. f understand that a copy of the applicable lawn, Section 7044 of the Business and Pmfesslons Code is available upon request when this application Is submitted or at file following Web site: httphvvnv.leginfa.ca.govlcalaw.hlnwt. DATE: SIGN: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70091 of Division 3 of the Business and Professions Code, and my license Is In tell force and effect. P�f LICENSE CLASS C /� (IC, NO.: i r DATE: r2:_° CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HERFRYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: V.. I have and will rialntair a Cerliffcale of Consent to SelfInsurefor Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I haveand will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the viork tar which this permit is issued. My Worker's Compensation Insurance Carrierand Policy Number are: CARBIFR it POLICY NUMBER f' UMSWflONNEED NOT BEC MPI RFD IFTHF PERMIT IS FOR ONE RUNDRED DOUM POQORLESS). I certty that in the performance of the work tar wWh this perm)t is fssyyod, l shall rml employ any perm» in any nemner seas to became sub) to €h Workoperhsalion Lavers of Califo "a'Mdagm at if 1 should become subject to We ylmkar's Compersa'qR=111317000fft1rh�WW)11A3lff rtnvith ply with these provisions. DATE: APPLIGANr:NIN : Fsecure Worker's Compensation c verage is unlawful, and shall subject an employer to edntlm f penalties and civil fines up to are hundred thousand dollars (y101i3OOO), In addition 10 the cost of the compensation, damages as provided for in section 370a of the labor code, Interest, and attorneys fees. CONSTRUCTION LENDING AGENCY I hereby alOrm under penalty of perjury that there is a Cons€ruction Lending Agency for the performance of the work for which this permit is Issued (Sec. 3097, Civ, C.). LENDEH'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 the abo -mention pertyy for Inspection pins. PE MITTEE NAME (PRINT) u �� SIGNATURE OF PERMRi£E DATE PRESS FIRMLY APPLICATION DAT : a ti I 11-,+ P/C# 1A4 ISSUE DATE: cllD ( PERMITii-_J(� �1 TYPE CONST OCC GROUP: ZONING SETBACKS FRONT RW ❑ REAR ❑ SfDE/SIDE STREET RW ❑ SIDE L PROPOSED LISE # DWEL. UNITS # STORIES It BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ, AREANALUATION SFRJADDJREM Garage/Carport w Patio/Deck rWi_ Pool/Spa ZRe -Roof --� 7 Commercial CO Valuation:( Adj. Area: QUANTITY DESCRIPTION FEE a V it ti u� w Lo z m nJ- J U Z CONSTRUCTION: PLAN REVIEW: 'A 1 a , L JI'> ELECTRIC: ^ PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: _ r SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: a Q� PRE-ALT FEE: BSAF: - r - -- TOTAL FEES a 1♦ 9 t=)1 o e COMMENTS: RECEIPT# i7wPAID BY: VALIDATION: WHITE— Department Copy, YELLOW —Finance Copy, PINK ---Assessor Copy, GOLDENROD— File Copy, GREEN—Applicantt's Copy COMMENTS: