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Home My WebLink About14566 (17)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS• l r 1 ef. �Gr C%1� d"°j APN LOT � MTRACT _ OWNE_77— R ADDRESS :'.- Y1_ K_""1^�+: .. `.� � •4'6'� CITY ZIP!ft 1�t' TEL��/'°Sa>�ud�L) APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCHIENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- t., A. S11. Ir• .. •Y. , CENSE UW (CHAPTER 9 (COMMENCING WITH SECTION 70DO) OF DIVISION 3OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS I$SOD) )' ❑ I•ASOWNEROF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IB NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED Pon SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WR HIN ONEYEAROF OOMPLE- TO CONSTRUCT THE PROJECT (SEC 7044•86SINESS AND PROFESSIONS CODE THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC. TORS LICENSE LAW.) ❑ 1 AM EXEMPT UNDER SEC _ B A P C FOR THIS REASON DATE tr �__—' OWNER 4T~ E,-' f-S .� C� ._ ------ LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT] AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT DIAEE CENSECr8S,, PIZ) _ LIC NO. _ 7 ano CONTRACTOR — WORKERS'COMPENSATION DECLARATION `��— I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOW,NG DECLARATION¢ I HAVE AND WILL MAINTAIN A CERT IFICATE OF CONSENT TO SELF.INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION SrW OF TI IE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED ---I HAVEAND WILL MAINTAIN WORKER5' COMPENSATION INSURANCE, AS REQUIRED BY SECTION a700 OF THE LABOR CODE. FOR FHE PERFORMANCE OF THE WORK FOR W^ICH THIS PERMIT IS ISSUED MMR§j rMPENSATKKJINSUR 'gRRI HAND POLICY NUMBERARE CARRIER _ (/�. �1Y.1,\`Y/-'� POLICY NUMBER ✓�H� � __. - (1HL4SECRONNI-ED NOT BE COAPaLTEDOFTHE PERMIT IS FOR EHUNDREf DOl1AfS($ i LE I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR ICH THIS PER UED I N ., •• �!••: �� TO THE A: :,V •.a4 :.r... - 1)BECOMF • =THE LABOR COD , I SHALL FOflTHWITH COMPLY WITH THOSE PROVISIONS DATE. _IPPLICANY SECTION 370E OF THE LABOR CODE, INTEREST, AND ArTORNEY'S FEESV CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT T14FRF IS A CONSTRUCTION I ENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097. CIV C ) I LENDER'S LENDER'SADDRESS _.,._-_ ---- ---- i I CERTIFY THATI HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT PP L IERMITTE ME (P > _ SIGNATUREOFPFR E DATE PRESS FIRMLY DATEAPPLICATION��a` I PERMIT d NUMBERI pl ISSUE TYPE OCC DATE CONST• GROUP ZONING SETBACKS FRONT _ RW ❑ REAR U SIDEISIDE STREET RW f_1 SIDE U _— PROPOSED USE NO- DWEL. NO. NO. UNITS STORIES BEDROOMS _ DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA(VALUATION SFR/ADD/REM 0) Garage(CarpoN W Patio/Deck V- PooVSpa 0 Z Re -Root 0 Commercial 5 m Valuation REA__ OVANTITY DESCRIPTION,4 FEE Q �? CC LJ U W J W C9 r m J o_ 4 U Z Q U W STRUCTION ` ` IN REVIEW G LECTRIC PLUMBING `3 ¢®}.__.._.___—_ MECHANICAL - E 4t'b"`s` INSPECTION FEE _ ISSUANCE nn SMIP , ENERGY P/C ENERGY PERMIT RETENTION FEE ' PRE-ALT FEE TOTAL FEES,��f COMMENTS a•r �,G VALIDATION,/ RECPT NO PAID BY WHITE —Department Copy, YELLOW--Finanoe Copy, PINK—ASS8360r copy, UULUCNKLn_J NIB L:OPy, L9HtCN—!Applicant s i upy w r 1� ,� ` \l n` ,v � �" `� �� O � C�\\\ �" � �' �� M ��