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HomeMy WebLinkAbout17268 (23) CITY�F DIAMOND BAR „C' � DEPAR'TMENT OF COIvIIvfUMTY&DEVELOPMENT SERVICES d I'�. �. 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS %.�4�� BUILDINGPEItMITAPPLICATION FIRMLY o ADDRIESS O DATE CATI� � NUMBER J� #/C � ISSUE--��'��TYPE OCC .- APN LOT RACT DATE CONST. GROUP p OWNER p ADDR ZONING SETBACKS � CI ZIP TEL. FRONT RW ❑ g APPLICANT TEL. REAR ❑ z SIDE/SIDE STREET RW ❑ Q CONTRACTO SIDE ❑ ADDRESS PROPOSE US o CITY ZIP TEL� � �� � w ARCH/ENG! z DESIGNER � ADDRESS N . . NO. NO ' � CITY ZIP TEL. UNITS STORIES BEDROOMS u� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFIRM UNDEF PENALTV OF PERJURV THAT I AM'cXEMP7 FROM THE COMRACror,s u- GaragelCarport W CENSELAWFORTHEFOLLOWINGREAS9N(SEC.7031.5BUSINESSANDPROFESSIONSCOOE�ANVCITVOR (n C.) COUNTYWriICNREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,OflREPAIRANVSTqUC- W Patio/Deck w TURE,PRIOR TO I7S ISSUANCE,AL50 REOl11RE5 THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSED PURSUANi TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9�COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�?fl0- � POOUSpd FESSIONS CODE)OR 7HAT HE OP SHE IS EXEM PTTHEREFfiOM AND THE BA515 FOR THE ALLEGED EXEMP- � TION.ANYVIOLAiIONOFSECTiON7031.5BYANVAPPLICANTFORAPERMITSUBJECTSTHEAPP�ICANTTO Z RB-ROOf A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLAqS(E5o0�.): ZOI,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWI'HWAGESFSTMEIRSOLECOMPENSATION, 0 COfIlf118fC181 WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOF SALE(SEC.7044,BUSI- J � NESS AND PROFESSIONS CODE;THE CONTRAGTORS LICENSE LAW DOES NDT APPLY TO AN OWNER OF � PROPERTV WHO BUIL�S OR IMPROVES THFREON,ANO WHO DOES Sl1CH WORK HIMSELF OR HERSE�F OR � THROUGHHISORHEROWNEMPLOVEES,PROVIDLDTHATSUCHIMPROVEMENTSARENOTMTENOEDOR m QOFFEREDfORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMEN715501DWITHINONEYEAFOFCAMPLE- 2 TION,THE OWNER�BUILDER WILL HAVE THE BUpDEN OF PROVING TFIAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). �y,� 71.ASONMERaFTHEPROPERN,AMEXGLUSIVELVCONTRACTMGWITHIICENSEDCONTRACTORS Q TO CANSTRUCT THE PROJECT(SEC.�044,BUSINE55 ANO PflOPES510N5 CODE:THE CONTRACTORS LI- V8II1211 ADJ.AREA W CENSEL4WDOESNOTADPLVTOANOWNEROFAPflOPERTYWHOBUIL�SORIMPROVESTHEREON,AN� � WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR(3)UCENSEDPURSUANTTOTHECONTRAC- OUANTI DESCRIPTION FEE Y TORSUCENSELAW.)- Q ❑I A�1 EXFMPT UNDEri SE4 B.8 P.0.FOR THIS REASON Q � U t� � onTE owN�A__ �— Z W � LICENSED CONTFACTORS QECLARATION W 6 � IHEREBYAFFIRMUNOERPENALTYOFPERJURYTHATIAMLIGENSEDVNDERPROYiSIONSOFCHAPTEP � d 9 iCOMMENCING WRH SECTION 7000)OF[71VI5!ON 30FTHE BUSMESSAND PROFESSIDNS COOE,AND z �X MY LICENSE IS M FULL FORCEA �E ECT. m � LICENSE CLASS LIC.NO_ ~ � � V DATE � � CONTRACTO � J W � WORKERS'COMPENSATION DECLARA710N a � U � IHEREBYAPFIRMUNDERPENALNOFPERJURYO>IEOFTHEFOLLOWINGDECLARATIONS: � Z Q 0 �IHAVEANDNALLMAIN7AINACEHTIFICATEOFCONSENTTOSELF-I!JSUREFORVIORKERS' S CAMPENSATION,ASPFOVIDEDBVSECTION37ooOFTHEUBORCODE,FORTHEPERFORMANCE U q OF THE WORN FOR WHICH iH15 PERMIT IS ISSUE�. � 0 w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION L/� Q 370D OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR NMICH THIS PERMITIS � 7 ISSUED.MY WORKEflS' MPENS ION INS CE CAR AND POLICY NUMBER ARE: CONSTRUCTION � . J j CARRiEH �„_ /{� PLAN REVIEW � POLICYNUMBER_ �"���(/ � ELECTRIC Q Q (THISSECTICNNEm1�qTBECOMPLEfE�OFTi-IEPERMRISFORQ'JEHUK7REOOOI.lARS�5100)ORLESS� PLIJMBING w I CEFTIFYTHAT IN THE PEPFOqMANCE OFTHE WORK fOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL Z — (•} SHALLNOTEMPLOVANVPERSONINANYMANNERSOASTOBECOMESUeJECTTOTHE � N WORRERS'COMPENSATIONIAWSOFCALIFORNIA,AN�AGREETHATIFISHOUl.DBECOME INSPECTIONFEE ? SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSEC710N37ooOFTHElA80R CODE,I SHALL FOfiTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE p DA7E: APPLICANT. SMIP •�Q J ENERGY P/C J WARNING FAIWRETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFt1L,AN�SHALL BE � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFWESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT �OLLAPS(5100,000),IN ADDRIONT�THE COST OF COMPENSATION.DAMAGES AS PROVIDED fOR IN J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. E� � RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREbVAFFIflMl/NDERPENALTVOFPERJURVTHAT7HEFEISACONSTRUCTIONLENDINGAGENCV p- FORTHc PERF-0RMANCE OFTHE WORK FOR WHICH�HIS PF.FiMIT IS ISSUED(SEC.3097,dV.C.J. Z W S LENDER'SNAME . . � F_ LENDER'SAODRESS __. ^ � ICERTIFYTHA7IHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES / 3�' /V 0. I AGREE TO COMPLY WITH AL.L CITY AN�COUNTY OFOINANCES ANO 5TATE 1�WS RELATING TO BUILDING � CONSTRUCTION,ANpHEFEBYAUTHORIZEREPRESENTATNESOFTHISCOUNTYTOENTERUPONTHE z AbOVE�MENTIONED PROPERTY FO SPECTION PURPOSE5. COMMENTS O �� m PER NA P�INT� � l GI1^/ /D � SIGNA7UREOFPERMITTEE �A S RECPT.NO. PAID BY� _ VALIDATION ~ WHITE—Depanment Co YELLOW—Fina�ce Co PINK—Assessor Co GOLDENROD—File Co GREEN— IicanYs Co qY� PY� PX PY, APP PY .. ..;.i ;a ti. :.;:,o. 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