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Home My WebLink About12582 (13)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 ^" BUILDING PERMIT APPLICATION JOBSITE hq ADDRESS jj-k� .S' APN LOT TRACT OWNER SCk Kt +i I<n t�Jl 14r — ADDRESS 11+ .S,_ DfA(Y_ .[iN @ A— ( CITY -t2ftjgImp _ ZIP CJ' �- TEL.*497.x� �r%�R' APPLICANT g.-- K � car TEL. CONTRACTOR Ltti P3 11k194 ' c- o ADDRESS CITY L_k ['& ZIP 11V TEL.(2tat ARCWENG/ DESIGNER ADDRESS CITY . ZIP TEL, OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COLINTYVMICH REQUIRES A PERMIT 10 CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE, PRIOR 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 a (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR 1 HE ALLEGED EXEMP- TION, ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVILPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($6w).): C1 I. AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI NESS AND PROFESSIONS CODE. 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 OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE.IF, HOWEVEfl, THE BUILDINGOR IMPROVEMENTIS SOLO WITHINONE YEAROFCOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUII D OR IMPROVE FOR THE PURPOSE OF SALE), TT I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONI PACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OE A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND VMOCONTRACTS FOR SUCH PROJECTS WITH,, A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) ❑ IAM EXEMPT UNDER SEC. 0.8 PC, FOR THIS REASON DATE __,__ _ OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTK)N 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. ` LICENSE CLASS If _a 'i LIC. NO. DATE 4 �L=_i_ - CONTRACTOR 4 f AA WORKERS' COMPENSATION DECLARATION �•! Jew'( 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONF.OFTHE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BYSECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. __.I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE., FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI-I IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE' CARRIER POLICY NUMBER (THISSECTION NEQJNOT BE CONI LETEDOF THE PERMIT IS FOR ONEHUNDRED DOU.ARS (SIO0) OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJL CT 10 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: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALT. BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF19 ($I0O,DO0), IN ADDITION TO THF. COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3D97, CIV. C.). LENDER'S NAME _.._—__._—_.._.._.._._.___ LENOER'SADDRESS_— I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COL N rY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE AME (PRINT) •� j� SIGNATURE OF PERMITT E -• ' OA7E r � PRESS FIRMLY DATEICATION a �q �� C2 NUMBERPERMIT v #1 C ff I LJ ISSUE TYPE OCC DATE. 02_ CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW `— I SIDE PROPOSED USE —I 1 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM W Garage/Carport LU Patio/Deck LL Poo!/Spa 0 Z Re -Roof Commercial m Valuatlon __. ADJ.AREA QUANTITY DESCRIPTION FEE J 4 U^ 2 - E- U W - W z0 Z S DO 3 r rrr�fi DL"1O a S t� >✓F dqo Q _U Z 6 2 U W CONSTRUCTION _- PLAN REVIEW ELECTRIC _ _____ %_s U il --__ - I_,� �Q BIN �Ai'� MECHANICAL INSPE ION FEE ISSUA C _.._._ Q�-—..__ MIP O�I7L'� DIAMOND ENERGY P/C �3 _-- gC�1IITirr ENERGY PERMWUILDI G ANTI R h,r'F.TS�_ RETENTION FEE: PRE -ALT FEE: _ TOTAL FEES COMMENTS (lv// RECPT NO. PAID BY �''�� VALIDATION T 11 WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy