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Home My WebLink About1470 ROLLING KNOLL RD (2)tn W Q j 0 Z LU w Z �10�D�D�tf' CITY OF DIAMOND BAR Q, V DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-70. PRESS BUILDING PERMIT APPLICATION PP -FIRMLY JOBSITE II (�'7 ADDRESS APN V1_V1 LOT, WT TRACT OWNER ADDRESS CITY IP IJ, 57 TEL. �-� --� *71 APPLICANT TEL.I�Gh �jtff L�/ CONTRACTO ADDRESS r CITY ZIP G/ TEL l ARCH/ NG/ DESIGNER 1\ ADDRESS CITY i . ,. -O M L (%( ZIP ( OTEL� OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7a31.S BUS W ESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT_ ALTER, IMPROVE, DEMOUSH, OR REP"RANY 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 LF CENSE LAW (CHAPTER 9 (COMMENCING VAT" SECTION 7000) OF DIVISION B OF 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSOOM: ❑ I. AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70A4, 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 HILMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER. THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER-BUI OER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, 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 A CONTRACTOR(S) LICENSED PURSUANT TO THE COVTRAC- TORS LICENSE LAW,). O 1 AM EXEMPT UNDER SEC. B. A P.G. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAMM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION4 700D) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE MS W FULL FORCE AND EFFECT. CENSE CLASS `� LIC. NO_ DATE�L CONTRACTOR \ I �WOFORKERS' COMPENSATION DECLARATION I. HEREBY AFFIRM UNDER PENALTY OF PEFUURY ONE OF THE FOLLOWING DECLARATK)NS: _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _ I HAVE AND 1YILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION 37W OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY W.ORKERS'COR ATIONIPSjU C' CAR1RIIEERANfD POLJC,TY NNUMBER/ARE: 1/ CARRIER 0lr/kL Ij r 111 bz `C2 r POLICY NUIMBER (THIS SEC; iON NEED NOT BE cOy.3.E EOOF THE PERMIT IS FOR CNE HUNDRED DRED DOLLARS ($100) OR LESS) I CERTIFY THAT IN THE PERFORMMATNCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA,ANDAGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS, DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (510O,0o0), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 37CS OF THE LABOR CODE INTEREST AND ATTORNEYS FEES. 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. 3097. CIV. C). LENDER'S NAME LENDERS ADDRESS I CERTIFY THAT I 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 HER BY AUTHORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROP RTY FOR INSPECTION PURPOSES. i D PERMITTEE NAME IPAINT) L/ �. I Ci OFPERMITTEE DATE WHITE—Deparrnent Copy, YELLOW --Finance Copy. PINK —Assessor wpy, GULUtNHUU—YIIB UOPy, UHL- N—APpIICanl'S L:OPy APPLICATION PERMIT / e✓ NUMBER Ik - k Si2,5 #/C DATE (' ISSUE 1 TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW 0- SIDE ❑ PROPOSED USE add I-k� cx'� NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREAIVALUATION SFS205hEM C/) Garaga/Carpon LLI Patio/Dock U-1 U- Poovspa zRe -Roof 0 Commercial 5 ca Valuation ADJ.ARF_A QUANTITY DESCRIPTION FEE I l U cc I, W J W ` Z m � \ D- Q U IT Z T U _ W CONSTRUCTION PLAN REVIEW �1� • -�_ S ELECTRIC PLUMBING co-7 - 8� Sa• 1 MECHANICAL INSPECTION FEE ++�� ISSUANCE SMIP ENERGY P/C �3 ENERGY PERMIT ��•�� RETENTION FEE: �c - a` --A PRE-ALT FEE: TOTAL FEES 9' COMMENTS 3 / _ RECPT. NO, PAID BY "'A` VALIDATION 'eYavS} �ut� 6Q -(583 , f k vk ®kc Ro&6 R6 zr^Je" ° k 3 6 V- 3AC, I -®&-- P- 41 1a J