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Home My WebLink About12280 (17)1 CITY OF DIAMOND BAR ........... DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES < 60 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUHDING P.ERMrr APPILI.CATION FIRMLY JOBSITE ADDRESS APN — 0 TRACT OWNER I -L .. 11 ADDRESS Z�i t3n g-, CITY ZIP n TEL. APPLICANT TEL. CONTRACTOR ADDRESS - 14& (W- K & 47,-/ CITY 6se(ttrvKe.. ZIP TEL. ARCFVENG/ DESIGNER ADDRESS CITY ZIP — TEL. OWNER -BUILDER DECLARATION IMEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CON7RACT0RS U- cr :NSE LAW FORTHEFOULOW ING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE:ANY CITYOR INC COUMTYWHICH RrOUIRES A PERVITTOGONSTnUCT.ALTEn, IMPROVE. DEMOLISH. OR REPAIRANYSTRUC. TUBE, 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 9 (COMMENCING WITH SECTION 7(XXr) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSKINS OWE) ORTHAI HE OR SHE IS EXEMP77HEREPROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF 'SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORETHAN FIVE HUNDRED DOLLARS 0 LAS OWNEROFTHE PROPERTYOR MY EMPLOYEES WITH WAGESAS THEIRSOI E COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, SUSI. NErS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BULDS OR IN PROVES THEREON. AND WHO DOES SUCH WORK HI MSELF OR HERSELF OR THROUGH" OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED ROR SALE. IF, HOWEVER. THE BUILDING OR IMPROVEMENT 19 SOLD WITHIN ONE YEAR OF 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). 0 1. AS OWNER OF THE PROPEFTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS To CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS Ll - CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACCINTRACTOR(S) LICENSED PURSUANT 70 THE CONTRAC- TORS LICENSE LAW.). 0 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE __ OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAL7Y OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF D rVISION a OF THE BUSINESS AND PROF ESS IONS CODE, AND MY LICENSE 15 IN FULL FORCE AND EFFECT LICENSE CLA-0 Lt.. NO. Z71 DATE, CONTRACTOR WORKERS'CCIVIPENSATION DECLARATION I HEREDYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: —1 HAVE AND WILLMAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSACION, AS PROVIDED BY SECTION 37oo oPTHE LABOR cooG, FOR THE PERFORMANCE ZITHE WORK FORWHICH THIS PERMIT IS ISSUED. I AVG WILL MAINTAIN WORKERWOOMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSU ED. MY WORK ERS' OOMPENS70N INSURANCE CARRIER AND I NUMBER ARE: N I CARRIER — I N POLICY NUMBER (THISSECTION NEEDNCT BE COMPLErEDOFTHE PERMIT IS FORCING HUNDRED DOLLARS (SICO)OR UESS� I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANN ER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGRE E T HAT IF I SHOULD BECOME SUBJECT TO TH E WORKEPIS'OOMP ENSATION PROVISIONS OF SECTION 3700 OF TH E LABOR OCIDE. I SHALL FORTHWITH COMPLY WITH THOSE PROVI I Ns. OSE PROVISI PPLICANT WARNING: FAILURE TO SECURE WORKERS'COMPENISATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYERTO CRIMINAL PENALI[IFS AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOILLAFIS (SIM.000). IN ADDITION TO THE COSTOF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IZ A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PEPA41T IS ISSUED (SEC. 3097, CIV. C.) LENDERS NAME LENDEFFS.'WDRrSS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHS ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALLCITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBYAUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. -r /L/rq C-4 PERMFITErN 6 RINT) SIQN0kTUREOF FFERATMI Z� DATE APPLICATIC PERMIT P/C DATE ITZ, � 6 NUMBER # ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT Rw L REAR SIDE/SIDE STREET RW LI SIDE El PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSIF ADJ. AREAIVALUATION SFRIADDYFIEM C/) GaragWCarport LLI Patio/Deck U- Pool/Spa — 0 Z Re -Root 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE LU _J LU 0 z CL LLI CONSTRUCTION PLAN REVIEW ELECTRIC PLUMSING'� 4p INSPECTION FEE ISSUANCE SMIP, ENERGY P/C ENERGY PERMIT RETENTION FEE: PRIE-ALT FEE: TOTAL FEES COMMENTS RECIPT NO. PAID BY . VAUDATION vc WKITE—Deparlment Copy. YELLOW—Finanre Copy, PINK—Assessor Copy. GOLDENROD --Pile Copy, GRE plicant' C " A � ��l 1 OF D34 Ilk MON Do B A R INSPIECTION, RE.CORD .............. . .. -------- --- ----- ------- -- -------- - - I r�z . ........ . . . ............. .. ............. ----------- - ..... ..... smam .. .. ......... ........ . . ........ . ... . . .......... . . ........... ..... ..... . ......