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HomeMy WebLinkAbout9524 - 3333 BREA CANYON RDCITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 909) 860 3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 3 t ri APN LOT/ TRACT OWNER LQllr-r 11 - ph.0,, (— ADDRE S—%? '30 b2c.-Jn.siN AL., CRY ZIP '26'L 3 TEL APPLICANT TEL CONTRACTOR /- ADDRE S -. CITY ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY Of PER.URY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FORTHE FOU DWMA PFAWA (SEC. 7071.5 BUSINFSS AND PROFESS -.DNS CDDE.-ANY CITY OR COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT, ALTER IMPROVE. DEMOUSH,OR REPAIR ANYSTRUG TURF- PRIOR TO ITS ISSUANCE. ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE UW (CHAPTER 8 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMR TON. ANY VIO AT10N Of SECTION, ECTION 7031.3 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TOACMLPENALTYOFNOTMORETFUNFIVEANYDOLLARS ($500) ): O L AS OWNEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORT( AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70u, BUS4 NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHINONE YEAR OFCOMPLE- TION. THE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR MPnOVE FOR THE PURPOSE OF SALE} C3 AS OWNEROF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT ISEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH AOONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE UW ). 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM MINDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER - e (COMMENCING WITH SECTION DIVISDIVISION700MOfDIVISIONSOFTHEBUSINESSANDPROFESSIONSCODE, AND MY LICENSE IS N ML FORCE AND EFFECT. LICENSE CUSS G" LIC. NO.LL DATE IQ — L S r CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIAM UNDER PENALTY CF PERJURY ONE OF THE FOLLOWING DECLARATION I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO 8ELFANSURE FOR WV RKM COMPENSATION, AS PROVIDED BY SECTION VW OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED, I HAVE AND WILL MAINTAIN WORKERS, COMPENSATION INSURANCE, AS REOUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE ARRIER AND POLICY NUMBER ARF: CARRIER GRr1 Caar OPOLICYNUMBER MSSECTMWMNOTsEav*tE-mOFTIEPFAATEi FORL?EHl OREDt1L1lLiR5 W70RI.ESSL I CERTIFY THAT N THE PERFORMANCE Of THE WORK FOR WINCH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON N 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 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WI THOSE PRQVISKINA DATE: /.l. 94 APPLICANT: WARNING: FAILURE TD SECURE WORKERS• OOMPENSATON COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 00DOLLARS (31 00,0), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY ('H 1 HEREBYAFf WL/ UNDER PENALTY DF PERJURY THAT THERE 15 A CONSTRUCTION MWONO AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, CIV C.). - - LENDERS NAME` LENDER'S ADDRESS ~ 1 CERTIFY THAT 1 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 TMS COUNTY TO ENTER UPON THE ED PROPERTY FOR INSPECTION PV ES. Phm(PINT) BONA RE DE DATE WHITE --Department Copy, YELLOW—Finance Copy, PINK—Assessor CON, GOLDENROD—FIW Copy, GREEN—A IDeanYs Copy PRESS FIRMLY APPLICATION '' G( PERMIT P/C DATE v t NUMBER - IiG' L J ISSUE TYPE OCC DATE CONSTT, GROUP ZONING SETBACKS FRONT RW _ REAR SIDEISIDE STREET RW SIDE_7T—_ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT, FACTOR PSF ADJ. 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