The URL can be used to link to this page

Home My WebLink About10020 (5)r v 0 w a w 0 O W U W am Z LU W ccW O Z W 0 O G W Q 0 In LU LU 2 T.7 h J w O d W n. 9 6 CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 & Copley Drive Suite 190 (909) 860.3195 Fax (909) 861.3117 BUILDING PERMIT APPLICATION i ADTE RIESSf�! APN LOT TRA T OWNER ADDRESS CITY ZIPF/_ TEL APPLICANT TEL CONTRACTOR ADDRESS CITY Z� TE ARCE iffNCJ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION - 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOLTHE FOLLOWING REASON (SEG 7011.5 BUSNESSNND PROFESSIONS ODDS ANYCITY OR COUNTY V&GCH REOUIRFSAPERWTTOCONSTRUCT.ALTER.IMPROVE-DEMOLISH.OR REPARANY STRUC TURF. PRIOR TO ITS ISSUANCE. ALSO REOU WES THE APPLIrANY FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT NE OR SHE IS UCEWED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO. FESSpHS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP• TION. ANY VIOLATION OF SECTION 70.71.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A GVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (15001.} O L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION. WILL DO THE WORK AND THE STRUCTURE IS NOT WTENDED OR OFFERED FOR SALE (SEG 71)4, BUST NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WkgBUILDS OR IM PROWS THEREON -AND WHO DOES SUCH MARK HIMSELF OR HERSELF OR THROUGH MS OR HER OWN EMPLOYEES PF40V FD THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT ISS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER BUILDER WILL PAVE THE BURDEN OF PROVING THAT HE OR SHE WD NOT BIAID OR IMPROVE FOR THE PURPOSE OF SALE} O L AS OWNER OF THE PROPERTY. AY EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 704• BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LF CENSE LAW DOES NOT APPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THERECK AND WMOCONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW), O 1 AM EXEMPT UNDER SEG & S P.0. FOR TMS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 NEREBYAFFIAM UNDER PENALTY OF PEFUL RY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS GOOF. AND MY LICENSE IS IN FULL FORCE AND EFFECT. �{ LICENSE CLASS ` UC. DATE CONTITACTo WORKERS'COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. _I HAVE AND WALL MAINTAIN ACERTIFICATE OF CONSENT TO SELF4NSUW FOR WORKERS - COMPENSATION. AS PROVIDED BY SECTION 2700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WKVA THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE AS REOUIRED BY SECTION 5700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER CARRIER POLICY NUMBER (iTGSECDONNEEDNOTBEOC IPUETEDOF THE PERMIT ISFORIOIEN NDACDDCIMS PIq On LES4 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 57000E THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH lR1�f qE P DATE71z APPLICANT. , , WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFU_ AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS tpoa.IX 0), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 1706 OF THE LABOR CODE INTEREST, INO ATTORWEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE 1S A CONSTRUCTION LEND*4 AGENCY FOR THE PERFORMANCE OF THE WOW( FOR WHICH THIS PERMIT RS ISSUED (SEG 5007. CV. G). LENDEITS NAME LENDEFTS ADDRESS I CERTIFY THAT 1 HAVE HEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, 1 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 ABOVE -MENTI NED PROPERTY FOR INSPECTION PURPOSES. PE G �� SIGNAPMeF EE I DATE PRESS FIRMLY APPLICATION'�J-Ljojqj DATE ISSUE DATE NUMBER ` �� TYPE CONST IYYC' OCC• GROUP ZONING SETBACKS FRONT REAR SIDEYSIDE STREET SIDE RW RW El " ❑ - ❑ ❑ PROPOSED USE C NO. DWEL NO. UNITS STORIES l� NO. BEDROOMS DESCRIPTION SO. Fr.. FACTOR PSF ADJ. AREANALUATION SFRIADDIREM cnUl GlLrepalCaryort U1 Pato'Deck U. PooVSpa Z R.Rod Commerew m Valuation ADJAREA QUANTITY DESCRIPTION FEE T.7 1 Z a J CONSTRUCTION PLAN REVIEW ELE C LUM MECHANICAL INSPECTION FEE ISSUANCE SMTP •_' ENERGY PIC I 1 ENERGY PERMIT RETENTION FEE., PRE -ALT FEE F Li ^ i { TOTAL FEES�� COMMENTS f/ RECPT, N PAID BY VAUDA WHITE— D"iVnant Copy, YELLOW—Fran s Copy. PINK—ASSO"OT Copt; GOLDeNROU—tue L:OPy. UMLLN—RppirAM S L.Gpy J Z:: LL!: O:cc z a. 0 F LL; 0 7-, r t= < d CID Ali 0 ❑ Z 'Lu m < < LL Cc 0 o cc 0 o LL w M Ltj �z W m L3 Z < 8 T z U- CL j O 0 z Es M CC Ir LU z a 'L 1 t W L, Ir LL cc �4 z c cc z C, a: (D -j Lu LU LL z m LU tz g z LU 0 a- wa 0 LU J: cr or 0 X < w z ul z 0. LU :9; 4L LLI S X a co t� -Z ED 1� z❑0 0 --J 0 —i 0 V) LL ❑< F5 --J co z w cl: C) LLJ LL m LL Z) D LL. U- Go .— LL. it W co CC 0 a. a IL 0 CL ul 0 LLI a 2� 0 :1!:L Lju z w IT I L Lu LU Z al 0 N W! F- (�o D 0 M E'= = P z ra TfjL) IL ol uj �: Z LU co N:: ul < ImNiy im 0 CC 0 <0 cc 0 CL ui 0 Ir Lu co LL z 0 x 4-0 LLI CL w z o ;z (L cc 0 w x Vi W. CL LIJ I ,V 0 M F-- 0 0 < m 'O 0 �= 0 0 0 -j -J < M Q 3�: a_ LLI Lu LU < z R, z < z Z< m LU LIJ LLJ 40 0 m LL cc cc Ir Ic 0 0 U) to V) E iL-, EL 10 0) U)