The URL can be used to link to this page

Home My WebLink About14903 (20)r, DIAMIN1)1111.;{ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY A DEVELOPMENT SERVICES 21660 E. Copley chive Sidie 190 (909) 860-3195 Fox (909) 861-3117 1117"I VG PU IIT APPLICATION DDSITE RESS t_12 -36p APN LOT j OWNER 10 ADDRESS CITY lit Ami zip -!P wgla d APPLICANT TEL. CONTRACTOR _ ADDRESS CITY ZIP j TEL X�- ARCRENGI DESIGNER ADDRESS CITY ZIP TEL, OWNER -BUILDER DECLARATION I HEREBY AFRAM UNDER PENALTY OF PERAURY THAT I AA EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWI KI REASON (SEC. 7011.5 BUSNESSAND PROFESSIONS CODE: ANYCITYOR OOUNTYWHICMRECI IMPSA PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR RERMR ANY STRUC- TURE, PRIOR TO ITB ISSUANCE, AL30 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIDNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. =LAW (NaMPTER P (C0IBAEMMIMKN WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO, FESSILINS CODE) OR THAT HE OR 3HE 18 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED FXFMP- TXNN. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACML PENALTY OF NOT MORE THAN FNA HUNDRED DOLLARS 0 I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED 08 OFFERED FOR SALE ISEC. TON, SUSI� NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WINO BUILDS OR IMPROVISE THEREON, AND WHO DOES SUCH WORK HMBELFOR HFABELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS AM NOT MENDED OR GfFOWD FOR SAL E. IF. HOWEVERTHE WUW40 OR MPPOVEMENT ISSOLOW M41NONE YEAROFCOWK E - TUN, THE OBMERWALM WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR MPiWVE FORTHE PURPOSE OF SALE). Q LAS OWNER OF THE PROPERTY, AM EXCLUSNELYCONTRACTNG WITH LICENSED OONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS COOS THE CONTRACTORS U. CENSE LAW DOES NOT APPLYTO AN OWNER OF A PROPERTY VAD BUILDS OR IMPROVES THEREON. AND WHOCONTRACTS FORSUCH PFIOJECTSWTTH ACONTRACTOR(S)UCENSED PURSUANTTOTHE CONTRAG TORS LICENSE LAW.). ❑ 1 AM EXEMPT/MDER SEG B. 1 PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PFP URY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND W LICENSE LS M FLU FORCE AND EFFECT r'+ L.K:EN LIC. N0, 77 Q DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PENURY CNE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION vW OF THE LABOR CODE. FOR THE PERFORMANCE ,OF THE WORK FOR WHICH THIS PERMIT 0153UE0, -_ P/ I NAVE AND WILL MAINTAIN WORKERS' COMPENSATIN INSURANCE, AS REWIRED BY SECTION 3100 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION tNvRANCECARR)Ejt AND POLICY I UMBER ARE•, CARRIER POLICY NUMBER IROS SECION NEEDNO7 BE COMPLETEDOF THE PENMT S PDR ONE t5ANDFED DOUAg61s10D) OR LES% I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT M ISSUED. I 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBdECTTOTHE j W��PLY UVB Of CALIFORNIA, AND AGREE THATif I SHOULD BECOME MPENSA PROVISDNSOFSECTDN 37000E THE R WS wsDwsDATE:LAANT. i FAILURE TOS OOMPENSATION CW COVERAGE ISUNLAWFUL. AND OUSAJ,BE SUMCT EMPLOYER DD TI CRIMINAL THE AND CIVa FATES , DAMAGES ONE HUNDRED TED FOR IN DOLLARS {t100,00p), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN j SECTIONS70A OP THE LIBOR CODE, INTEREST. AND ATTORNEY'S FEES. i CONSTRUCTION LENDING AGENCY 1 LHEREBY —IRM UNDER PENALTY OFK FOR W ICH THIS PE ISACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE VNOW( FOR WHICH THIS PERMIT IS ISSUED ISE4 3017, C(V.4). LENDERS NAME F$ LENDER'SADDAESS j I CERTIFY THAT I HAVE READ THIS APPLICATION AM STATE THAT THE ABOVE INFORMATION IS CORRECT. 1MNREET000MPLYWITH'sy ANO CO/NTYXTAT'CES AND STATE LAWS RELATING TO BUILDING CONSTRUCTtlN, AND HEREBY AUTHORIZE NEPRESE ATNES Of THIS WIRNTY TO ENTER UPON THE ABOVE.MENTIONED PIIDPERTY FORT 6PEOTION PU ES. 3 PERMI (PRNn SGNA OFPE EE GATE - PRESS FIRMLY, APPLICATIONS/1 PERMIT PIC DATE Cry NUMBER i1 ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SDE/SIDE STREET RW p SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SMADDRiEM co Garagocaryort UPaiWDeclt LL Powspa � Re -Roof Commercial - 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE 3 U 1- U W J W U 1 �V 3 0- 0 - CONSTRUCTION CONSTRUCTION PLAN REVIEW ELECTRIC ""tc L PLUMBING MECHANICAL INSPECTION FEE wnn N ISSUANCE -—Y 71 O QjA,1 SMIP G i ENERGY PIC `3UTIMI G NVIND,cit? f -Y ENERGY PERMIT RETENTION FEE: PRE -ALT FEE TOTAL FEES COMMENTS or -- / I L'N:...z ✓ -O 1 -71 RECPT. NO. PAID BY _LLYTVALIDATION WHITE --Department Copy. YELLOW --Finance COPY. PINK—AMMAor CON,, GOLDENHUU- -143 k OW. 6'OR