The URL can be used to link to this page

Home My WebLink About16655 - 1050 S GRAND BLDG OEDUL110,14 BaK i CITY OF DIAMOND BAR DEpA.RTjvmN ` OF CO M17i*THY & DEVELOPMENT SERVICES 21925 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN L T TRAM OWNER f+ ADDRESS CITY �� ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL.�7Y� 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- CENSELAWFORTHEFCLLOWING EASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE: ANYCITY OR COUNTY WHICH REQUIRESAPER rTTO CONSTRUCT,ALTER,IMPROV=,DEMOLISH,ORREPAIRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, LSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 DF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HEOR HEISEXEMPTTHEREFRCM AND THE BASIS FORTHEALLEGEDEXEMP- TION. ANY VIOLATION OF SECTION 7031 A BYANYAPPLICANT FOR A PERMIT SUBJEC'TS'HE APPLICANT TO A CIVIL PENALTY OF NOT MORE T AN FIVE HUNDRED DOLLARS ❑LASOWNEROFTHE PROP PTV, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE ST UCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUSI- NESS AND PROFESSIONS CODE: HE CONTRACTORS LICENSE LAW DOES NOT APPLY i0 AN OWNER OF PROPERTYWHOEUILDSORIMPR VIES 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 FORSALE. IFHOWEVER, HEBUILDINGORIMPROVEMENT ISSOLDWtTHINONEYEAROFCOMPLE- TION, THE OWNER -BUILDER WILL AVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF ALE).. ❑ 1,ASOWNEROFTHEPRO RT'. AM EXCLUSIVELY CONTRACTINGWITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (S C. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI - DENSELAWDOESNOTAPPLYTO N OWNER UFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PRO ECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. 1 P.C. FOR THIS REASON DATE OWNER I LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7600) OF DIVISION 3Or THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE ANO EFFECT. LICENSE CLAS + LC. NO. DATE BI CONTRACTOR L✓'r �'�" 7 i WORKE"IRS' COMPENSATION DECLARATION ) I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3730 OF THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHIC lTHIS PER lS ISSUED. ] I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODEI FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'C MPE 10,11 INSU ECARRIER DPOLICYNUA9BERARE: CARRIER___ --- v POLICY NUMBER (rHIS SECTKKJ NEED NOT BECOMPLETED OFTHE PERMITIS FOR ONE H,UNDREDDOLLARS Sl DDJ OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY FIFRSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE 7 WORKERS'COM PENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD 13ECOME SUBJECT TO THE WORKEFjS'COMPENSATION PROV IONS OF SEC ON 37000FT LABOR COD ,1 ALL FD WITH COMPLY WITH THOS DV1SiON5. J DATE: PLICANT u '] WARNING: FAILURE TO SECURE WbRKEAS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE J SUBJECT AN EMPLO'fERTO CRIMiALPENALTIES AND CIVILFINES UP TO ONE HUNDRED THOUSAND L DOLLARS I§100,o00), IN ADDITION 10 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR GODS, INTEREST, AND ATTORNEYS FEES. i CONSTRUCTION LENDING AGENCY L IOR THE ERFO MUNDERANCE OF THE YOF PER I TH THE RE lSACONSUED(S C. LENDING AGENCY FOR THE PERFORMANCE OF THE WI DR �'�,F R IC HIS PERA7IT IS ISSUED (SEC. 3097, CIV C.). A'7 L LENDER'S NAME ---- LENDER'S ADDRESS CERTIFY THAT I HAVE READTHIS APPLICATION AND STATE THATTHEABOVE IN:%ORMATION IS CORRECT. ')'] IAGREETO COMPLYWITH ALL CITY AND'COUNTY ORDINANCES ANDSTATE LAWS RELATING TO BUILDING i CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FC R INSPECTION PURPOSES. t � G _ PERMITTE" AME (PRI T :1] /V .! rn SfQ17ATUREOPPERMITTEE DATE g PRESS FIRMLY APPLICATION PERMIT P/C DATE NUMBER # n ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR � j SIDE/SIDE STREET RW :1 SIDE C PROPOSED USE NO. DWEL NO, NO. UNITS STORIES _ BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFPJADD/REM GaragelCarport co WPatio/Deck LL POD/Spa ZRe -Roof ® Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U r µJS J C7 Z � G CL U Z Q 2 UJ CONSTRUCTION PLAN REVIEW ELECTRIC -- PLUMBING MECHANICAL INSPECTION FEE ISSUANCE- SMiP ENERGY P/C - e ENERGY PERMIT -- RETENTION FEE: _ F PRE-ALT FEE: TOTAL FEES t✓ - COMMENTS � 7 RECPT. NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK—ASSeSSOr copy, UVLUClNY VU—rl le VV'Hy, �n��rv—nppuwu o ..�Py FAT CM MANDIM) "All'i 11 S 112 ... a Y', 1 `.w T Y u. a