The URL can be used to link to this page

Home My WebLink About15063 (20)C) O n J W J CL cc a_ S LU Li d. Z in in Cn X 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 JOBS AD RIESS/ /J '"f p/HA1 C1A_) O 184/t &D #E APN LOT TRACT OWNER ADDRESSIf� CITY J) AL,QZIP _ TEL. APPLICANT TEL. CONTRACTOR L /IMAK ADDRESS T 1 CITY C_ b Gl /� ZIP 9%77? TEI n ARCH/ENG/ DESIGNER MO0c56 ADDRESS g^—'Y' ZIP TEL. OWNER -BUILDER DECLARATION i HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR OOUNIY WHICH REQUTAESAPERMITTO 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 PROWSIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER B SHE 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 THE ALLEGED EXEMP. TON. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THF. APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): [31, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL (JO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044• BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE. LAW DOES NO'T APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUC14 WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IR HOWEVERTHE BUILDINGOR IMPROVEMENTIS SOLD W ITHIN ONE YEAROF COMPLE- TiON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OP A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE OONTRAC- TORS LICENSE LAW). ❑ 1 AM EXEMPT UNDER SEC. B. & PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 0(COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULLFORCEAND EFFECT. `Z LICENSE �CLASS , 1_� -- ® LIC. NO. 5/ DATE JJ[��_ CONFRACTOR M d W. - , I ' WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND W ILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PEPrORMANCE 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 PERMIT IS ISSUED. MY WORKERSCOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIE POLICY NUMBER (THIS SECTION N®NOT BE OOMPLERDOFTHE PERMIT IS FOR ONE HUNDRED DOLLARS (5100)OR LESSi I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALLNOT EMPLOYANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECT TO T HE WORKERS' COMPENSATION LAWS OF CALIFORNIA, U AGREE THAT IF I SHOULD dCCO SUBJECT TO THE WORKERS'COMPENSATION PRO SIGNS OF SECTION 3700 OF T AR CODE, I�S�HALL�FORTHWITH COMPLY WITH RQVI f DATE: _ L2 _ v � APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGEISUNLA ULAN ALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HU L RED H USAND DOLLARS (6100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES ASP AIDED FOR IN SECTION 9708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PLRJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE THF WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV, C). LENDERS LENDER'SADDRESS 1 CERTIFYTHAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESFNTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTKONED PROPERTY FOR INSPECTION PURPOSES. PER TTEE E(PRI ATE PRESS FIRMLY APPLICATIONt.— '� PERMIT�(� k"`" DATENUMB RI ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW 71 REAR Ll SIDE/SIDE STREET RW I.1 SIDE ❑ _� ff'' PROPOSED USE VaJ V� NO. DWEL. NO, NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport WPatio/Deck LL Pool/Spa ZRe -Root p Commercial in Valuation A.DJ.AREA __„_. QUANTITY DESCRIPTION FEE J Q U H U w J W Z_ Do d� / U CL/ c(00�Ca�J� i 11 W CONSTRUCTION �s PLAN REVIEW ELECTRIC --- PLUMBING --' ' _ MECHANICAL in INSPECTION FEE____'c^_�_ tj ISSUANCE SMIF -- ENERGY P/C --ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: _ �T TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION -.- WHITE—Departme opy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy