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Home My WebLink About148980 1111.UI CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 851-3117 BUILDING PERMIT APPLICATION ADDRITE SSS/I APN LOT TRACT OWNER '' ADDRESS_17 CffY YX/uKMa ZIP TEL.�e,' I- i I APPLICANT TEL CONTRACT R % ! L/� ADDR SS CITY ^ l IP /7i�6 TE .;- g3/-�27I ARCFlENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI. CENSE LAW FORTHE FOLLOWING REASON (SEG 7051.6 BUSINESSAND PROFESSIONS CODE: ANYUTYOR COUNTY WFBC H REOLMESAPERMRTO CONSTRICT.ALTER IMPROVE.DEMOUSRL OR REPURANY STRUC- TURE- PRIOR TO ITS ISSUANCE. ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED EN STATEMT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U - CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRO- FESSON. ANY VIOLATION ONS CODE) ORTHATHEORSHE ISEXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TOF IO SECTN 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO M A CL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500.1: 0 LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, MND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7044, BUSI- NESS AND PRCIFESSKM CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VAIO BUILDS OR IMPROVES THEREON. AAO WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HE R OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN DED OR OFFERED FORSALE F. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN MEYEAROF COMPLE. TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) O L AS OWNER OF THE PROPERTY, AM EXCLUSNTMC ELYCONTINO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE UW DOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUMS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH FFIWECTS WITHACOHTRACTOR(S)LCENSED PURSUANT TO THE CONTRAC- TORSLICENSE LAW.). ❑ 1 AM EXEMPT CINDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HERESY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS Cu CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLAS$6_6'f LIC. NO. � DATE 2 3 CONTRACTOR Zj-P_ WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL WNTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 7700 OF THE LABOR OOOF: FOR THE PERFORMANCE OF THE WOR( FOR WHICH THIS PERMIT N ISSUED. I RAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOORRKEERRS/OOOMPEN/$-ATON �NsSUFLW/jCE CARRIER AND POLICY NUMBER ARE: CARRIER Y^ IC lJl JT t L POUCYNUMBER e0 _ 1_ — (M1aS SECTION NFID NOT BE COLRETFDOFTHE PEAR 0 FORONERINDREDDOLLARS RIOM OR ulw5 1 CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY W TH THOSE PROVISIONS. DATE APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL. AND SHALL BE SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.0001. N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HERESYAFFIAM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 7097, CIV. C.j LENDERSNAME LENOER'SADDRESS I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREETO COMPLY WITH ALL CITY ANOCOLWT/O ANCES AND STATE LAWS RELATING TO BUILDING CONSTRICTION, ATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEJAENTIDN F URPOSES. PERM (PR `/ vO I SKLNATURE OF PERMITTEE DATE EXPIRED JUN 19 2002 PRESS FIRMLY APPLICATION PERMIT PIC DATE CSO NUMBER r o9 N ISSUE TYPE OCC �± DATE CONST. _ V —ri GROUP i ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL, NO. NO. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ_ AREAIVALUATION SFR/ADD/REM Tn Garage/Carport W PatiolDeck - LL PCaI/S Re -Root ZT+a7O 3$ -bb . � Cammerclal - Ln Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U 2 H U w J w ED 2 m i a U_ Z Q S U \A NN 1 t 2000 OF DIAMOND B t b R�i7T CONSTRUCTION 7�I7a`T SI' PLAN REVIEW AMTV ELECTRIC PLUMBING MECHANICAL {I s INSPECTION FEE ISSUANCE OWN SMIP AM \ ENERGYP/C ENERGYPERMIT RETENTION FEE: PRE -ALT FEE TOTAL FEES COMMENTS RECPT. NO. •� PAID B VALIDA N WHITE-Departrnent Copy. YELLOW -Finance Copy. PINK -Assessor Copy, GOLDENROD -File Copy, GREEN-AppicaM's Copy