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HomeMy WebLinkAbout25346CITYOFDIAMONDBAR DEPARTMENT OFCOMMUNITY & DEVELOPMENTSERVICES 21825CopleyDrive, DiamondBar, CA91765 909) 839-7020Fax (909) 861-3117BuildingInspectionHotline (909) 839-7027 BUILDINGPERMITAPPLICATION PRESS FIRMLY JOBSITE ADDRESSIL~ vl _~~ IaoAh APNLOTTRACT OWNER ADDRESS ~3G~~JLG>1F CITYZIPTEL.=-3L0'-j//c0' APPLICANTTEL. CONTRACTOR _ & t ADDRESS62Cr CITY € tc__ ZIPfItTEL.'fi -V -7 -613 ARCH/ENG/ DESIGNER ADDRESS CITYZIPTEL. OWNER-BUILDER DECLARATION IHEREBYAFFIRM UNDERPENALTYOFPERJURYTHATIAMEXEMPTFROMTHECONTRACTORS LI- CENSELAWFORTHEFOLLOWING REASON (SEC. 7031.5BUSINESSANDPROFESSIONSCODE: ANYCITYOR COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT, ALTER. IMPROVE, DEMOLISH, ORREPAIRANYSTRUC- TURE, PRIORTOITSISSUANCE. ALSOREQUIRESTHEAPPLICANT FORSUCHPERMITTOFILEASIGNED STATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORS LI- CENSELAW (CHAPTER9 (COMMENCINGWITHSECTION70001OFDIVISION3OFTHEBUSINESS ANDPRO- FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TION. ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANT FORAPERMITSUBJECTSTHEAPPLICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS (5500).): 1, ASOWNEROFTHEPROPERTY, ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, WILLDOTHEWORK, ANDTHESTRUCTUREISNOTINTENDEDOROFFEREDFORSALE (SEC. 7044, BUSI- NESSANDPROFESSIONS CODE: THECONTRACTORSLICENSE LAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVES THEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES, PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALEIF, HOWEVER, THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- TION. THEOWNER-BUILDERWILLHAVETHEBURDEN OFPROVINGTHATHEORSHEDIDNOTBUILDOR IMPROVEFORTHEPURPOSEOFSALE). OI, ASOWNEROFTHEPROPERTY, AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECT (SEC. 7044, BUSINESSANDPROFESSIONSCODE: THECONTRACTORSLI- CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON, AND WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S) LICENSEDPURSUANTTOTHECONTRAC- TORSLICENSELAW.) UIAMEXEMPTUNDERSEC. B. & P.C. FORTHISREASON DATEOWNER LICENSEDCONTRACTORSDECLARATION IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATIAMLICENSEDUNDER PROVISIONSOFCHAPTER 9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESSANDPROFESSIONS CODE, AND MYLICENSEISINFULLFORCEANDEFFFEECT. LICENSE CLASS LIC. NO. 141h -3. OATS '_'_'_-'Z_ ' CONTRACTOR9 WORKERS' COMPENSATION DECLARATION IHEREBYAFFIRMUNDERPENALTYCFPERJURY ONEOFTHEFOLLOWINGDECLARATIONS: IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' COMPENSATION, ASPROVIDEDBYSECTION3700OFTHELABORCODE, FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED. XjHAVEANDWILLMAINTAINWORKERS' COMPENSATIONINSURANCE, ASREQUIREDBYSECTION 3700OFTHELABORCODE, FORTHEPERFORMANCEOFTHEWORFORWHICHTHISPERMITIS MFE INSURANCEBRIERANPOLICYNUMBERARE ISSUED. MYWORKERS' CO SATIQ N C J, CARRIER- JYtt.~11 POLICYNUMBERZZZZ-G- 2 THISSECTIONNEEDNOTBECOMPLETEDOFTHEPERMITISFORONEHUNDREDDOLLARS ($r00) ORLESS). ICEISTIFYTHATINTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMIT15ISSUED, I SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE WORKERS' COMPENSATIONLAWSOFCALIFORNIA. ANDAGRFIETHATIFISHOULDBECOME SUBJECTTOTHEWORKERS' COMPENSATION PROVISIOPSEC" 3700OFTHELABOR CODE, FFFRTTyHWITHCCMPLYWITHSEPROVOI . DATE: A; APPLI7ANT. WARNING: FAILURETOSECUREWORKERS' COMPENSATION COVERAGEISUNL, ANDSHALLBE SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEDREDTHOUSAND DOLLARS1$1M,000), INADDITIONTOTHECOSTOFCOMPENSATION, DAMAGESASPROVIDEDFORIN SECTION3708OFTHELABORCODE, INTEREST, ANDATTORNEY'SFEES. CONSTRUCTION LENDINGAGENCY IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDING AGENCY FORTHEPERFORMANCEOFTHEWORNFORWHICHTHISPERMITISISSUED (SEC. 3097, CIV. C.)L LENDER'SNAME LENDER'SADDRESS ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATION ISCORRECT 1AGREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION, ANDHEREBYAUTHORI?EREPRESENTATIVES OFTHISCOUNTYTOENTERUPONTHE ABOVE-MENTIOEDPROPERYFORINSPECTION PURPOSES. PEEN .(PTIr SIGNATUREOFPERMIEE4/' DAT APPLICAT1'-J4I110-7NUMBER-35P/C DATE - ISSUETYPEOCC 7J '1 DATE CONSTGROUP ZONINGSETBACKS FRONTRW ^ REAR ^ SIDE/SIDESTREETRW ^ L SIDE ^ PROPOSEDUSEeKr Sc NO. DWEL. NO. NO. 3 UNITS STORIESIBEDROOMS DESCRIPTIONSQ. FT.FACTORPSFADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport WPatio/Deck LLPool/Spa Z600 bommercial 5 Valuationy- 'ADJ.AREA QUANTITYDESCRIPTIONFEE J U U W J W 0 a- J Z Q W CONSTRUCTION -T PLANREVIEW ELECTRIC PLUMBING MECHANICAL INSPECTIONFEE ISSUANCEcS- O'Z SMIP4 ENERGY P/C ENERGYPERMIT RETENTIONFEE: I _ cam, PRE-ALTFEE: TOTALFEES COMMENTS RECPT. NO. PAIDBY /rVALIDATION 1NHITE-DepartmentCopy, YELLOW-FinanceCopy, PINK-AssessorCopy, GOLDENROD-FileCopy, GREEN-Applicant'sCopy