The URL can be used to link to this page

Home My WebLink AboutPR21-295EMcc # 1690652463 5/12/21 PERMIT i$: PR202100t00295 OWNER.BUII.DER DICLARATION I herel:y affirm under penalty of perjury that I am e(empt from the contractor's state License Law for the rr:asc,n(s) indir::atedbelow by the checkrnark(s) I have placed ne)ft to th(: applicable item(s) [Section 70:1j..5, Business and profe:;sions code: /\ny city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also require:; the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the contrilctors'State License Law (Chapter 9, Commerrcingwith section 7000 of Division 3 of the Business and professions r3ode) or thal he or she is L'xempt from licensure arrd the trasis for the alleged exemption. Any violation of Section 703L.5 by any applic;lnt for a pernrit subjects the applicant to a civ'il penalty of not more than five hundred dojlars (9500).1: (-) las owner of the property, or my employees with wages as their sole compensation, will do (_) all of or li_) F,ortions of thework, arrd the struclure is not intended or offered frrr sale. (Section 7044, Business iand professions Code: The contractors' 'State I icense Law does not apply to an owner of property who, through employees' or personal effort, builcts or improvcs theprope|ty, provided that the improvements are not intended or offered for sale. lf hr:wever, the building or improvement is :;old within one year of completion, the Owner-Buikler will have the burden of proving that it was not built or improved 1'ort:he purpose of sale.l {-) l, a:; owner of the property, am exclusivel,/ contrtcting wrth licensed Contractors to construct the projecl.. (Section 70.44, Ilusines$ and Professions code: The Contractcrs'State License Law does not apply to an owner of property who builds orimprot'es thereon, and who contracts for the projects with a licensed contractor pursuant to the contractors,state License l-aw.) (-) | anr exempt from licensure under the Contractor's State License law for the follcrwing reason(s): tly my sBnature below I acknowledge that, except for my personal residence in rarhich I must have resided for at teast oneyear plior to completion of the improvements coverred by this permit, I cannot legally sell a structure that I have built as an owner'builder if it has not been constructed in its eltirety by licensed contractors. I understancl that a copy ofthe appl cable law, Sec'tion 7044 of the Business and Profes:;ions Ccde is available upon request when this application is submitted or at thefollowi rlq Web site: frttp/www.leginfo.ca.govTicalaw. htm I S]GNAI LIRE OF PROPERTY oWNER oR AUTHcIRIZED AGENT:DATE: LICEIlSED CONTRACTOR'S DECLARATION I hereb / affirm under penalty of perjury that I am licr:nsed under provisions of Chapter 9 (commencing with ljection 7000 j ofDivisiorr .3 of the Business and professions cocle, and my license is in full force and effect. LICENSI: CLASS: C39 _ LTCENSE NUMBER: 916982 \,I/ARNIII]6: FAILURT TO SECURE WORKERS' COMPEN;ATION COVERAGE IS UNLAWFLJL, AND SHALL SUBJECT,AN IMPLOYE'R TOcRIMINAL PENALTIES Al\D clvlL FINEs uP To (lNE H|.JNDRED THOUSAND DoLLARS (:;i00,000), tN ADDtTtoN To'rHE cos-ti oFCOMPENSATION, DAIVAGES AS PROVIDED I.OR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I IIEREBY AFFIRM UNDER PENALTY OF PERJURY ONE CF THE FOLLOWING DECLARATIONS: I have and will maintain a certilficate of consent to self-lnsure for workers' compensation, issued Lry the Director of Industrial Relations as provided for by Section 3700 ofthe Labor Code, for the perl,ormance oflhe,z work f or which this permit is is:;ued, l/ I have and will maintain workers'compensation insurance, as requireri by Section 37oo of the Labor code, forthe performance of the work for which this permit is issued. My workers' compensation insur;lnce carrier andpolicy number are: cARRrElt: state compensation Insurance PoLlCy #: '1 /l 3/-Zt'+o EXptRAloN DA!E, io { I f ).. I , --::::----:-:---I{AME OF AGENT:97L3725 EX p I RA f l o N pArE : :-6Tr;r r>_.*=*ffi #ry==* lcertifythat,intheperforrnanceoftheworkforwhichtt.i,o",';;;Til:il subject t'l lhe workers'1:ornpensation laws of California, arrd agree that, if I should become subject to the workers,compensatronprovisiors ot section 3700 of the Labor Code, I shall forthwith comply with those provisions, STGNATURE oF APPLIcANT: DE.LARAT'or,r REGARDTTT.,G cor\rsrRrJcro*ofltio,r,, AGEr,rcy - I hereby;lffirm under penalty of perjury that there s a conr;truction lending agency for the performance oflhe work for which this per nit isissued (So(tion 8172, Civil Code). LENDER'!i h]AME: LENDER'5 /\DDRESS By nry slgnature below, I ce'rtify to each of the foilorvirrg I arn Ihe I)roperty owner or ;ruthorized t.J act on thF property owner s behali. I have re.d this applicati0n and tire informatjon I have provicJed is correct. I aiqree to comply with aii applicable city and county ordinaaces and state iaws relating to building construction. I authorize representatives of the city of Diamond Bar to erter tl.re above-icientified property fcl]QlnNlATt OC nE bd^hrnrSIGNATL F,E OF PROPERTY oWNER oR AUTHoFIIZED AGENT: J