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Home My WebLink About14992 (29)UI,1)1111U Ii,IR CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY& DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (9D9) 851-3117 TION ' BUILDING PERMIT APPLICA ranm�r IIUO AvaiD AAE BLU' -DATE NUMBER M DDRESS DATE CONST. GROUP ZONING SETBACKS FRONT �, - "1 RW p APN __LOT TRAC C SIDEISIDE STREET RW ❑ OWNER A S PROPOSED USE ADDRESS UNITS STORIES BEDROOMS CITY ZI TE913 DESCRIPTION SO -'FT FACTOR PSF ` - ADJ. AREA/VALUATION APPLI ANT ki E TE SFR/ADD/REM CONTRACTOR III Garage/Carport ADDRESS 7!q le Palio/Dock CITY Ve0k)11Z0 ZIP TEL Li ARCWENG/ �IEjIT DESIGNER • Commercial ADDRESS - t? — CITY ZIP m TEQ_W Z� a3 n = OWNER -BUILDER DECLARATION QUAA.NTITY DIfSCRIPTION F 1 HEREBY AFFRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LI- HCENSE CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITYOR n ZO � F COUMY WHICH REOUIIESAPERMTTO CONSTRUCT, ALTER MPROYE, DEMOUSK OR REPWRANY STRUC• \ �r 91M TORE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U• S CENSE LAW (GUIPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PR0- FESSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BYANYAPPLICANT FOR A PERMIT SUBJECTS THEAPPLICANT TO .KF7. A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SWI E CLAS OWNER OF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILLDO THE WORK, AND THE STRUCTURE IS NOT MENDED OR OFFERED FOR SALE (SEC. 7044. SUSI. _ i NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREOH.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR ac THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE: NOT INTENDED OR _ OFFERED FOR SNE IF, HOWEVER THE BUILDING ORIMPROVEMENT IS SOLD WRTNN ONE YEAR OF COMPILE - TION. THE OWNER.BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF MEL ,LJ = C L AS OWNER OF THE PROP ERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 704A. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U- 11 CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND = WHO CONTRACTS FORSUCH PFIOJECTS WTTHA CONNTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- ELECTRIC - T .. LICENSE LAW.). PLUMBING C IATA EXEMPT UNDER SEC. B. s P.C. FOR THIS REASON MECHANICAL N Y R - DATE OWNER INSPECTION FEE ISSUANCE 6 V n ' 7, 2D09 LICENSED CONTRACTORS DECLARATION ,I L SNIP CITY 1))ANIONDBA IHERESYAFFRM UNDER PENALTY OF PERJURYTIAT IAM LICENSED UNDER PROVISIONS OF CHAPTER . ENERGY P/C lel' 8 COONAF.NOIO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND ENERGY PERMIT UJILDING AN MY LICENSE IS N FULL FORCEMO EFFECT. JyJ[ �[1�Q PR L10EN5 S LIC. NO. AF U LALTE - CONTRACTOTi w ._.. WORKERS' COMPENSATION DECLARATION ,�..: •_" ": _ Cn y I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: RECPT. NO. PAID BY VALIDATION A CERTIFICATE OF CONS ENT TO SELF -INSURE FOR WORKENS rz G _IHAVEANDWALLMMNTAN COMPENSATION, AS PROVIDED BY SECTION 3700 0 F THE LABOR COO E. FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PERMIT 11 ISSUED. - `.. HAVE AND WILL MASNPAN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION - Q 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WOW( FOR WHICH THIS PERMIT IS ISSUED. MY�WOO7R•KKEESR_T CCOORjP�.lH(R�ANTIOIN'�IN.SURANCE CARRIER AND POLICY NUMBER ARE: ' . '- CARRIER JF�1TL'�� • ✓[�' POUCYMIMSER E `� (TITSW=MNEMN0TBEpOL IUMOFTHEPEMr ISFORONEIA3t(YDOOIJAns R+oo)OILESSj LU I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I 0 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE U`3 WORKERS' COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PRO FSECTION 37000E THE LABOR ISHAL/L/j�GORT!ry HCOMPLr WITH S. OCQpE C Q DATE: . i�_�J+APPLIG SHALL BE COVERAGE ZONE YINAL PEYCOEPE SUSXCTWAMINGANEURETOSEWRE HUNFUL DRED THOUSAND PENALTIES SA AND CMLFNES.UP TODAM ONE MNDPEDTHOUSAND (3100. 000), N AOOITON TO THE COST Of COMPENSATION. DAMAGES AS PROVIDED FOR K DOLLARSLJECTANEMPLOYERTOTIONTO 6 SECTION37os OF THE LABOR CODE INTEREST, ANDATTORNEY'S FEES. aW- CONSTRUCTION LENDING AGENCY d1 NEPESYAFFRM UNDER PENALTY OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMITIS ISSUED (SEG 3007. CIV G). LENDERS NAME Ir LENDERS ADDRESS W I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. d (AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING '^ S� CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FOR INSPECTIONP}1RPOSES. �YU m (Fj EOF PF EE DATE (T PRESS WHITE—DWSrtmenl Copy, YELLOW—Finance COpy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN-,"icant's Copy ✓ %.10 ranm�r APPLICATION'10,PERMIT �P/C—/� 00 -DATE NUMBER M ISSUE TYPE OCC .. DATE CONST. GROUP ZONING SETBACKS FRONT �, - "1 RW p REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. ` UNITS STORIES BEDROOMS DESCRIPTION SO -'FT FACTOR PSF ` - ADJ. AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Palio/Dock L- PDOI/Spa ZRe-Roof4 0 Commercial — 133 Valuation ADJ.AREA QUAA.NTITY DIfSCRIPTION F U OC n ZO � F F - w \ �r 91M W 0 Z U _ i z _ S, w 2 ti CONSTRUCTION PLAN REVIEW ELECTRIC - PLUMBING MECHANICAL N Y R - INSPECTION FEE ISSUANCE 6 V n ' 7, 2D09 ,I L SNIP CITY 1))ANIONDBA ENERGY P/C lel' ENERGY PERMIT UJILDING AN RETENTION FEE: Q' PR TOTAL FEES �� • , S /„ cc Q 44 A1� anni RECPT. NO. PAID BY VALIDATION WHITE—DWSrtmenl Copy, YELLOW—Finance COpy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN-,"icant's Copy ✓ %.10