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Home My WebLink About12244 (13)CITY OF DIAMOND BAR'-, 1 ` DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES' r 21660 E. Copley Drive Suite 190 N " (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY ADDRIESS IIZO N. FLYJP4 h9LL RAGC APN LOT 2x TRACT ?6':5(015' OWNEE ADDRESS CITY flOAJp &14- ZIP TEL APPLICANT 65fty A22 %E7 TEL ^ CONTRACTOR -ADDRESS CITY ZIP TEL ARCIUENG/ DESIGNER ADDRESS - CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE UW FOR THE FOLLOWING REASON (SEG 70.71.5 BUSINESS AND PROFESSIONS CODE MIYOTY OR COUNTYWMCH REOLARESAPERMITTO CONSTRUCLALTER MPROVE.DEMOUSH, OR REPAIR AMSTRUC. - TURF. PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A BONED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS u CENSE UW (CHAPTER v (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRRO- FESSONS000E) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR APEMBT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW)* . O1.ASOWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WON, ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 70". BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILD$ OR IMPROVES THEREON. AND WHODOES SUCH WORK HIMSELFOR HERSELF OR THROUGH MS OR HER OWN ETAPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE F. HOW MK THE BUILDING OR IMPROVEMENT 15 SOLD MTN W ONE YEAR OF CCMPLE- T10N. THE OWH "UILMR WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT PAD OR IMPROVE FOR THE PURPOSE OF SALEL . O L AS OYNEROFTHE PROPERTY.AM EXCLUSIVELY CONTRACTHO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 701A. BUSINESS AND PROFESSIONS COOS THE CONTRACTORS LL CENSE LAW DOES NOTAPPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON. NO WHOOONTRACTS FOR SIKH PROJECTSWITH A COMRACTOR(S) LICENSED PURPLANT TO THE CONTRAC- TOMS LICENSE LAW.), O IAM EXEMPT UNDER SEG B.0. P.G FORTWSRE/SON DATE OWNER LICENSED CONT TORS DECLARATION 1 NERFBY AFFI M UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 5 (mAWENCND WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE AND W LICENSE G N FULL FORCE AND EFFECT. UCENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFFNM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS _I NAVE AND WILL MANTANACERTIFICATE OF CONSENT TO SnFJNSURE FOR YORKERS' COMPENSATION.AS PROVIDED BY SECTION 0700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. __ I HAVE AND WILL MAINTAINWORKERS' COMPENSATION INSURANCE. AS REGURED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. LAY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY MA.18ER ARE GARNER _ .. POLICY NUMBER (DUSEOMNEEDNOTSEaMPLETEDOFTHE PERMTTISFaLONEHUN WMI)MAX ($10C)O RLESS), 1 CERTIFYTHAT N THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON N AM MANNER SO AS TO BECOME SUBJECT TO 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 CODE I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRANK PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND COLLARS (Stoo.oco). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 3705 OF THE LIBOR LOGE INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENOINO AGENCY FORME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 70W.OV. GF LENDERS NAME LENDERSADDRESS ICERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY MPRH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS SELATWD TO BUJDNG CONSTKX74K AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVNAENTONED PROPERTY FOR INSPECTION PURPOSES. JEWy 2A21-)6 PERMITTEE NAME (P I 81GNATL.._ POME _P/C P/C APPLICATION f+ DATE 1 %Z / D NUMBE 0 ISSUE TYPE I OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR O SIDE/SIDESTREET RW ❑ SIDE ❑ PROPOSED USE - f QO/1I0N-- OF _LONA - /x X 15 O=ar ILA ul' NO. DWEL. NO.'-'- NO. UNITS STORIES BEDROOMS DESK IPTION SO. FT. FACTOR PSF ADJ.AREANALUATION SF EM -- Garage/Carport WPaWDeck - - -- L- PooVSpa Z Re -Roof - 0 Commercial S /50 K/Valuatlon •i ADJ.AREA UANTITY ' DESCRIPTION FEE U gu Z/ of t- . V ` _i� a / rtauNbl Ps}w D J 0 2 J n. U -- - -' - Z- Q S U W CONSTRUCTION PLAN REVIEW L ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE. SMIP ENERGY PIC ENERGY PERMIT - - RETENTION FEE: PRE FEE TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION _ WHITE—Department Copy, YELLOW—Fnarae Copy. PINK—ASSeB80r "N. UuLutNnuu—rue wpy. kxKttN—ApPI cans 3 wpb -- Ao 0 ME n 71 L-, - *,- z �� — i,- :� 2� - �: a - LL LL� ca z 0 z z o w 0 w > Ir LLI cr rr 0 'o C- LL, cl z D 0 0 LL 0 - '? 5 5 . --, - 0: W Uj CL 0 < 0 0 L.� Z- w Z Z cc 0 0 0 0 LL LU Z z m �D w E 0 M EL J-- 0 ul L� LL n 77 61 ; fi Z -1 Z Z 10 z (D Z) m ¢K- F�2 0 :E U) ccl > F- 2 2 M I z W cr: -� W, S 0 LL, w �e cc 0 < 0 L) o E 0 cr CL U) El: L) < LL z Q9 C� f"Ll 0 uj CD 16 =) , CL LLI LL (9 w M -i -j :-j Lu CL < < < 0 < 0 Z) D 0 Lu Lu cn 0 cr 0 0 0 0 = w cc Lu < z z ir LLI IC a: CC Cc U) LLI :5; 0 0 0) Cl) Lou) LL ED W (D (1) �; L4 w FL ui Li UJ