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HomeMy WebLinkAbout24102.pdfCITYOFDIAMONDBAR DEPARTMENT OFCOMMUNITY & DEVELOPMENTSERVICES 21825CopleyDrive, DiamondBar, CA91765 909) 839-7020Fax (909) 861-3117BuildingInspectionHotline (909) 839-7027 BUILDINGPERMITAPPLICATION JOBSITEI ` ADDRESS (~-OLr,,4S(i(Ll1(,J APNL-11LOTTRACT OWNERD>>- ADDRESS Zi6y1rtiSr. CITY .Q/*biAotA9IKZIPTEL. APPLICANTpjpyk241-ft - TEL. - S"1 CONTRACTOR ADDRESS221 ~Smgr \[I~~ CITY 1 'l (CZIP _* TEL. _ r ARCHIENG/ ARCWENG/ 83Z3 DESIGNER ADDRESS CITYZIPTEL. OWNER-BUILDER DECLARATION IHEREBYAFFIRM UNDERPENALTYOFPERJURYTHATIAMEXEMPTFROMTHECONTRACTORS LI- CENSELAWFORTHEFOLLOW114GREASON (SEC. 7031.5BUSINESSANDPROFESSIONSCODE: ANYCITYOR COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT, ALTER. IMPROVE, DEMOLISH, ORREPAIRANYSTRUC- TURE. PRIORTOITSISSUANCE, ALSOREQUIRESTHEAPPLICANT FORSUCHPERMITTOFILEASIGNED STATEMENTTHATHEORSHESLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORS LI- CENSELAW (CHAPTER9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESS ANDPRO- FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TION. ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANT FORAPERMITSUBJECTSTHEAPPLICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS ($500).) I. ASOWNEROFTHEPROPERTY, ORMYEMPLOYEESWITHWAGES ASTHEIRSOLECOMPENSATION WILLDOTHEWORK. ANDTHESTRUCTUREISNOTINTENDEDOROFFEREDFORSALE (SEC. 7D44, BUSI- NESSANDPROFESSIONS CODE: THECONTRACTORSLICENSE LAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVES THEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES. PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALE. IF, HOWEVERTHEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- TION. THEOWNER-BUILDERWILLHAVETHEBURDEN OFPROVINGTHATHEORSHEDIDNOTBUILDOR IMPROVEFORTHEPURPOSEOFSALE). I, ASOWNEROFTHEPROPERTY, AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECT (SEC. 7044, BUSINESSANDPROFESSIONSCODE: THECONTRACTORSLI- CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON, AND WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S) LICENSEDPURSUANTTOTHECONTRAC- TORSLICENSELAW.). LIIAMEXEMPTUNDERSEC. - B. & P.C. FORTHISREASON DATEOWNER LICENSEDCONTRACTORSDECLARATION IHEREBYAFFIRMUNDERPENALTY OFPERJURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER 9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESSANDPROFESSIONS CODE, AND MYLICENSEISINFULLFORCE ANDEFFECT II L D LICENSE CLASS LICNOV DATE____ -V~ CONTRACTOR WORKERS' COMPENSATIONDECLATION IHEREBYAFFIRMUNDERPENAI-TYOFPERJURY ONEOFTHEFOLLOWINGDECLARATIONS: IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' COMPENSATION, ASPROVIDEDBYSECTION3700OFTHELABORCODE, FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED. IHAVEANDWILLMAINTAINWORKERS' COMPENSATIONINSURANCE, ASREQUIREDBYSECTION 3700OFTHE1A80RCODE, FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED. MYWORKERSCOMPENSATIONINSURANCEARRIERANDPOLICYNUMBER ARE: CARRIERST_-fP~ l__ - POLICYNUMBER THISSECTORNEEDNOT3ECCAIPLETEDOFTHEPERMITISFORONEHUNDREDDOLLARS ($100) ORLESS). ICERTIFYTHATINTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED, I SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE WORKERS' COMPENSATION LAWSOFCALIFORNIA, ANDAGREETHATIFISHOULDBECOME SUBJECTTOTHEWORKERS' COMPENSATION PROVISIONSOFSECTION3700OFTHELABOR CODE, ISHALLFORTHWITHCOMPLYWITHTHRO OPVISINS. SS"e4 DATE:. APPLICANT WARNING: FAILURETOSECUREWORKERS' COMPENSTIOIOVERAGEISUNLAWFUL, ANDSHALLBE SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND DOLLARS )S100,000(, INADDITIONTOTHECOSTOFCOMPENSATION, DAMAGESASPROVIDEDFORIN SECTION3708OFTHELABORCODE. INTEREST, ANDATTORNEY'SFEES. CONSTRUCTION LENDINGAGENCY IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDING AGENCY FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 3097, CIV. C.). LENDER'SNAME LENDER'SADDRESS CERTIFYTHATIHAVEREADTHSAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. AGREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION, ANDHEREBYAUTHORIZEREPRESENTATIVES OFTHISCOUNTYTOENTERUPONTHE ABOVE-MENTIONEDPROPERTYFORINSPECTION PURPOSES. PERMITTEENAME (PRINT) SIGNATUREOFPERMITTEE ATE WHITE-Department Copy, YELLOW-FinanceCopy, PIN PRESS APPLICATIONPERMITP/C DATE 2410L NUMBER a TYPEOCC ISSUE61 l s o( DATEiCONSTGROUP ZONINGSETBACKS FRONTRWE\] REAR ^ L SIDE/SIDESTREETRW ^ SIDE ^ RROPOSEDUSErL_( }-Iyh-L ~4cIle -fC-r7 4- iffCC_-* DWEL. NO. NO. UNITSSTORIESBEDROOMS DESCRIPTIONSO. FT.FACTORPSFADJ. AREA/VALUATION SFR/ADD/REM U)Garage/Carport WPatio/Deck LL Pool/Spa 0 ZRe-Roof Commercial M ValuationADJ.AREA QUANTITYDESCRIPTIONFEE J U I- U W W 0 Z ca a Z4~ w 2,f~c ' ' ./~SiACA 2 U W CONSTRUCTION PLANREVIEW ELECTRIC PLUMBING MECHANICAL INSPECTIONFEE ISSUANCE SMIP ENERGY P/C ENERGYPERMIT RETENTIONFEE: . DQ PRE-ALTFEE: 132- t & ~" /000 TOTALFEES d~ COMMENTS RECPT. NO. PAIDBYUG. VALIDATION UrvOFb,,- PAR FT1ONtit -.Jr(D INSPECTORINSPECTION DATEINSPECTOR