The URL can be used to link to this page

Home My WebLink AboutPR 14-3532 (4)UI�L�lOATD BAR r . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY.& DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION JOB SITE ADDRESS 'i 3 O S- \C�M� C+V� C ►� APN LOT�— TRACT OWNER)( :i21_ ADDRESS w x7 CITY!D, Q ww 1 Ict ! ZIP q174TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY r1A4 W_* ZIPS% 1VTEL.9y7'" ARCH/ENG/DESIGNER 1d, �r e�w'rr��AI V,Cts ADDRESS, i ZOJ H J1 VfZD'j CITY-26,LX,\,_ ZIP '95TTZTEL. 2. 4-,7,00 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt tom the Contractor's State License Law for the reason(s) indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 70315, Business and Professions Cotte: Any city or county that requires a permit to construct, alter, Improve, demolish, or repair, any structure, prior to its Issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. 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 ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions 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 property who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale. If however, the building or Improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to constrict the project (Section 7044, Business and Professions Code: The Contractors' State License taw does not apply to an owner of property who builds or Improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' Stale License Law.). U I am exempt from licensure under the Contractor's State License law for the following reasorr(s): By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the Improvements covered by this permil,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed In is entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web site: hUpAwrw.leginfo.ca.gov/calaw.html. DATE: SIGN: LICENSED CONTRACTOR's DECLARATION I hereby affirm under penalty of perjury that I 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 forces and effect LICENSE CLASS- rJ n SIC. NO.: DATE 7 CONTRACTOR: SIP44X! WORKER'S COMPENSATION DECLARATION I HEREBYBFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: ✓ I have and will maintain a Certificate of Consent to Self -Insure lar Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. �LI have and will maintain Worker's Compensation Insurance, as required by Secfion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carder and Policy Number ap .p CARRIER >r71%A lk-rmNfi' POLICYNUMBER (T}gS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE M NDRED DOLLARS ($100) OR LESS). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the Workers Compensation Laws of California, And agree that if I should become subject to the Workers Compensr pr of Seeker 3700 of the Labor Cade, I shall forthmath campy with those pmvislorrs. DATE: I APPLICANT: WARNING: Failure to secure Workers Compensation coverage is unlawful, and shall subject an employer to criminal penaPoes and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's 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-- LENDER'S AMELENDER'S 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 hereby auftirize representatives of this county to enter upon the above-mentioned p rty for inspection purposes. PERM E NAM INT) . 9 SIGNATURE OF P DATE MA APPLICATION DATE: S IN LI -11, � P/C# IFiR \ �k ' J30� S ISSUE DATE:C _ n / `Z- 4 , IPERMIT# 3,-,-3 2 - TYPE TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE X ` ' h 4 i /v Hti A.,+?,.A Vn w Ti Ci ` S p,' 16-,- CG # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FF. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport rn w Patio/Deck LL Pool/Spa 0 Z Re -Roof O CO Commercial CO Valuation !&10,000 Adj.Area: QUANTITY DESCRIPTION FEE U w w z J (L z U W CONSTRUCTION: PLAN REVIEW:q�l � •• Com ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: Jlwfl ENERGY P/C: ENERGY PERMIT: RETENTION FEE: v PRE -ALT FEE: BSAF: TOTAL FEES y -p 8 (oCtt. COMMENTS: RECEIPT # �.� O f0 _ PAID BY: '7 V VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD COMMENTS: V%o d'r-t Na.<j ! rw616146�t CITY OF DIAMOND BAR. DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 aB BUILDING PERMIT APPLiCATiON i JOB SITE ADDRESS s- �0.W�i•� G i APN LOT—�— TRACT OWNEr.r,Trt.ti ADDRESS : wtoxt D CITY ZIP g1i4 TEL APPLICANT TEL D CONTRACTORf ADDRESS �-y Y(O M/NLtT/j/V _A�UX— p CITY Fi(��/� —ZIP 11 TEL. 5 /'O C� ARCH/ENG/DESIGNER lz sw•wt ti r C -c- ADDRESS,,-"L7ZOV Iiv ZUrj CITY-Sc0+4i A,\4-- ZIP '8SZS1TEI -OO I DINNER -BUILDER DEtxiwATION I hereby affirm under penalty of pergrry that I am exempt from the Contractor's State License Law for the reasons) h indicated below by the checkmak(s), I have placed next to the applicable Heats) (Section 703/.5, Bmines, and Professions Code: Any city.or county that fequhw a permit to Construct, after, hnprore, demolish, or repair, any i structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statement gnat he Orshe is licensed pursuant to the provisions of the Contractor's State License Law (Chapter B) Commend" with SecUm i 7000 of Division 3 of the Business and Professions Code) or that he or she Is exempt from fkenstne and the basis for n. the alleged exemption. Any violation of Section 7031.5 by any applicant for a pemdt subjects the applicant to a duff penally of riot more than foe hundred dollars ($500). i U I, as owner of the property, or my employees with wages as Iheir We compensation, will do U an of or U portions of the work, and the structure Is not Intended or offered for sale Cecft 7044, Business and Professions Coda_ The ! Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, buff i or Improves the property, provided that the Improvements are not Intended or offered for sate. ff however, the building or Improvement is sold within one year of completion, the Owner-Bunder will have the burden of proving that it was not built or Improved for the purpose of sate.). 1, as owner of the U Properly, am exclusively contracting with licensed Contractors to construct Lha Project (Se,f on r 7044, Business and Professions Code: The Contractors' State License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for the projects with a licensed Contractor purcvard to ft Contractera• State License Law.). i U I am exempt from licensure under the Contractor's State License law for the lotpwing reason(s): . By my signature below I acknowledge that, except for my personal residence M which I must have resided for at least one year prior to completion of the Improvements covered by this permft,l cannot legally sen a Structure that I have bull[ as an owner -builder If It has not been constructed In its entirety by licensed contractors. I understand that a copy of line appitcable law, Section 7044 of the Business and Professions Cade Is available upon request when this applicatian is submitted or at the following Web site: httpWw .leginfo.ca.gov/calaw.html. DATE: SIGN: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (cor mhenckng with Section 7000) of Division 3 of the Business and Professions Code, and my ncerse is in full force arta effect. LICENSE CLASS•�� !7 C. NO.: � DATE: �J CONTRACTOR: dL71N(�. WORKER'S COMPENSATION DECLARATION I HEREBYjIFRRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: ✓ I have and will maintain a Certificate of Consent to Set -Insure for Walrer's Compersatb% as provided by Section 3700 of the Labor Cade, for the performance of the work fdr ivttch this permit is Issued I have and will maintain Worker's Compensation insurance, as required by Sector 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My Worker's Compensation insurance Carrier and Policy Number a CARRIER'/ /VT�'nN • O .4 POLICYNUMBER 7%.ri i,✓PaT-!;-5 (RIS SECTION NEED NOT BE COMPLETED IF THE KRpAT IS FOR ONE Milan DOLUIRS RSl DU OR LIM. I certify that in the performance of the work forwhich Ods pemit Is isaned, I stag not employ any parson in any mahlw sl, as lo become subject to the Worker's Compensation Laws of Cal ornla And agree that ff l ahalld become subject to the Ihkras COmpensatie pr ons Section 3700 of the Labs Code, l shall lortnvlth campy with ifrose Ixtrvbl m DATE:. APPLICANT: . WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal penalties and chtl fines up to one hundred thousand dollars ($100,000), M addition to pre cost of the compensation, damages as provided for in section 3708 of the labor code, Interest and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction Lending Agency M the performance of the wok for which this permlt Is Issued (Sec. 3097, Civ. C.). LENDER'S NAME LENDER'S ADDRESS: I certify that I have read this application and state that the above inlor,.anon is correct I agree to campy with an d$' and county ordinances and state laws relating to building construction, and hereby authorize retimserriatNn of this county to enter upon the above-mentioned p rty for Inspection purposes. PERM E NAM IfTT) SIGNATURE OF P - . DATE r PRESS FIRMLY APPLICATION DATE:_ Ny P/C#_e& aS�la ISSUE DATE: Ck/ `�-, 4 PERMIT# P IZ I U '.35 3 2 - TYPE TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW REAR C SIDEISIDE STREET RW O SIDE PROPOSED USE)[-1N44z -a V—kV—u `S i If DWEL. UNITS # STORIES # BEDROOMS CONSTRUCTION: r{- �d —T S' PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: r D PRE -ALT FEE: BSAF: __ p s TOTAL FEES 'rm- �4 COMMENTS: RECEIPT 0. .�.1 d6� PAID BY. 1L 7 V VALIDATION:_Cr WHITE —,De . partment Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — Rie Copy, GREEN — Applicant's Copy DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport cn Patb/Deck LW Pool/Spa _Z 9 R,Roof Commercial rD Valuatio O U O 0 Adj. Area: QUANTITY DESCRIPTION FEE co m J CONSTRUCTION: r{- �d —T S' PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: r D PRE -ALT FEE: BSAF: __ p s TOTAL FEES 'rm- �4 COMMENTS: RECEIPT 0. .�.1 d6� PAID BY. 1L 7 V VALIDATION:_Cr WHITE —,De . partment Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — Rie Copy, GREEN — Applicant's Copy