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Home My WebLink About18301 (11) Y CITY OF I7IAMOND BAR �!'� �� -�'� 7 DEPARTMENT OF CONQviUNTi�Y&DEVELOPMt:NT SERVICES � �,w�� 21825 E.Capiey Ihive (909)860-3195 Fax(949)861-3117 PRESS ' °'-:v��' BUILDING PERMIT APPLICATIUN F1RMl.Y � JOBSITE APPLICATION �.�' 1�_U� PERMIT n P/C � � AD4RES5_ ZS�� C�tS't�I RIC�t'�� !'. dATE �+ �NUMBER�� # ��y " � � APN t�OT 2O TRACT_�7�� SSUE TYPE OCC DATE CC}RlST. GROUP 0 owN�R Diarnand Bar West L—L��----� ADDRESS 34$�1 orrance e-3�0— zor,�NG se-rancKs � ciTv Torrance ziP 90503r��.��?1�3�39 R�aRr Aw ' ❑ — � APPUCAN--T ��C dCC� GUUIC�� TEL. SIC}EISIgE STREET_ RW � O Q GONTRACTQR ��C CCTtI5CCUCtS011--�Q« _ SIDE ❑ � ADpRESS �m� aS owner a GITY Z1P TEL. P��PK7SED USE w ARGHIENG! �� ESIGNER R.. GQUICI F. ASSOC, Np.DWEL. Np. NO. V � ADORESS�R14 �S OW112Y' UNiTS Sl'S3RIES BEDR�MS � GITY ZIP TEL.-- � DESCR4PTION t}.�T. FACTOR PSF A J.AREANALUATI4N cr� � (JWNER-BUIIDER DEGLARATI6N gFF{/ADt7JREM � 1� C? . � i HERE6Y AFFIHM 41NDER PENALTY OF PERJURY tHAT 1 AA1 E%EMPT FRpM TFIE CON7FACTbflS ll� � GaragelCarport Y ; W CENSEUWFORTNEFOILOWiNGREASONtSEG.�oat.58U5iNE5SANDPftOFESStdNSCQ6E:ANYCI7YOR � COUNTYWHICHREOUIRE9NPERMITTOCONSTRUGT,ALTEH.IMPROVE,QEMOUSH,ORREPA�flANYSTRl1C. W j � TURE,PR16R TO RS iSSUANCE.ALSO RE�lii(iES THE APVl1CANT FOR SUGN PERMIT 70 FILE A SIGNED W Pe�lb/DBCk � ♦ � 9TATEMENT THAT HE OR$iE IS l7CEN5E�PURSUANT TO THE VROVISIONS OF iHE CQNTRAC70RS U- � CENSE LAW(CHAPTER 9(ODMMENCING WITH SECTION 70q0)OF piVISION 3 OF THE BUSINESS AND PRO� u' PooUSpa p FESSiONSCODE)ORTHATNEOqSNEiSEXEM�TTHEREFflOMAt�THE9ASi5WRiHEALIEGEDEXEMP� {� U TION.ANYVIOLA7K1NOF9ECTION�o31,5B�ANVAPPLICANTFORAPERMITSU6IECTSTHEAPPL�GANTTO Z Re-Roof � AqY1lPENpLTYOFNOTMOpETHANfN[HUNDREDDOLLP.RS(SSW).)' � pI,ASpWNEROFTHEPR04'EftTY,ORMYEMPIOYEES`hM1TNWAGESASTNEiRSCxECpMPEN5A7i6N. � COtt11i12tCtHI 2 WILLpO THE WORK,AND i'HE STRUCTURE IS NOT INTENCIED OR OFFEFED FOR SALE(SFC.�044,BUSI� J � NESS AND PftOFESS�ONS S:ODE'.THE CONTRAGTORS L7GENSE I.AW DqES NQT APPI.Y TO AN OWNER OF = /y �p �'` (r THROUGFIHISORNEHOW'JEMPLOVEESHPRC7VIDEGTHATOSDGHMP OVEMENiSAFIENOT�INTENDEDOq m ^ m�� l� �y � 4FFER£OfQRStd.E.�F,HOtMEVEA.THEBUiIDWGORiMPROVEMENTi5SC7lOWiTMINONEYfAROFCOMPIG� �� G� v_ � V �� T10N,THE OWNER�BUILpEfi WII.L HAVF.iHE OURDEN OF RROVING TNA7 HE OR SHE OiD NOT BUiID OR = IMPROVE FOR TH[PVRPOGE OF SALE�. _ W t:)i.A50WNEliOFTHEPftOts`cRTY,AMEXCIUSiVELYCONTRAGTINGWITNLICEN5EDCC5NTflACTOftS [[ TO CqN51RUGT TME PRO.�ECT(SEC.7ode,BlJ51N�55 ANO PROfE5510N5 COOE:THE CONTRACTORS li� ValU8ti011 t ADJ�AREA _ 1.11 C£NSEIAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWNOeUILD50RIMPROVE57HERE6N,AND � WH6CONTRACTSF6ti5UCHPAOJECTSWiTHACONTRACTOR(S}LiCENSEDPURSURNTT�THECANTRAC� QUANTITY DESCR1PT14N FEE � TORS UCENSE LAW�. — � J Q ❑I AM EXEMPT 11N0EA SEC. _ �_, H.