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Home My WebLink About16777CITY 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 3 iJAAYi ZIP.?'I'7 i TEL O APPLICANT TE .�jrsJI CONTRACTOR ADDRESS %7 ! f:✓+'t:a%!f" CITY L s ,!._ ZIP F1,761 TEL. j eL-3 Vaf_5'0 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. 7W1.6 BUSIN ESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH RE-OUIRESA P£RM FTO 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 (CCMMEi DING 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 THEALLEGED EXEMP- TION. 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, ASOWNER OF THE PROPF�RTY OR MY EMPLOYEES WITHWAGES 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 CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ IAM EXEMPT UNDER SEC. B. B P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTYOF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION] 0)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCEANE EFFECT,`' "` z e LICENSE CLASS LIC. NO. DATE CONTRACTOR S! WORKED LL.% A� S' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY(( OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVEAND WILL MAINTAI ACERTIFICATEOFCCNSENTTOSELF-INSUREFORWORKERS' COMPENSATION, AS PRO, "ED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICHi THIS PERMIT IS ISSUED, I HAVEAND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37a00F THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' MP SATION IN RANCECAHRIERAND 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 OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOYANV WORKERS' COMPENSATIO BISON INANY MANNER BOAS TOBECOMESUBJECTTOTHE LAWSOF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKE S'COMPENSATION 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 UNDER PENALT OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE JORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CIV C.). LENDERS NAME LENDERSADDRESS I CERTIFY THAT 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. PERMITTEE NAME 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 Re -Roof ' Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U W LU w (D Z m d U® 10�iC141Pw� L'F' .`lam di�.>r ,s! Z Q 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE I SMIP ENERGY P/C _ ENERGY PERMIT r_ u RETENTION FEE: PRE-ALT FEE: TOTAL FEES tj COMMENTS A RECPT NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy alai till Im.. E& f SET 540,'N 571f, SL AS SRADE 7 P VIM? PCYWP� ... . . ..... . . plot! 1-1 now mv FT ...... ------ ------- - ------ - FIVEP WOM], 330t FSPI 05TRII AM— KATO N i FW -115 FIAT — CA c, MEA? h DEPT F NO- '00 NUMNO ----------- SEPIRD TA09 ISIME SEER PIN WE`