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Home My WebLink About15280 - 2702 SOUTH GEORGE LANE (2)_! CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES w 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 ,9 ~ BUILDING PERMIT APPLICATION JOBSITE .may^6 ADDRESS / , Zy 6.1(= t(0 APN LOT TRACT _ OWNER APPLICANT ,1 ASS' � TEL. � CONTRACTOR _ ADDRESS _ CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION i HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESSAND PROFESSQ NS CODE ANYCITYOR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANYSTRUC. TORE, 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 (COMMENCING WITH SECTION 7000) OF DIVISION 3OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION, ANY VIOLATION OF SECTION 703' 6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (&500) ) CI 1. AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS TI IEIR 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 FORSALE IF HOWEVER. THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT III OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALE) I 11. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS Lk CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FORSUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW) ❑ I AM EXEMPT UNDER SEC ._ B & PC FOR THIS REASON DATE +7'-Y - J iJ OWNER—�(-'y�-__— _— LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 700D) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS _ LIC. NO DATE_.-- CONTRACTOR - WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS --I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATON, 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 WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER _-_ —_..— POLICY NUMBER (THISSEETION NERJNDT BE DOMPLEfED OFTHE PERMIT IS FORONE H14DRED DOLLARS ($100) OR LESS. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, l SMALL NOT EMPLOY ANY PERSON IN ANY MANNFR SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE. LABOn CODE. I SHAD FORTHWITH COMPLY WITH THOSE PROVISIONS DATE: _ APPLICANT V Y,• r • 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 3087, CIV C ) LENDER'S NAME LENDER'SADDRESS PERMITTEE NAME (PRINT) ' I ggiNArunr oF PERIVIOTEE DATE I 0� PRESS FIRMLY APPLICATIO I PERMIT l % P/C DATE L NUMBER I ,G # ISSUE TYPE OCC DATE CONST- GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ^� "� PROPOSED USE Z'�f^ f5/f�S_C �J/iF '(/f"'G (6- NO. DWEL. NO. NO. UNITS STORIES _ BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ-AREANALUATION SFR/ADD/REM Garage/Carport WPatio/Deck U- Pool/Spa ZRe-Rcof Commercial _J m Valuation -- ADJ AREA QUANTI DESCRIPTION a,. FEE .r g H U W J W Z —� __ `' r !-pie f� S ,f L _� m J n. J Q U_ Z Q 2 W CONSTRUCTION PLAN REVIEW ELFCIRIO ---------- ------ ---- PLUMBING } MECHANICALPAID-- INSPECTION FEE ISSUANCE SMIP ENERGY P/C P'T7+Wi ,Y i bY'H NL) B AR ENERGY PERMIT w rxv �f1T�-DII°iYam`+ ' AD 0 AIMTV a�aazx RETENTION FEE- PRE-ALTFEE: TOTAL. FEES r. COMMENTS__ _. " RECPT- NO. _ PAID BY`N— —• WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File COPY, GREE�— -liicaq;4)Copy I