&P.C.FORTHIS REASON U . '�'S '__ .... —.' � �'�' DATE _,.. OWNER�.,,�, _. U Z w p LICENSED CONTRACTOFiS DFCLARATIq��V w d � IHEREBYAFFIRMUNDERPENALTYOGPERJUFYTNATiAMtiCENSEDUNDEftPftOVISIONS{iFCY.APTEfl ue (i 9(CQMMENCING WITH SECTION 7000)OF DIVISION 30FTNE BU31NES5 AND PAOFESSIONS CODE,ANCI Z w kY 110ENS£15 IN FUIL FCtflCE AND EFFECT � u�ENSE o�ss_.. B ��.Nn 6 719 82 � U DA7E _.i,,._ CONTRACTOA��U �' _ w t�i WORKEFS'COMPENSATION DECLAfiATION a = U � I HEREB�AFFIRM VN�ER PENALTY OF PERJURV ONE OF THE FOILOWiNG 6EClARATK�NS: N Z 4 d IFi.M1YEANDWiLIMAMTAINACERTiF�CATE6FCONSENTT45ELF�IN5UREFOflWORKERS' _ Q �CQMPENSATION,p5 PROVICIED BV SECTIAN a]oo OF THE IABOF CpCE,FOR THE PERFqRMANCE U OF THE WORK FQR WHICH THIS PERMIT IS i55UED. w 0 � w IHAVEANDWII.LMAIN7AINWQRKERS'CUMPENSATIONINSURANCE,ASNEI]UIP�EDBYSECTION /{ /� Q 3�6a OF THE IABOR CODE,FOR TNE PEFFORAlANCE OF THE WORH FOft WNiCH TH75 PERMtT i$ _��y�_ 4 �/� 0 ISSUED.MV WOFIKERS'COMPENSA71ON INSURANCE CARRIER AND POLICYNUM6EIiAFE: CONSTFUCTION .. .. ._.. �.�� j CARR�ER S—ta��t�e�C�no�I�m ensation tnsur Fund P,.Ar�aEV,Ew �'��,` ' ' Z aoucvNUMSEFi_.. 1 O V�+�� ----...._._ E�EC7RIC _� V,�� .—�. ¢ � {7}11SSEC'f10NNFEDNOTBEWM0.E('EDOr7NEPERM(iISFORONEHI.PAHEDDOLLViS(5100)ORLESS). PLUMBING __ �� W I CERTIFYTHAT IN THE PERF9RMANCE OI"THE WORK FOft WHICHTHIS PFRMIT IS ISSUE�.1 MECHAT*IICAL � •J Z .. ..._ _._�_ {} SNAIiNQT EtaPLOY ANY PEfl50N IN ANY MANNGfl SOAS TO BFCOME SUBJECT TO THE � �j WORKEflS'CONPEN5A710N1AW50FGAUFOflNiA,FN6AC#iE£THRTIFISHOiJLDBECQME INSPECTI4NFEE .__ SUBJECTTO TNE WORKERS'COMPENSATION PROVISIONS OF SECTON 37oc OF THE U.00R F= ISSUANCE �C7� � CGDE,i SHALL t�QftTMWiTit C4MPLY WITH TH45E PftQYi510N5. —�-- —��— � SMIP �� p OATE: � APF'UCANT: `_.. .. .—.."—. W ENEFtGY PJC �. J WARNING'FAILURET03ECURE WUflKERS'GOMPENSAT'ION C4VERAGE IS UNLAWFUL,AND SHALI.BE LL SVBJECTANEMpLOYE(iTOCR{MtNALPE4ALTfESANDS:tYilf{NESUPTOONEHUNOREDTHOUSAND �NERGYPERMIT _ . D04LAR5({t oa,obo),IN A�D1710N TO THE COST OF COMYErvSAT�ON,�AMAGES AS PROViDED FOR iN � - � SECTION��o80KTHElABORCO�F,INTEREST,ANDA7TORNEYSFEES. HETENTIONFEE: �' � �—' d CONSTRUCTION LENDING AGENCY pRE-ALT FEE: . .._..... —. Q � IHEREBVAF=1qMUNpfRPENpLTYQFPERJURYiHAT7HEREiSACO45TRUCTIONIENDWGAGENCY _ d FORTHE PERFORMANCE OFTHE WOR�FqRN'HICH 1HI5 PERMIT IS ISSUEb(SEC.3o9],CN.C.). Z � ...,.. _ .� W � LENDER'SNAME _, .� � _ F= LFNDER'SADDflE55_ ,,,_ .. . _ ... " wICERTIFVTHATIHAVEREADTHiSAPPLICATIONANDSTATETHATTHEAe04'EMFORAiAiiONiSCORRECT TOTA�FEES � �`"�fa(t �� 1 AGFEE TO COMPI V NII1H ALL GTY AND COUNTY OHOINANGES AND STATE LAwS REIATING TO BVILpING COFiSTRUCTtON.AND HEREBY AUT}{4RiZG ftE�ftESEMATiVES OF THIS COVNTY TQ ENTER UPON THE � ��.� ' �j� — A60VE-MENTqNED P'�aOPERTY FOR INSPECTION PURPOSES. �� z COMMENTS t�' � l f F-{f-5- ��;+...! �a� — — � � — � _ � F�RMt ENA RPINT} -. � ... ... _. a ' _" _ C/} . , ^ '�''� --... � SIG 7 O ERMiT�EE � ATE S PECPT.NO, _PAiD BY VALlDATION � WHiTE-4e artment Ca YEL�9L'V—Finsnce Go PINK—Assessot Ca GOtDEh'R40—Fife Co GREEN— IlcanYs Co P p}r. py. PY, PY� APA PY � C"s m�&,�f� o � . , ,. . . . . � �� 4�re �� .,��'� �� m iF � .. . . . . . .. . . . . , . .. ... .. � ��E'��2� �i"...