The URL can be used to link to this page

Home My WebLink About14897CITY OF DIAMOND BAR - DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Strife 190 (909)860-3195 Pax(909)861-3117 BUILDING PERMIT APPLICATION JOBSADDRESS*W 5 Q16ffer/10 61440k J6410t Sd!/�' G APN LOT _ TRACT' OWNER JW441L iN SEr e,,,v ADDRESS G 50 TTY - 0" ZIP jr4r, Zr' TEL 710 -;W 731=° APPLICANT jSyGi-5- / h4ZA.-F=hJ T fLf Sa% !6 i' 7 CONTRACTOR ADDRESS AAO A CITY L ZIP VQ& TEL - ARCFVENGJ DESIGNER %'/ C -&2- t, A D D R E S 3 .> " CITY 1 i ZIP TE fi 55'/ S%? 7 OWNER -BUILDER DECLARATION I HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U• CENSE LAW FOR THE FOLLOWING REASON (SEG 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITYOR COUNTY W HIGH REOUIRES APERMRTO CONSTRUCT,ALTER BIIPROVE. DEMOUSH, OR REPAIR ANY STRVG TURF PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPUCAHT FOR SUCH PERMIT TO FILE A SIGNED 6TATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LN CENSE LAW (CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS OOOE)ORTHATHEORSHE ISEXEMPT THEREFROM ANDTHEMIS FOR THE ALLEGED EXEMP- TON.ANY VIOLATION OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (ISM).1' - t. O L AS OWNER OFT/IE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WOW, AND THE STRUCTURE IS NOT MENDED OR OFFERED FOR SALE (SEG 70". BUS4 NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF PROPERTY WAO BUILDS OR IMPROVESTHERECH AN WIND DOES SUCH WORK HIMSELFOR HERSELF OR THIROUDH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F. HOWEVER THE BUILDING OR IMPROVEMENT 6 SOLD WITHIN ONE YEAR OFOOMPLE- TON, THE OWNER-NJLDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} I', O L AS OVMER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND W40 CONTRACTS FOR SUCH PROJECTS NTH AOWMACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). !I 01 AM EXEMPT UNDER SEG B. a PC, FOR THIS REASON DATE OWNER I . LICENSED CONTRACTORS DECLARATION I HEREBYAFFNM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER I (OOMMENCNG WITH SECTION TOM) OF DIVISION a OF THE BUSINESS AND PROFESSIONS CODE, AND W LICENSE IS N FULL FORCEANOEFFECT. LICENSE CLASS ~ / LIC. NO. Y p � 7 /O DATE 3 '� ��Z CONTRADTOR C S WORKERS' COMPENSATION DEC TION 31 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE NODE TONS I HAVE AND WILLMAINTAN A CERTIFICATE OF CONSENT TO SELF•IN REFORWORKERS' COMPENSATION, AS PROVIDED BY SECTION SM OF THE LABOR COOS FOR THE PERFORMANCE ��R OF THE WORK FOR WHICH THIS PERMIT LS ISSUED. 1 HAVE ANO WILL LIAIHTAN WORKERS =P OF INSURANCE, AS REWIRED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W WORKERS' COLIPENSATON r— INNSURA�NCE CARRIER AND POLICY NUMBER ARE: CARRIER _ YN/0• POLOYNLIMBER PHS SECTION NEED NOJBE� BZP14 ICERTIY THAN IN THE PERFORMANCE OF THE WORK FORWHOHTHIS ERMI�U. SU,I SHALL NOT EMPLOY ANY PERSON MANY MANNER SO AS TO BECOME SUBJECTTO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR CI SHALLL'TrHWITH COMPLY WITH THO EP SINS OD. [LITE: ^2LI _211PPLICANL WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS IS 100.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN BECTON 37DO OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THATTHERE LS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3007. CIV. G). LENDER'S NAME LENDER'SADDRESS 1 CERTIFY THAT 1 HAVE AM THIS APPLICATION CT ATN AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 AGREE TO COMPLY WITH NTL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. /,,NN�TT�jj-fi�e' .j�A/ �1 PERMITTEIWG / !L..•"'� �L 3ry""• 1��Q V O SKA RMITTEE DATE r 0 ( I PRESS ;FIRMLY. APPLICATION O PERMIT l� Cj PIC � ro DATE NUMBER E !! 0 ISSUE / (1fl TYPE OCC DATE ' (? CONST. GROUP vZONING SETBACKS'' FRONT RW_0_ REAR p SIDE/SIDE STREET RW O SIDE p PROPOSED USE I NO. DWEL ,(I t� 'NO NO. UNITS 'v /r STORIES BEDROOMS �!r DESCRIPTION SO. FT." 'FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM .. Garaga/Carport i W PaW/Deck ILL Pool/Spa Z RB -Roof 0 CGmmerclal r ,S _ - m aluation ADJ.ARFJ4 QUANTITY DESCRIPTION FEE 0RIF UV / L cc r ,PULL W L706A Z VSr CO 0 OILS k Q17 0 n /tin e(I - J 2 4 U W led / O CONSTRUCTION PLAN REVIEW T I ELECTRIC PLUMBING MECHANICAL ' INSPECTION FEE ^ ISSUANCE SMIP f ENERGY PIC 1 'Q ENERGYPERMIT -- r� RETENTION FEE: E•A T �� A TOTAL FEES LLog U. M COMMENTS G�\� I RECPT. NO. PAID BY VALIDATION WHITE—Oepanment Copy, YELLOW—Finance Copy, PINK—A6Sessa Copy, GOLDENROD—File Copy, GREEN—AyWicant'6 Coq I /