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CITY OF DIAMOND BAR
--��'—-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES i�'� �
,,,.�� 21660 E.Copley Drive Suite 190 pRESS
(909)860-3195 Fax(909)861-3117
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES�/�'�
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMTI'APPLICATION
PRESS
FIRMLY
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ADDRESS
APN LOT� ��TRACT�?U� '7
OWNER� � 12K� '�•�
ADDRESS tN�T P.='//
CITY�' 1 � �IPt�tl.�c�TEL.
APPLICANT�TEL. -•-
CONTRACTOR_
ADDRESS
CITY ZIP TEL.
ARCWENG/�r'�� ��a�r� �n
DESIGNER !S�rd ��"�S
ADDRESS��" � � •v' '
CITY��ZIP TEL. '� �'L
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UIVDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE IAW FOR THE FOLLOWING REASON (SEC. 70.31.5 BUSINESS AND PROFESSONS CODE:ANY CITY OR
COUNTY WHICH REOUME'�5 A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRK)R TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
CENSE LAW(CHAPTER 9 iCOMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSK)NSCODE)OR TH/lf HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TKIN.ANY VKXATION OFSECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
^t,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 70u, BUSI-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN DWNER OF
PROPERTY WHO BULDS OR IMPROVES THEREON,AND WHO GOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH MIS OR HER OlYN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF,HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WFTHIN ONE V EAR OF COMPLE�
TKNI,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURWJSE OF SALE).
^ 1,AS OWNER OF 1'HE PROPEFTV,AM EXCLUSIVELY CONTRACTING WFTF{ LI::ENSED CONTRACTORS
TO CONSTRUCTTHE PRWECT(SEC. 70u,BUSINESS AND PROFESSIONS CO1 E:THE CONTRACTORS LI-
CENSE LAW DOES NOT AI'PLV TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT 70 THE CONTRAC-
TORS LICENSE LAW.).
^ I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THiS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDEP PENALTY OF PERJURY THAT LAM LICENSED UNDER PROVISIONS OF CHAPTER
0 (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COLE,AND
MV LICENSE IS IN FULL FORCE AND EFFECT.
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DATE OG�O1 0 1 CONTRACTOR_Fy1�J11J!A-L.'+1,L;G [_
1NORY.ERS'CUMPENSA.TION DECLARATION
I HEREBY AFFIRM UNDEF: PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS.
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS'
CUMPENSATKJN.AS PROVIDED BV SECTION 3h0 OF 7'HE LABOR CODE,FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION
37000E THE LABOR CODs, FOR THE PERFORMANCE OF THE WORK FOR WHICh{THIS PERMIT IS
R AND POLICY NUF,iBER ARE:
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ISSUED. MV WORKERS'COMPENSATION INSU
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POLK:Y NUMBEF_��L\LZ547-------
� (!H5 SECf10N NEED NOT BE NMR.ETED OFTHE PERAtt 6 F(%1 CXJE HUN)FiED [XM.lAFi5(5100)OR LESS).
I I CERTIFY THAT�N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, 1
{ SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
j WORKERS'COMPENSATION LAWS OF CALIFORNIO.AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
{ CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
1
DATE: APPLICANT
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1
F
WARNING: FAILURE TO,.ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
1
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND
DOLLARS(5700,000),IN NDDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE L4BOR CODE,INTEREST,AND ATTORNEY'S FEES.
� CONSTRUCTlON LENDING AGENCY
i
_ 1 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. 3087,CIV C.).
LENDER'S NAME
LENDER'S ADDRESS
� I CERTIFY THAT I HAVE F1EAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATK)N 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
3
ABOVE-MENTIONED PROPERTY F R INSPECTK)N PURPOSES.
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CERTIFICATE OF OCCUPANCY
Community Development Department-Building Division
This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
Certifying that at the time of issuance this structure was in compliance with the various ordinances
of the city regulating building construction or use. For the following:
Use Classification Residential Building Permit No. 15923
Group R Type Construction V-N Use Zone R-1
Owner of Building Mr.&Mrs. Mark Kuo Address: 2515 Crowfoot Ln.
Diamond Bar,Ca 91765
ju-Ad 2515 Crowfoot Ln. Locality Diamond Bar
Date Issued December 6,
D nnis A.
Tarang
Building Official
11
CBO
2002