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Home My WebLink About18538 (11)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNrFY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION �.. LN- fiJ1, FIRMLY JOBSITE ADDRESS APN LOT TR�AM T_ OWNER (;.,_rV Ad1flP,) �fi llt� ADDRESS yy CITY ZIP TE 1 APPLICANT _� TEL. CITY (�AnrcZIP ARCH/ENG!/� DESIGNER A 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 CODE. ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, 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 IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SPCTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM. AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS "`HF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500;.)_ U I, AS OWNER OFTHE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION WILL DO THE WORK, AND THE ',STRUCTURE IS NOT INT ENDED OR OFFERED FOR SALE (SEC. 7044. BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NTENDED OR OFFERED FOR SALE. IF. HOWFVE:R. THE BUILDING OR IMPROVEMENT IS SOLO 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). ❑ I. AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CON-RACTORS U CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO awins OR IMPROVES THEREON, AND WHO CONTRACTS fOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) DATE Ci I AM EXEMPT UNDER SFC. - B. B. 8 PC. FOR THIS REASON OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PPOFESS,ONS CODE, AND MY LICENSE IS IN FULL FORCE A EFFECT. I LICENSE C LIC. NO. V DATE 0 K CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE.AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE 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 Wil L MAINTAIN WORKERSCOMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKE ' COMPENSA NCE 7) AND POLICY NUMBER ARE: CARRIER /) POLICY NUMBER THIS SECTION NEED NOT RE OOMPL ETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (SI W) OR LESS). I CE RTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSAI ION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECTTO THE WORM: ERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURETO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T O ONE HUNDRED THOUSAND DOLLARS (S100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CDDP INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY Ai FMHM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR 'HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEC (SEC. 3097. CIV CT LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORREC I. 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 ABOVE NIVA40NED PROPERTY FOR INSPECTION PURPOSES. , ,111 NAME (PR 'TI _� v_a._�f^_. IRE OFVER ITTF(/�'E D F APPLICAT PERMIT �� } P/C DATE NUMBER ✓ )s # ISSUE -ry i TYPE DATE I 3 i' CONST. OCC GROUP ZONING SETBACKS FRONT RW ❑ REAR L SIDE/SIDE STREET RW _ SIDE _ ,�pp PROPOSED US lJ L NO.DWEL NO. tA- UNITS _ STORIES L BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport WPatio/Deck. LL POOUSpa 0 Z Re -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U H U LU W C7 Z DO a- 4 U_ Z 2 U w +'j CONSTRUCTION _ PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS !nrRECPT. NO. _ PAID BY VALIDATION __ WHI t L—Uepanment Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMOND BAR DFPARTME—IT OF COIvIlvIUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS w APN LOT TRA T _ OWNER Cj„_—,/—( --- (M a— ADDRESS CITY ZIP TE APPLICANT TEL. CONTRALTO ADORE _ CITY ZIP TE— ARCH/ENG/ DESIGNER ADDRESS CITY ZIP _ TFL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OF COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANV STRUC- TURE, 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 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS C'gDE) OR THAT HE OR SHE IS E%EMPT THERE FROM AND 7HE BASIS FOR THE ALLEGED E%EMP- TION. ANV VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT .SUB3EC f S'f HF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).). u I, AS OWNER OF THE PROPERtt, OR MV EMPLOYEES WITH WAGES AS 7HEIP SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT IN i ENDED OR OFFERED FOH SALE ;SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE— TION, THE OWNER -BUILDER WILL NAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I. AS OWNER OF THE PROPERTY. AM E%CLUSIV ELV CONTRACTING Wii H 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 a'JII.DS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PFI03EC-FS W ITH A CONTRACTOR(SI I.ICENSCD PURSUANT TO THE CONTRAC- TORS LICENSE LAW). Ci I AM E%EMPT UNDER SEC. _ B. 8 PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI TY OF PE RJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE A EFFECT. f // —"J LICENSE C LIC. NO. V DATE 4r CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINT,41N ACERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BV 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 BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKE ' COMPENSA ly$yq CE ARp—i AND POLICY NUMBER ARE: I CARRIER T I POLICY NUMBER (i}i15 SECTION NEm NOT BE ODMPLETED OF THE PERMIT IS FOF (N9E HIMDRED DDLI.4RS (fl W) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS 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 WORMERS' COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: _- APPLICANT: WARNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOP IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENAI_TV OF PERJURY THAT THERE IS ACONSTR'JCTION LENDING AG ENCV FOR THE PEH FORMANCE OF THE WOP,K FOR WHICH THIS PERMIT IS ISSIJED (SEC. 3091, CIV C.). LENDER'S NAME LENDER'S 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 HERERV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE ONED PROPERTY FOR IN CTION PURPOSES. PERMITT NAME (PR I SIGNATURE OF VER ITTEE AT D E WHITE -Department Copy, YELLOW -Finance Copy, PIN —r"G"a " r" off, �. PRESS FIRMLY