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Home My WebLink About13689 (18)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES �o C) z g 0 �O t.0 z W o.. rn Im C 0 U Z W N LU W W CC Y 3 ILL. L11 �m h.nl C F Jtij Ij Dl�1�lil►ll 1i,11: � 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSETE ADDRESS CC�I (T n APN LOT RACT OWNER �� V -r ADDR Cis CITY ZIP ` TEL APPLICA TEL Z (L,n CONTRACTOR CI tG ADDRE S CITY ZIP q 166 WEL. ARCI 1ENGI V X c,+_g,° 1 FL DESIGNER I - ADDRESS CITY d ZIP TEL. OWNER-BUII DE42DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U* CENSE LAW FORTH£ FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CiTYOR COUNTYWHICH REQUIRESAPERMITTO CONSTRUCT,ALTER IMPROVE, DEMOLISH, OR REPAIRAJNY STRUC- TURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A STONED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER u (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE 805INE55 AND PRO, FESSIONS CODE) OR THAT HE OR SHE IS £XEMPTTHEREFROM AND THE SASH FOR THE ALLEGED EXEMP- 110M ANY VKK.ATiON OF SECTION TD31.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ❑ I, AS OWNER OFT#NE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7041, BUS;. NES5 AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ppOP .RTY WHO BUILD5OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF, HOWEVER, THE BUILDINGOR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALE). El1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCTTH£ PROJECT (SEC. 7nu, BUSINESS AND PROFESSIONS OOV E: THE CONTRACTORS U- CENSE LAW DOES NOT APPLYTOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACra FOR SUCH PROJECTS WITH AOONTRACTOR(5) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.), Ei I AM EXEMPT UNDER SEC, B. d P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT €AM LICENSED UNDER PROVISIONS OF CHAPTER 0ICOMMENCING WITH SECTION 7owl OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. B LICENSE CLASS LIC. N0. DATE 2- CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _2LL YE AND WILL MAINTAikACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABDR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, HAVE AND WILL MAINTAIN WORKERS' ODMPENSATKNN INSURANCE, AS REQUIRED BY SECTION O' kv 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER "SECTION NEED NOT BEOCMFLETEOOFTHE PERMIT 15 FOR ONE HUNDRED DOLLARS CVMORLESS} 1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT LS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 370D OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE P OVISIO/NJS�. DATE: +; APPLICANT 1�J/ , 1 WARNING: fAILURETO SECURE WORKERS' COMPENSAT3ON OOVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALMES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,IXIO), LN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 979E OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY '- I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAIIOFFiE i5 ACONSTRUCTION LENONG AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PFHW IS ISSUED (SEC. 3097, CIV. C.), LENDER'S NAME LENDER'S ADDRESS { CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INPOR MATIoN IS CORRECT. I AGREE iO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES Of THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. BCol kL)a — AERMITTEE (PRINT} 2 SIGNATURE OF PE MITTEE DATE PRESS FIRMLY APPLICATION ` PERMIT i` O p/ DATE a/��/ NUMBER ISSUE �— TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDElSIDE STREET RW ❑ SIDE cl PROPOSED USE -' l AWVG WALL NO. DWEL. NO. NO, UNITS STORIES BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREA/VALUATION SFRIADDlREM Garage/CaNport LLU LI Patio/Deck LL Poollspa 0 Z Re-RDoi Commercial t Valuation OO �ADJ.AREA QUANTITY DESCRIPTION FEE Q rr y f" U W LLNLU z CD J EL. 6 U Z T U LLN CONSTRUCTION REVIEW r ELECTRIC PLUMBING MECHANICAL INS FEE fSUANCE _ - ENERGY P/C ENERGY PERMIT RETENTtON FEE: PRE-ALT E- TAL FEES MMEN4'_ "C' } RECP7 NO. PAID BY VALIDATION WHITE-0epartment Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD—IIe Copy, GREEN --Applicant's Copy