The URL can be used to link to this page

Home My WebLink About14-4509 (12)R11ri, IOUD IZ�Uif CITY OF DIAMOND BAR DEPARTMENT OF COMMi.jNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 � ] BUILDING PERMIT APPLICATION JOB SITE ADDRESS 1 7 - APN LOT TRACT OWNER IMU ADD SS I CITY [�_ ZIP - TEL APPLICANT TEL. CONTRACTOR i c ADDR S CITY ZIP TEL. � ARCH/ENG/DESIGNER m ADDRESS CITY ZIP TEL. i OWNER-BUILDI R DECLARATION I hereby affirm under penalty Of perjury that I am exempt Iran the Cadractur'9 State License Leer for the reason s) indicated below by the checkmark(s), I. have placed next to the applicable lem(s). IsecNon 70313, Bush. and Professions Code: Any city or county that requires a permit to construct, after, Improve, dome. He% or repair, an i structure, prior to its Issuance, also requires the applicant for the Poen, to Bleu a" statement Myst he or sty Is licensed pursuant to the provisions of the Contractor's State license Lasa (Chapter B) �rmrenchtOf with Section 7000 of Division 3 of the Business and Professions Code) a that he a she Is exempt from Iksrtsureand the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a penNt sub)ects the applicant to a cull pertalty of not more than five hundred.dollars ($500). U 1, as owner of the property, or my employees with wages as.thdr sale compensatlen will do (j all of Dr u porOmts of the work, and the structure is not Intended or Offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of properly who, through employe", or persarrel effort, btft or improves the property, provided that the Improvements are not Inured or offered for sate. Of however, the building or .improvement is sold within one year of compfetOn, the Owner -Builder will have the burden of proving that it was not built or Improved for the purpose of sale.). 1 U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for the projeds with a licensed Contractor pua'suant to the CatractoreState License Law.). - U I am exempt from licensure under the Contractor's State License law for the following reason(s): By my signature below I acknowledge that, except for my personal r;;ence lo which I must have resided for Id least one year prior to completion of the Improvements coibred by fits permt,l cannot "Ify sell a structure fiat I have bull as an owner -builder If it has not been constructed In Its entirety by lren" d contractors I understand that acopy of tie sppficablo law, Sectlon 7044 of the Business and Profession Code Is available upon request when this sppOcatlon Is shorrhMed or at the following Web she: htlpAvww.leglnfo.cn.gov/calaw.html. DATE: SIGN: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions at Chapter 9 (commendnp with Section 700(1) of Division 3 of the Business a/n�d Pzroles ons Code, and my license is in fug force and effect. ' LICENSE DATE: _6 CONTRACTOR: 0r WORKER'S COMPENSATION DECLARATION - I HEREB�AFRRM UNDER PENALTY OF PERJURY.ONE OFTHE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self-Inshrte for Worker's 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 will maintain Worker's Compensation insurance, as required by Section 3700 Of"' Labor Code, for the performance of the k for wthich tMs permit is Issued. Worker's Cogmensalon Ireshaarmce Cartier and Policy Number are: ��,/�^Q- CARRIEii V�\Ik1`�J Ire' POLICY NUMBFA (THIS SECTION NEED NOT BE COMPLEfEO IF THE PE Mff IS FOR ONE M NIUM COLLARS (SIDO) OR LESS. I certify that in the pedortnance of the work for wtdoh this permit Is issued, I strap not employ any person lo`arly manner so as to become subject to the Worker's Canpensitlon Laws Of. Callmrrda. And agree that t I MOM becoms subject to the Worker's COmpen lila ions; Section 3700 a La Code, I Ito mgh Comply with Oose provisions. DATE: APPLICANT: �� WARNIN Failu to secure Worker's Co I lion coverage is urdawM, and shat subject an employer to criminal penalties and civil Mas W to one bund ousand dollars (:100,000), In addition to the cost of that eomprnsation damages as provided fm in sectton 3708 of the labor code, Interest, and attmrtey''s fees. o CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a Construction Lend g Agency for the perlorrtiace tit the crock for which this permit Is Issued (Sec. 3097, Civ. C.). +. LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the fibu4 information is correct I agree to comply with ell qty and county ordinances and state laws relating to building constimcfIon, and hereby authorize representatts�s of Ods county to enter upon the above-mentioned property for Inspection purposes. , 't PERMITTEE NAME (PRINT) SIGNATURE OF PERMITTEE - DATE PRESS FIRMLY APPLICATION DATE: P/C# ISSUE DATE: 7. — / PERMIT# TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW 171 REAR SIDE/SIDE STREET RW ❑ SIDE MAIN lrfwf PROPOSED USE Ili0rMq_W__ DWEL. UNITS # STORIES If BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport rn W PeUo/Deck U_ Pod/Spa ZRe -Roof 9 Commercial 5 RI Valuation: Adj: Area: QUANTITY ESCRIPTION FEE CONSTRUCTION: PLAN REVIEW: - ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT. RETENTION FEE: �� PRE -ALT FEE: BSAF: TOTAL FEES COMMENTS: RECEIPT 0 0'79 7 . PAID BV: _ `l-%P•��_ VALIDATION: WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD— Fite Copy, GREEN — Applicant's Copy CITE( OF DIAMOND BAR INSPECTION RECORD