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HomeMy WebLinkAbout24778JOBSITE )) ,~ ~~"~~ ADDRESSZ,>& tni' 3pi7 APNLOT TRACT r OWNERrst ,clO.CU•`~~a~ ADDRESS CITYZIPTEL. APPLICANTTEL. CONTRACTORc? cel 'tiirLr~ ADDRESS> ^ J CITYZIP (~,ATEL. 977 -Ct ARCWENG/ DESIGNER ADDRESS CITYZIPTEL. OWNER-BUILDER DECLARATION IHEREBYAFFIRM UNDERPENALTYOFPERJURYTHATIAMEXEMPTFROMTHECONTRACTORS LI- CENSELAWFORTHEFOLLOWING REASON (SEC. 7031.5BUSINESSANDPROFESSIONSCODE: ANYCITYOR COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT, ALTER, IMPROVE. DEMOLISH, ORREPAIRANYSTRUC. TURE. PRIORTOITSISSUANCE. ALSOREQUIRESTHEAPPLICANT FORSUCHPERMITTOFILEASIGNED STATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORS LI- CENSELAW (CHAPTER9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESS ANDPRO- FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TION. ANYVIOLATIONOFSECTON7031.5BYANYAPPLICANT FORAPERMITSUBJECTSTHEAPPLICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS ($500).): I, ASOWNEROFTHEPROPERTY, ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, WILLDOTHEWORK, ANDTHESTRUCTUREISNOTINTENDEDOROFFEREDFORSALE (SEC. 7044, BUSI- NESSANDPROFESSIONS CODE: THECONTRACTORSLICENSE LAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVESTHEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES, PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALE. IF, HOWEVER, THEBUILDINGORIMPROVEMENT ISSOLDWITHINONEYEAROFCOMPLE. TION. THEOWNER-BUILDERWILLHAVETHEBURDEN OFPROVINGTHATHEORSHEDIDNOTBUILDOR IMPROVEFORTHEPURPOSEOFSALE). I. ASOWNEROFTHEPROPERTY, AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECT (SEC. 7044, BUSINESSANDPROFESSIONSCODE: THECONTRACTORSLI- CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON, AND WHOCONTRACTSFORSUCHPROJECTS WITHACONTRACTOR(S) LICENSEDPURSUANTTOTHECONTRAC- TORSLICENSELAW.). IAMEXEMPTUNDERSE.C. B. & P.C. FORTHISREASON DATEOWNER LICENSEDCONTRACTORSDECLARATION IHEREBYAFFIRMUNDERPENA_TYOFPERJURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER 9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESSANDPROFESSIONS CODE, AND MYLICENSEISINFULLFORCEANDEFFECT 7 LICENSE CIO. NO. J D DATECONTRACTOR K_ Iyjlet WORKERS' COMPENSATION DECLARATION IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' COMPENSATION, ASPROVIDEDBYSECTION3700OFTHELABORCODE, FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED. IHAVEANDWILLMAINTAINWORKERS' COMPENSATION INURANCE, ASREQUIREDBYSECTION 3700OFTHELABORCODE, FORTHEPERFORMANCEOFEWORKFORWHICHTHISPERMITIS ISSUED. MYWORK(E RS' COMNSATIONIN*SJDANCECARIERANDPOLICYNUMBERARE: CARRIERJ POLICYNUMBER771 <-12-2l4 _ _ 00 THISSECTIONNEEDNOT13ECOMPLETEDOFTHEPERMITLSFORONEHUNDREDDOLLARS ($100) ORLESS). ICERTIFYTHATINTHEFERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED. I SHALLNOTEMPLOYANT' PERSONINANYMANNERSOASTBECOMESUBJECTTOTHE WORKERS' COMPENSATIONLAWSOFCALIFORNIA. ANETHATIFISHOULDBECOME SUBJECTTOTHEWORK=RS' COMPENSATION PROVISISECTION3700OFTHELABOR CODE. SHAORTHWITHCOMPLYWITSEPRSIS. ~ DATE: lzi '+ APPLICANT: ,'L '4' WARNING: FAILURETOSECUREWORKERS' COMPENSATION COVERAGEISUNF ,ANDSHALLBE SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHDREDTHOUSAND DOLLARS ($100,000), INADDITIONTOTHECOSTOFCOMPENSATION, DAMAGESASPROVIDEDFORIN SECTION3708OFTHELABORCODE, INTEREST. ANDATTORNEY'SFEES. CONSTRUCTION LENDINGAGENCY IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDING AGENCY FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 3097, CIV. C.), LENDER'SNAME LENDER'SADDRESS CERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. 1AGREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION, ANDHEREBYA1THORIZEREPRESENTATIVES OFTHISCOUNTYTOENTERUPONTHE ABOVE-MENTIONEDPROPERTYORINSPECTION PURPOSES. 1L \\ CSCie PEENAMPNT) 1b) Z SINATUREFPERMIEDATE co IY OLL_ w 0 a c\[ 0 0 w w a' co U) O 0 w U W U F 0 Z U) C LL d W OO W U) Q W w Z ED C/) 0 0 w I LL CX_ W a 0 CL- z: W S 1-- cc W CD Z J U) rn I CITYOFDIAMONDBAR DEPARTMENT OFCOMMUNITY & DEVELOPMENTSERVICES 21825CopleyDrive, DiamondBar, CA91765 909) 839-7020Fax (909) 861-3117BuildingInspectionHotline (909) 839-7027 BUILDINGPERMITAPPLICATION PRESS FIRMLY APPLICATION (11 /, ' NPERMITUMBERZi17~ #/C DATE ISSUETYPEOCC DATECONST. GROUP ZONINGSETBACKS FRONTRWp REAR ^ SIDE/SIDESTREETRW SIDE PROPOSEDUSE iP NO. DWEL. NO. NO. UNITSSTORIESBEDROOMS DESCRIPTIONSO. FT.FACTORPSFADJ. AREANALUATION SFR/ADD/REM U)Garage/Carport LLlPatio/Deck LLI LLPool/Spa ZRe-Roofcoo Omercial Valuation (N.L7LADJ.AREA QUANTITYDESCRIPTIONFEE J Q W W CT, Z Fn J a Z Q 2 0 W CONSTRUCTION ~T . 15.L PLANREVIEW _ ELECTRIC PLUMBING MECHANICAL INSPECTIONFEE ISSUANCEZS•~) SMIP ENERGY P/C ENERGYPERMIT RETENTIONFEE: P -ASTFEE: TOTALFEES COMMENTS RECPTNO. PAIDBYVALIDATION WHITE-DepartmentCopy, YELLOW-FinanceCopy, PINK-AssessorCopy, GOLDENROD-FileCopy, GREEN-Applicant'sCopy DBAR TIO-qRECORD INSPECTIONDATEINSPECTOR INSPECTIONDATE INSPECTOR