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Home My WebLink About16777 - 611 ALDER LN (3)CITY OF DIAMOND BAR / I I I I DEPARTMENT OF CONDAUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY AZ24i ZA"r ' ADDRITE SS e2 & N LOT TP � OWNER ADDRSSC / 41-dC'' /.N CITY bjAAY4i ZIP.?'I'7 3 TEL O APPLICANT TE .�jrsJI CONTRACTOR ADDRESS %7 ! f:✓✓t:a%!f" CITY L s ,!._ ZIP F1,761 TEL. j tg�,3 V4150 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION ]HEREBYAFFIRM UNDER PE ALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.E BUSIN ESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH RE-OUIRESA P£RMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMEi CING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR E HE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- 710N. ANY VIOLATION OF SECTION '0315 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE TH N FIVE HUNDRED DOLLARS(8500).): ❑ I, AS OWNER OF THE PROPF�RTY OR MY EMPLOYEES WITH -WAG EB AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPR ES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPL YEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOWEVER. THE BUILDING OR 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 FOR THE PURPOSE OF SALE). ❑ [,AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ IAM EXEMPT UNDER SEC. 13.8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTTI OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION ][��00) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOS, AND MY LICENSE IS IN FULL FORCEAN EFFECT,`' "` z e LICENSE CLASS LIC. NO. DATE CONTRACTOR �� S!riF' WORKEFS' A/Z.i COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY(( OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WILL MAINTAI CC ACERTIFICATEOFNSENTTOSELF-INSUFO RERWORKERS' N, COMPENSATIOAS PRO' CED BV SECTION 3700 CF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICHiTHIS PERMIT IS ISSUED, I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37a0GF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' MP SATION IN RANCECARRIER Al. POLICY NUMBER ARE: CARRIER POLICY NUMBER THE PERMIT IS FOR ONE HUNDRED DOLLARS (SI00) OR LESS). (THIS SECTION NEED NOTBEPOMPLETEDOF I CERTIFY THAT IN THE PERFORMANCE SHALL NOT EMPLOYANV OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I ERSONINANYMANNERSOAB TOBECOMESUBJECTTOTHE WORKERS' COMPENSATIO LAWSOF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKE S'COMPENBATION PROVISIONS OF SECTION 37000E THE LABOR GOGE, I SHALL FORTHWIT COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE WARNING: FAILURE TO SECURE WORKERS' SUBJECTAN EMPLOYER TO CRIMINNAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION OTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR COE E, INTEREST, AND ATTORNEYS FEES. COI JSTRUCTION LENDING AGENCY I HEREBY AFFIRM U NUER PENALT OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE ORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087. CIV C.). LENDERS NAME LENDERSADDRESS I CERTIFYTHAT I HAVE READ THIS APPLICATION AND STATE THATTHE 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. PERMITTEENAME �,...- SIGNAT DATE APPLICATION �-� PERMITNUMBER I Y � #/C DATE ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE n PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck L- POOI/Spa Z Z Re -Roof ' Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U W LU W (D Z m CL U ® 10�iC141Pw GE .`lam C �?e, . s! Z Q 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL - INSPECTION FEE ISSUANCE SMIP & t a ENERGY P/C _ t ENERGY PERMIT - - -��- RETENTION FEE: � PRE-ALT FEE: TOTAL FEES �� b COMMENTS A RECPT NO. I LIS y PAID BY L VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy U RIM Rh ARM till SET SAY, REOM ...... . .. ... ... ... . ........ ETAS SRAD E VIM? POYT�i��i F, 1-1 now nw"111, FT 3 �G . ...... . p1mvp UVRM], WARSAW STATUTE— POOL PSIVI?i-- WWI F- . . . . .. .... . MEA? h DEPT F NAL ----------- SEPTU TA09 ISIM SEER RAN WE` ---------- -- -1 .Ljn