� . � d� � ��l _ a-�� : o�° � �'�'` _ _ -- �,� _ � �5�� ,:/ �� : �y��7,� � g� � � ��%�3 _ �� ?� �(Z�� ^ , ,, a . c�=-f�� s�. q, �- � ti , ' � _ �� t� c��, ��_ � 7 Z Z-�.� ,D- r:�z� .�e��o�rl �"�i— �Nr/"�,�� /c��ir�s �r�o.�J �c� �o�6� ��q' F�� ,r � �' �a/�r'��. �v�,�� /�5.-- �'-,�. ,�{ , . �� _ a . :. e� F _ � _ � � � � : _ _ � � � �� -.� �� : �� _ � �� m, � . _ _ _ _ s e � � d �� r��.u�� , o _ � �x�� : rr -; _ � � ,a .,. � .�� _ � ., � I .. ruw,'t w JOBSITE ZH8�9 C�StaI Ridge Dr. ADDRESS APN LOT 2�TRACT X7850 OWNER Diarnond Bar West L ADDRESS 3480 orrance e cITY Torrance ziP 90503TEL. APPLICANT�IC I�d GOUIa TEL. 1CC Construction 0. CONTRACTOR ADDRESS SafTle aS owner CITY ZIP TEL. ARCH/ENG/ DESIGNER R.. CiOUId?;ASSOC. ADDRESS�IIle aS owner CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLO W LNG REASON (SEC. 7031.5 BUSINESS AND PROFESSKNS CODE:ANY CITY OR COUNTY WHICH REQUIRES N PERMIT TO CONSTRUCT,ALTER. IMPROVE, DEMOLISH,OR REPAIR ANV STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR BHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(GDMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATK)N OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^I,AS OWNER OF THE: PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND 1'HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESSAND PROFESSIONS(:ODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWIJ EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TK)N,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROS ECT(SEC. 7064, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSELAW DOES NOT APPLY TO AN OWNEq OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SU(.'H PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW). C]I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDEq PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND EFFECT MV LICENSE IS IN FULL FORCE AND �� 67 LICENSE CLASS v LIC. N0. Ons rU 1 DATE CONTRACTOR_. WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATI(XJ INSURANCE CARRIER AND POLICY NUMBER ARE: Com ensation Insur Fund sate CARRIER C 6U POLICY NUMBEFI (THIS SECTION NEED NOT BE OOMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(ft00)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,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. DATE:APPLICANT: i I I I WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN I SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. I CONSTRUCTION LENDING AGENCY i I 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. 3097,CIV.C.). I LENDER'S NAME LENDER'S ADDRESS I I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY NIITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING f CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 3 P�RMI ENA PRINT) E' _/'d0 �SIG T 0 ERMITTEE ATE CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION �i� PRESS FIRMLY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy tp CA-S 1_LhaC.. 1 77---4 M