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Home My WebLink About14998 (19)C LL C 5 C CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES a 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 561-3117 "A BUILDINGPERMIT APPLICATION JOBSITE ADDRESS f 0 C APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR✓ ADDRESS_ CITZIP _ f 6 TEL. ARC ENG/Y 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. 7031.5 BUSINESS AND PROFESSIONS (`.ODE: ANYCITY OR COUNTY WHICH REQUIRESA PERMITTOCONSTRUCT,ALTER, IMPROVE, DEMOLISH,CR REPAIR ANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031 b BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANTTO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (E500),J: - 111. AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044,.BUSi- NE55AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IM PROVES THEREON. AND WHO DOP.S SUCH WORK HIMSELF OR HERSELF OR - THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR- HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROFCOMPLE. TION. THE OWNER- BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). LJ 1. ASOWNER OF THE PROPERTY, AM EXCLUSIVELYCONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACTS FOR SUCH PROJECTS WITHAODNTRACTOR(S) LICENSED PURSUANTTO THIF CONTRAC- TORS LICENSE LAW.). - ❑ I AM EXEMPT UNDER SEC. A P.C. FD EASO DATE OWI! R A - LICENSED CONTRACTORS DECLARA I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UN RPROVISIONSOFC TER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC, NO. DATE CONTRACTOR- WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _^ i HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFANSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 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, FORME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (rHLSSEGMeN NEEDNOTBEOOhSL=OFTHE PERUT IS FCRONE HUNDREDMILARS (5100) OR LESS). 1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNINAND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: - APPLICANT: - - - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCT ION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). I LENDER'S NAME_ LENDERS ADDRESS — I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOYE-MENTION PROPERTY FOR INSPECTION PURPOSES. i i a TEE NAME (P R OFPERMITT DATE I/ i PRESS FIRMLY APPLICATION f� "I 'IPERMIT I P/C DATE NUMBER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE, p� f / bil NO. DWEL. NO. NO. UNITS STORIES . BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM GaragoiCarport WPatio/Dock LL Pool/Spa ZRe -Roof C1 Commercial - 5 Valuation ADJ.AREA -QUANTITY DESCRIPTION FEE J U F- 0 W W C7 -_ z m J LL Q U_ Z g W CONSTRUCTION t2"- 4s PLAN REVIEW ELECTRIC 'DAM PLUMBING MECHANICAL - - INSPECTION FEE ZUUU °y ISSUANCE MAY2 3 -•+k! Cd SMTP ^�s -, p�YT0.�� f��' ENERGY PIC . - -- 5� ENERGY PERMIT - RETENTION FEE: PRE -ALT FEE: — TOTAL FEES a� t COMMENTS e VALIDATION RECP7. NO. PAID BY WHITE --Department Copy, YELLOW—Finance Copy, PINK—ASSesaOr copy, UVLutFNHvu—nIe ropy' u"M=w—ApPl lit ropy l