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Home My WebLink About3333 BREA CANYON RD (4) (2)a. CITY OF DIAMOND BAR I IkA DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES '0 1 21810 Copley Drive Diamond Bar CA 91765 t PRESS y ,, (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLYBUILDINGPERMITAPPLICATION JOB SITE ADDRESS C\ APN LOT TRACT OWNER ADDRESS Z CITY ZIP TEL. APPLICANT TIE . CONTRACTOR ADDRESS CITY ZIP TELT 13 Vf ARCH/ENG/DESIGNER ADDRESS CITY ZIP TEL. 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), I have placed next to the applicable items) [Section 70315, 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 of the Contractor's 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 ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U 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. U 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 i roved for the purpose of sale.). 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License 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' Stale License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): By my signature below I acknowledge 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,) 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 of the applicable law, Section 7044 of the ELusiness and Professions Code is available upon request when this application is submitted or at the toI10% `p W ite: h .leginfo.ca.gov/calaw. DATE: / SIGN: LICENSED CO TRA R'S DEC ATION I hereby affirm under penalty of perjury that I am licensed under provisi of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ICENSE CLA S: LIC. NO.: 54 6 91 ATE. CONTRACTOR: AP1/AAl L ,bn( If WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section.3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POIJCY NUMBER THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (S1 00) OR LESS). 1 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 Worker's Compey io pro isio of Section 3700 of the Labor e/I shall/forlhwNt comply with those provisions. DATE:-J APPLICANT. WARNIN ail to cure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. I agree to 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. PERMITTEEM NT) RA .. SIGNATURE 0 E EE ATE U APPLICATION DATE: -7/ l S I \4- ISSUE DATE: i I?)\ I \9' TYPE CONST. P/C# FQ \4r-- Ar\ !t\ PERMIT# F\2 \or OCC GROUP: ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW RW PROPOSED USE DWEL. UNITS # STORIES BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport co Patio/Deck LuLL Pool/Spa 0Z Re -Roof O Z) Commercial Go Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J U 2HL) w co cc Jd JQU Za w CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: 3 • \j ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: S . A -S BSAF: I • O n TOTAL FEES \ $ . 33 COMMENTS: a a 9 . RECEIPT fl Of0T \0 PAID BY: y.' VALIDATION:_ WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD COMMENTS: