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Home My WebLink AboutPR13-2049JOB SITE ADDRESS APN LOT TRACT OWNER ADDRESS CITY ZIP TEL, APPLICANT TEL. CONTRACTOR �L—k ADDRESS CITY ZIP TEL, ARCH/ENG/DESIGNER ADDRESS CITY ZIP TEL, OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Contractor's Stale License Law for the reason(s) indicated below by the checkmark(s), I have placed next to the applicable hernia) (Section 7031.5, Business and Professions Cade: 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 far the permit to file a signed statement that he or she is tieensed pursuant to the prow€slons of the Contractor's State License Law (Chapter (l) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensors and the basis for the alleged exemplion.Any violation of Section 7031.5 by any appl€coat for a permit subjects the applicant to a 601 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 at or (_) protons of Our work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Cade: The Coritraciors' Slate License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided [hat the Improvements are not intended or offered for sale. if however, the building or improvement is said within one year of completion, the Owner-Builderwill have the burden of proving thalitvias not built or improved for the purpose of sale.). . L) I, as owner of the property, am exclusively contracting with licensed Cuntraclors to construct Ilia project (Section 7044, Business and Professions Gode:The Contractors' Slate License Law does not apply to an owner of property who builds ar improves thereon, and who contracts for the pra)ecls with a licensed Contractor pursuant to lire Contractors' Sla€e License Law.). (� I am exempt from licensure under the Contractor's State License law for the following resson(s): By my signature below I acknowledge Ibat, except for my personal residence in which I must have resided for atfeast one Year prier to com of the improvements covered by €his permit,t cannot legally, sell a sWcture gnat I have built as an owner -builder' i ha n eenconstructed in its entimtybylicensed 0mnt%r1h,1.Irusta""rof[Ilatacopyoftheappllrable tavr, Seclio 044 siness and Professions Code Is a i e enlhis applicagon is subm tted or at the tallol g Well : h .€eginio.ca.gevlcalaw.ht DATE: SIGN: r- _ LICENSE ECLA 71Df I hereby ailtm under penalty of perjury that I am licensed under provisions of Chapter 9 mmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. LICENSE CLASS: _. ,— LIG. NO.: DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARAnONS: I have and will maintain a Certificate at Consent to Sell -insole for Weikel's Compensaion, as provided by Section 3700 of The Labor Code, for the performance of the work for which Ibis 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 work for which this permit is Issued. My Worker's Compensation insurance Carder and Policy Number are: CAHRIFA POLICYNOMBER (MIS SECTION NEED NOT BEGOMPLETED IF THEPERMif IS FO ONE HUNDRED DOLLARS (S100) OR LESS). I certify Ihat in ante of Die work for which thispertni fed,€ all n6 - m �b any-prrsan In arty mannersoas to beL le Workers CGcrimjnal pensation, dSor in section 370a of the labor code, interest, and attomey's fees. CONSTRDCTION LENDING AGENCY I hereby affirm under penalty of perjury that there Is a Construction Leading Agency for the performance of the work for which this permit is issued (Sec.3097, Civ. C.). LENDER'S NAME: LENDERTADDRESS: I certify that [ have read this application and state that the above Information is correct. I agree to comply whin all city and county ordinances and state laws relating to building cuns€rocton, and hereby authorize representatives of this county 10 enter upon the above -mend d piope far Inspection purposes. PERM FNAME{PRINT) Jill 1%� SIGNATURE OF DATE APPLICATION DATE: 'k, ` a� PICft V7M 1), - ®7 4zb/3 ISSUE DATE: \ i \ \ PERMIT# TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT REAR SIDEISIDE STREET SIDE RW E Ct....... RW EI Cl— PROPOSED USE S'V Vq IA=-4 \b kmtj &C'6 It DWEL. UNITS ft STORIES A --A i # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR7 DD/REfw€ t Garage/Carport w Pati ❑eck �]��? LL Pool/Spa C7 Z Re -Roof d -j Commercial 7 Valuation: i 24on 11ypgra . Adj. Area: QUANTITY DESCRIPTION FEE eT SIN kJ m ��t J i (L `o q 4A Z 2- a U U1 — CONSTRUCTION: PLAN REVIEW: I t2 �'� • ' IRS ELECTRIC: Oho PLUMBING: MECHANICAL: q • �$ INSPECTION FEE: ISSUANCE:- • ?. SMIP_ ENERGY P/C: 9'.. 4 ' ENERGY PERM P RETENTION FEE: PRE-ALT FEE: : • �� BSAF: TOTAL FEESC COMMENTS: RECEIPT q 1 � • PAID BY: \ � � ? VALIDATION: Y} _ WHITE— Department Copy, YELLOW — Hrtanee Copy, PINK —Assessor -Copy, GOLDENROD— File Copy, GREEN ----Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD Ph COMMENTS: