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Home My WebLink AboutPR16-2816I. '? CITY OF DIAMOND BAR r ' DEPARTMENT OF COMMUNJITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 9?765 PRESS \ (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS \ �+ Q APN LOT TRACT OWNER aZ ADDRESS e'] L CITY � 1,K ZIP TEL. S I b 3 APPLICANT 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 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 7031.5, Business and Professions Code: 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 L 1 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 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 projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure gler the Contractor's State License I�or the following reason(s): Date :n 12 % 2 ' Sign: v By my signature below I acknowledge that, except far my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its 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: http/www.leginfo.ca.gov/calaw.html. 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 force and effect. LICENSE CLASS: LIC. NO.: EXP.DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure 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. 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED 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 become subject to the Worker's Compensation Laws of Califomia. And agree that if I should become subject to the Worker's Compensation provisions of S on 3700 of the Labor CAe, I shall forthwiit"comply with those provisions. DATF.y 12 PLICANT:_ z WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties 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 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 authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. c PERMITTEE N INT) Z�1 GNATURE OF PE MI ' L DATE APPLICATION DATE: „ I %a 11(. �P/C# ISSUE DATE: ,a 11,. I lb PERMIT# : ?(-, A 6 — d B 1(o TYPE CONST. OCC GROUP: Scope of Work 3 so ►+. 91--*1001— Yk-t. If DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM S r Garage/Carport w Patio/Deck �SL LL Pool/Spa A 0 ,8S ZRe -Roof `Q Commercial f` • Y ra m ti G 40 11101 Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U U w J W m J a ZU_ Q x U CONSTRUCTION: a��a • (,.' PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: Off• O'-� PRE-ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES -I9 COMMENTS: P/C: B PAID BY: _ r p VALIDATION: RECEIPT # 3Z� tr5� PAID BY:y �SS-1 VALIDATION:_ S1 WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD COMMENTS: 1`) 2. �'` r r WORXERS' COMPENSATION Dc_CLARATION I hereby affirm that 1 Bove a certificate of consent to seff Insure, or o certifico`o of,Workers' Compenslion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) PoliicyNc!r/ ? Company P Certified copy is hereby furnished. Certified copy is filed with the county building inspec• tion�deportment.• • Dote /7(�' APPlicant -'f / CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars (5100) or less.) I clrlifr i!•ot in the performance of the work for which this permit is Issued. I shall not employ any person in any manner so as Ip become subject fa the Workers Compensation laws. Dore Applicant NOTICE TO APPLICANT: If, offer making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of The Labor Code, you must forth• with comply wilh such provisions or this permit she be. deemed revoked. N LICENSED CONTRACT ORS DECLARATION I hereby olfrrm That I am licensed under provisions of Chapter a (commencing wish Section 7000) of Division 3 of the Business and Professions Coda, and'my licence is in full force and effect. ticense Number %�3 tic.Class— Contractor I am exempt from The licensing requirements as 1 am a licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Business and Professions Coda). Lie. or Reg. No. Data OWNER -BUILDER DECLARATION I hereby affirm that I am oxempt from The Contractor's License Low for the following reason (Section 7031.5. Business and Professions Code): I, as owner of the properly, or my employees with wages as their sole compensation, will do the work and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code). ❑ 1, as owner of the property, am exclusively corrracting with licensed contractors to construct the project -(Sec. lion 7044, Business and PRafesslons Code). CONSTRUCTION LENDING AGENCY I hereby offirm that there is a construction lending agency for the performance of the work for which this permit if issued (See. 3097, Clv. C.I. Lender's Name 1 tender's Address 1 certify that I have read this application and state thet the above information is correct. I agree to comply with all County j ordinances and State laws rotating to building construction. and hereby authorise rep a ontoeves of this County to enter up-onf��FFFir ebeCo•m no /d property For inspection purposes. S,g-ofure of AKFhconr or Agent owe • ; i ,ter E.... APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ' S ADDRESS SS I r% BUILDNO ADDRESS r �I L" locAIITY ; ' !•% CITY (ilk my % Zip 91 q CROSS ST. ,/ ys NO. Or BLDGS. ASSESSOR SIZE OF LOT '/✓?' NOW ON LOT MAP BOOK PAGE PARCEL T ✓ '�' .•'� BLOCK LOT NO. VS. ZONE- ; ; J /: MAP ill. �n r R /%% /ll t)•Uf} nro.l.%• � '.� St{CIAL ccuDlntDvs 'Z „ISIR:CI GROUP FIRE PROCESkD BY ESS ,e40 r`TnJJ je JlYP1 CON/S'T� ZONE CITY ARCHITECT C4 _ /J 7 IIl•.STr.Ai 9A11S11CAl CLASfiFICATION l API. CUN00. NEER !%/t`.f7G� CLASS NO, DWELL. Win_ TT��fI/i/ /NO. ESS '/.It-/ A"4/1f/! .�i. J(1�j/. /i�i�Sl [AD SEW-M.. DK PG (/ VAIIITATION TEL.NO. "% Aj ESSA55 01 v �� Nc '1I 'J 3VALUATION ^lw1T C y SS,. -:/.ten T. ��7''�U/ 'r0. 14 NO. OF CIISCK <L' STORIES FAINLIS ONEIPTICN S FNAL FINAL 9 7 A f rr 1 •�� •� •'` •� � 7 . rs • r/ CF WCRK /��' t-1/ r JJ(� WW ❑ ADD ,,.��,,, �• anER ❑ REPAIR D_OL ❑ USE Of /t.J EXISTING BIDG //%i/F !�-,/h lc / AFR I/ 1 It C > �. (PRINT)A/A�'iJiGsc1 No..F/%/I$7 fPRINrI/'/rn r.. .0 .��G i� ::u/•;• CF^�_ ADDRESS JRL_rhr BURDING ADDRESS LOCALITY MOVING TEL. CONTRACTOR NO. ADDRESS RtOV•R`D SE1 ..ASK YARD MYr TOTAL SETBACK IROM pRCP LNE EXIST. WIDTH FrCxN' P /.•i % slo- p I. ' P.C. Fees Pwmit Fee Isrunnce Ire �'r ' In.esupenon Fee// $EE REVERSE FOR EXPLANATORY LANGUAGE