HomeMy WebLinkAbout14983 (20)DIA. (RD IIAI' Il
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 Lt. Copley Drive Suite 190
(909) 860-3195 Fax (909) 851-3117
BUQ.DING PERMIT APPLICATION
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ADDRESS 0 1 L W EAC V (L
APN LOT TRACT
OWNER C `I
ADDRESS _<,4l�rY_ i
CITY ZIP TEL'C Oil
APPLICANT TEL
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CONTRACTOR DIA(�1C L) IZeOr t ^��7
ADDRESS I 310 �+�lff�i—
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ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFTRM UNDER PENALTY OF PERJAIRY THAT 1 AM EXEMPT FROM THE CONTRACTORS LL
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSNESSAND PROFESSIONS CODE ANYCIIY OR
COUITYWAICH REOlARE9APERMRTOCONSTRUCT.ILLTER IMPROVE, DEMOLISH, OR REPAIRANY ST RUC
TURF. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FRE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF
CENSE LAW (CHAPTER I (COMMENCING WITH SECTION TOM) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS
ROFESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXFMP•
TION. ANY VIOLATION OF SECTION 707.5 BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FINE HUMORED DOLLARS (5500) r
O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORT( AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUS6
NESS AND PROFESSIONS COOS: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO 9VLDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK WUSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HIOWE VETLTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPL &
TION. THE OWNER4=ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 00 NOT BUND OR
IMPROVE FORTHE PURPOSE OF SALE}
D L AS OWNER OFTHE PROPERTY, AM EXCLUSNELYCONTRACTINi WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 704,, BUSINESS AND PROFESSIONS COOS THE CONTRACTORS LI.
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR MPROVE3 THEREON, AND
WHO CONTRACTS WI
OJECTS
FOR SUCH PRTH A OONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAO
TORS LICENSE LAW I.
D I AM EXEMPT TINDER SEC. B. L Pa FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
N
• (OOMMENCG WITH SECTION 7000) OF OMSOIO
N$ 3 OF THE BUSINESS AND PROFESS COOF. AND
MY LICENSE 15
IN FULLLFFORCE AND EFFECT.
LICENSE
TSE SE
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RA.CTDR� __
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TD SFIF.INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION VW OF THE LABOR CODE, FOR THE PERFORMANCE
Of THE TVORK FOR WH9CH1 THIS PERMIT is ISSUED.
_I HAVE AND WILL MANTAN WORKERS• COMPENSATION INSURANCE, AS RECUIRED BY SECTION
5700 OF THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEPMIIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
--
POUCYNUMBER _ .3-C:TQ C
(HIS SECIVINNEEDNOTBECOPLFTEDOFTHE PERMIT B FOR ONE HUN[ D DNLARS(HOD)ORLESSL
1 CERTIFY THAT N THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT K ISSUED, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER 50 AS TO BECOME SUBJECT TO THE
WORKERT COMPENSATION LAWS OF CALIFORNIA- AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE WITH FORTHWITH COMPLY THOSE PROVISIONS,
DATE: 00 APPLICANT _
WARNING. FAILURE To SECURE WORKERS COMPENSATON COVERAGER
1 IS UNLAWA, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CML FINES UP TO ONE HUNDRED THOUSAND
DOUARS (3100.000), N ADDITION TO THE COSTOF WMPINIATON. DAMAGES AS PROVIDED FOR IN
N 3T
I SEcno 00OFTHELABOR .,.TC,., AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
i
I OR THE
ERFO UNDER PENALTY OF PERJURY THAT THERE B A DONSTRUCTION(SEC. LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3av7, CN. C.),
I
LENDER'S NAME
LENDERS ADDRESS
I I CERTIFY THAT I HAVE READ TIS APPLICATION AND STATE THAT THE ABOVE I TORMATOON IS CORRECT.
1 AGREE TO COMPLY LWTH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES CF THIS COUNTY TO ENTER UPON THE
ADOVE4AENTIONED PROPERTY FOR INSPECTION PURPOSES.
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SIGNATURE FPERMITTEE GATE
PRESS
FIRMLY
APPLICATION%�f PERMIT P!C
,6
DATE / '� v NUMBER� Jp
ISSUE /A / TYPE OCC
DATE v v CONST GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE Y I tiSTAN� L ld�
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'
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION
SFR/ADDIREM
GaragalCarport
W
PatbiDeck
LL
POOVSpa
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Commercial '
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Valuation �7l �- %% ADJ.AREA
QUANTITY DESCRIPTION FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING 'g
MECHANICAL 1 ��
INSPECTION FEE
ISSUANCE MAY 12-n nn
SMIP
CITY OF DIAMOND
ENERGY Pr_
BUILDING AND SAF I'Y
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES U . a
COMMENTS
RECPT, NO. PAID BY VALIDATION
WHITE—Department Copy, YELLOW—Fids— Copy, PINK—Assessor Copy, GOLDENHVU—•r-Re L:Qpy, GHEL:N—APpKxnr3 copy