HomeMy WebLinkAboutPR21-10618/6/21
EMCC # 2289854277
8/17/21
8/17/21
9/9/21
9/9/21
9/9/21
8/18/21
8/18/21
PERMIT #: PR20210001061
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated
below by the checkmark(s) | have placed next to the applicable item(s) [Section 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions ofthe
Contractors'State License Law (Chapter 9, Commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031-.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).1:
(_) las owner of the property, or my employees with wages as their sole compensation, will do (*) all of or (_) portions of the
work, and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who, through employees'or personal effort, builds or improves the
property, provided that the improvements are not intended or offered for sale. lf however, the building or improvement is
sold within one year of completion, the Owner-Builder will have the burden of proving that it was not built or improved for
the purpose of sale,)
(*) I, as owner ofthe property, am exclusively contractingwith licensed Contractors to construct the project. (Section 7044,
Business and Professions Code: The Contractors'State Lic€nse Law does not apply to an owner of property who builds or
improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors'State License
Law.)
(_) | am exempt from licensure under the Contractor's State License law for the following reason(s):
By my signature below lacknowledge that, except for my personal residence in which I must have resided for at least one
year prior to completion of the improvements covered 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 entirety by.licensed contractors. I understand that a copy ofthe applicable
law, Section 7O44 of the Business and Professions Code is available upon request when this application is submitted or at the
following Web site: http/www.leginfo.ca.gov/calaw.html.
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT:DATE:
LICENSED CONTRACTOR'S DECTARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) ol
Division 3 of the Business and Professions Code, and my license is in full force and effect.
|CENSE CLASS: B LTCENSE NUMBER: 934902 . i
EXpIRATIoN DAIE: (2t -Za - Zq - - corrrrnncron ticroir*r, fi7;; jr, ffit/7eZt
WORKERS'COMPENSATIONDECLARATION: I
WARNING; FAITURE TO SECURE WORKERS, COMPENSATION COVERAGF IS UNLAWFUI,, AND SHAI.L SUBJTCT AN EMpLoYER To
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONT HUNDRED THOUSAND DOLLARS ($1OO,OOO}, IN ADDITIoN To THE CosT oF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COD[, INTEREST, AND ATTORNEY'S FEES.
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATTONS:
I have and will maintain a certificate of consent to self-lnsure for workers' compensation, issued by the
Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance, as required by Section 3700 ofthe Labor Code, for
the performance of the work for which this permit is issued, Mv workers' compensation insurance carrier and
cARRTER: :r"e fiiilhd polrcy#: 0f WCZzttZg EXprRAroN DArE:(r.zl.Zz
NAMEOFAGENT: G.LirJ< pHorurg: E'le- <aI-1C}n
I certify that, in the performance of the work for which this permit is 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 ofSection 3700 ofthe Labor Code, I shall forthwith comFtlv with those provisions.
SIGNATURE OF APPLICANT:DATI:
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for whjch this permit is
issued (Section 81,72, Civil Code),
LENDER,S NAME:
LENDER'S ADDRESS:
By trry signature belorv, I ccrtify to each ilf the f oilowing:
I am tl'lo property owner or d{lthorized to act on the pfopertv owner's behalf.
I hzrvc rcdd this application and thc infornration I have provided is correct.
I agr€e to comply with all applicable [ity and couoty ordinances and state iaws relating to building construction.
I authorize representalrives of the City of Diarrond Bar to enter tire .rbove-identified properl.y for inspection purpogt?s.
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT: Aleiandro Del Real
DArE: I'Ll- 2l
