Loading...
HomeMy WebLinkAbout24694.pdfJOBSITEvin ADDRESS ~ LILAL/112iAStC-*t\\' APN LOT T RACT OWNER11_ A4tJfLI_J- X \\, 5 ADDRESSZ--3cli7 (-oLc6f- 5Oi( N(rr0 (#I CITY () -t~vVlor~JI3i. ZIP2JJTEL. Q(::,7 APPLICANTTEL. _,gf64 CONTRACTOR /7V- ADDRESS2212Sc. CITYZIPJ( TEL. W, ARCH/EG/ 2i DESIGNER C c///4Je1 `127_3 ADDRESS CITYZIPTEL. OWNER-BUILDER DECLARATION IHEREBYAFFIRM UNDERPENALTYOFPERJURYTHATIAMEXEMPTFROMTHECONTRACTORS LI- CENSELAWFORTHEFOLLOWING REASON (SEC7031.5BUSINESSANDPROFESSIONSCODE: ANYCITYOR COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT. ALTER, IMPROVE, DEMOLISH, ORREPAIRANYSTRUC- TURE, PRIORTOITSISSUANCE, ALSOREQUIRESTHEAPPLICANT FORSUCHPERMITTOFILEASIGNED STATEMENT THATHEORSHEISLICENSEDPURSUANT TOTHEPROVISIONSOFTHECONTRACTORSLN CENSELAW (CHAPTER9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESS ANDPRO- FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TION. ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANT FORAPERMITSUBJECTSTHEAPPLICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS ($500).): 1, ASOWNEROFTHEPROPERTY. ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, WILLDOTHEWORK, ANDTHESTRUCTUREISNOTINTENDEDOROFFEREDFORSALE (SEC. 7044, BUSI- NESSANDPROFESSIONS CODE'.: THECONTRACTORSLICENSELAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVES THEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES, PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALEIF, HOWEVER, THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- TION, THEOWNER-BUILDERWILLHAVETHEBURDEN OFPROVINGTHATHEORSHEDIDNOTBUILDOR IMPROVEFORTHEPURPOSEOFSALE). I, ASOWNEROFTHEPROPERTY. AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECT 'SEC. 7044, BUSINESSANDPROFESSIONSCODE: THECONTRACTORSLI- CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON, AND WHOCONTRACTSFORSUCHPROJECTS WITHACONTRACTOR(S) LICENSEDPURSUANTTOTHECONTRAC- TORSLICENSELAW.). OIAMEXEMPTUNDERSEC. B. & P.C. FORTHISREASON DATEOWNER LICENSEDCONTRACTORSDECLARATION IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATIAMLICENSEDUNDER PROVISIONSOFCHAPTER 9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESSANDPROFESSIONS CODE, AND MYLICENSEISINFULLFORCEANDEFFECT LICENSECLASS ~ZS,LiLIC. NO. DATE ,/ J- CONTRACTOR --- ERS' COMPENSATIONDECLAI WORK IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' COMPENSATION, ASPROVIDEDBYSECTION3700OFTHELABORCODE, FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED. IHAVEANDWILLMAINTAINWORKERS' COMPENSATIONINSURANCE, ASREQUIREDBYSECTION 3700OFTHELABORCOLE, FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED. MYW RKERS' COM ENSATIONINSUR A NNECARRIERANDPOLICYNUMBERARE: P O CARRIERSrF(--/,lc POLICYNUMBERL1:3to - - 7 ~-. J ITHSSECTIONNEEDNOTBECOMPLETEDOFTHEPERMRISFORONEHUNDREDDOLLARS ($100) ORLESS). ICERTIFYTHATINTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED, I SHALLNOTEMPLOYANYPERSONINANYMANNER5OASTOBECOMESUBJECTTOTHE WORKERS' COMPENSATION LAWSOFCALIFORNIA, ANDAGREETHATIFISHOULDBECOME SUBJECTTOTHEWORKERS' COMPENSATION PROVISIONSOFCTN3700OFTHELABOR CODE, IHALLFORTHWITHCOMPLYWITHTHEPROVISIONS DATE: I). j'-? - APPLICANT: WARNING: FAILURETOSECUREWORKERS' COMPENTIONERAGEISUNLAWFUL, ANDSHALLBE SUBJECTANEMPLOYERTOCRIMINALPENALTIESANCIVILFINESUPTOONEHUNDREDTHOUSAND DOLLARS (5100,0W). INADDITIONTOTHECOSTOFCOMPENSATION, DAMAGESASPROVIDEDFORIN SECTION3708OFTHELABORCODE, INTEREST, ANDATTORNEY'SFEES. CONSTRUCTION LENDINGAGENCY IHEREBYAFFIRMUNDERPENAL( YOFPERJURYTHATTHEREISACONSTRUCTION LENDINGAGENCY FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 3097. CIV. C.). LENDER'SNAME LENDER'SADDRESS CERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. AGREETOCOMPLYWITHALLCI1YANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION, ANDHEREBYAUTHORIZEREPRESENTATIVES OFTHISCOUNTYTOENTERUPONTHE ABOVE-MENTONEDPROPERTYFORINSPECTIONPURPOSES I36 .~ 4J~b/ (- PERMITTEEE (PRINT) SIGNATUREOFPERMITTEE DATE tt O w z 0 cc O tY O w C-) Z W 0 U G cc 0 w O X W 0 U w U_ 0 W w Z 7 U) 0 in W J iy Ui W a - C) Ex- W W 8- CD m U) CITYOFDIAMONDBAR DEPARTMENT OFCOMMUNITY & DEVELOPMENTSERVICES 21825CopleyDrive, DiamondBar, CA91765 909) 839-7020Fax (909) 861-3117BuildingInspectionHotline (909) 839-70 BUILDINGPERMITAPPLICATION PRESS FIRMLY DATECATIO~1`NPERMITUMBERft+ri/C ~• ISSUEl TYPEOCC DATE CONST.GROUP ZONINGSETBACKS FRONTRW^ REAR^ SIDE/SIDESTREETRW^ SIDE^ PROPOSEDUSE NO. DWEL. NO.NO. UNITSSTORIESBEDROOMS DESCRIPTIONSQ. FT.FACTORPSFADJ. AREANALUATION SFR/ADD/REM U)Garage/Carport WPatio/Deck V-Pool/Spa ZRe-Roof qCommercial ValuationADJ.AREA QUANTITYDESCRIPTIONFEE J U cc: U W J W a Z In J CL LiJC4-a Z Q WsL' v. S75`( CONSTRUCTION PLANREVIEW ELECTRIC PLUMBING MECHANICAL -U moo( 5'V INSPECTION FEE_ ISSUANCE~~••~~.... SMIP ENERGY P/C ENERGYPERMIT RETENTIONFEE:- • CZ? PRE-ALTFEE: TOTALFEES. Sv COMMENTS RECPT. NO. PAIDBYVALIDATION IfWHITE-DepartmentCopy, YELLOW-FinanceCopy. PINK-AssessorCopy, GOLDENROD-FileCopy, GREEN-Applicant'sCopy CITY0. CAR INSPEcTIONF&WORED INSPECTIONDATEINSPECTOR INSPECTIONDATE INSPECTOR