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Home My WebLink About191524 CITYOFDIAMONDBAR DEPARTMENT OFCOMMUNITY & DEVELOPMENTSERVICES 21825E. Copley \[hive 909) 860-3195Fax (909) 861-3117 BUILDINGPERMITAPPLICATION JOBSITE ,,~~ • ADDRESSIWOS. G1P~N -o +wE.__ APN _ LOT OWNER ADDRESS- CI APPLICANT CONTRACTOR ~Dll~ 1A!x- PA -S-L. IF ADDRF_SS__- ?S- Li/ VA^L, A, l4~Ge._ a1 CITYZIP °(28D(oTEL. 7 ARCH/ENG/ DESIGNER ADDRESS CITYZIPTEL. OWNER-BUILDER DECIARATION IHEREBYAFFIRMUNDERPENALIYOFPERJURYlHA' IAMEXEMPTFROMTHECONTRACTORS LI CENSELAWFORTHEFOLLOWINGREASON (SEC70315BUSINESSANDPROFESSIONSCODEANYCITYOR COUNTYWHICHREQUIRESAPERMITTOCONSTRUCTAlTERIMPROVE, DEMOLISH, ORREPAIRANYSTRUC- TURE, PRIORTOITSISSUANCE, ALSOREQUIRES THEAPP: ICANTFORSUCHPERMITTOFILEASIGNED STATEMENTTHATHEORSITEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORS LI. CENSELAW (CHAPTER9 (COMMENCING WITHSECTION7W0) OFDIVISION 3OFTHEBUSINESSANDPRO FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TION. ANYVIOLATIONOFSEITTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTS THEAPPICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS ($500) ): LIASOWNEROFTHEPROPERTYORMYEMPLOYEESWITH WAGESAS1)1EIHSOLECOMPENSATION, WILLDOTHEWORK. ANDTHESTRUCTUREISNOTINTENDED OROFFEREDFORSALE (SEC7044, BUSK NESSANDPROFESSIONSCODETHECONTRACTORS LICENSELAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVES THEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES, PROVIDE\[) THATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALE. IFHOWTIER, THEBUILDINGORIMPROVEMENT ISSOLDWITHINONEYEAROFCOMPLE TION, THEOWNERBUILDER WILLHAVETHEBURDENOFPROVINGTHATHEORSHEDIDNOTBUILDON IMPROVEFORTHEPURPOSI: OFSALE) II, ASOWNEROFTHEPROPERTYAMEXCLUSIVELYCONTRACTING WITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECTiSCC -044. BUSINESSANDPROFESSIONSCODE THECONTRACTORS LI CENSELAWDOESNOTAPPIY10ANOWNEROFAPROPERTYWHOBUILDSORIMPROVES THEREONAND WHOCONTRACTSFORSIJCIPROJECTSWITHIACONTRACTORIS, IICENSEDPIJRSIIANTTOTHE. CONTRAC TORSLICENSELAW) IIAMLSEMIIUNDLT -LC - B & PCFORTHISREASON DATEOWNI-.H IICENSEDCONTRACTORSDECLARATION IHEREBYAIFIRMUNDERPENALTYIFPELLATHYIHATIAM1II.ENOEDUNDERPROVISIONSOFCHARTEH 9 (COMMENCINGWITHSECTION70W) OFDIY', SION3OFTHEBUSINESSANDPROFESSIONSCODEAND MYLICENSE ISINFlllIFFOHC:ENDEFFECT LICENSECLAN -Ci•• _3, IIC, N(o DATEIONTHT WIRKERSC(,MPENSAI10) JDELLARATION IHEREBYAFFIRMUNUEHPtNAL17OFPEHI' HYOIJEOF11,E1-13LOWINGUECLARATiONS DAVEANDWITIMANTAINACEH1II-It:lIF,,-:.ON~FOTI, SELEINSUREF,,RWORKERS COMPENSATIONA5PROVIDEDB" SEC7ION1%000; THETABORCODEFORTHEPERFORMANCE CFYITEWORKFOHnfPCHTWSFFN4+1TISISSUED HAVE1NI1NIL, MANIAINWORKERSI;OMPEIIsAI, )NIN51'HANCEASHEIJIIIREUBYSECTION 310, ITTTHEIABOECODEFOR1HEPERFORMANCI ), THEWORKFORWHICHTHISPERMITIS ISSIEDMYWORKERS' COMPENSATION -NSURANCFI ; A'HHIERANDPOTICYNUMBERARE I., SECIKXJNEEDr•OIBEOJMF1LIEL,, II' fillPERMITISH,hUIEiIUFtLHEUILJLIARS (b1W) ORIE55j TEHTIIITHATINitItPERI-CIHMANCE OVIlitWORKI (,HWHICHTHISPERMITISISSLEl) I SALINOTEMPLI'IANYPERSONINANYMANNER0ASTOBECOMESUBJECTTOTHE WORKERS' COMPENS A'IONLAWSOFCALIFORNIAANDAGREETHATIFISHOULDBECOME SUBJECTTOTHEWORKERSCOMPENSATION PROVISIONSOFSECTION3700OFTHELABOR CODE. SHALLF09-IIWITHCOMPLYWITHTHOSEPROVISIO DATE1 -7b3APHICANf WARNINGIAllITELTOSE, HEW<1HKEHS :,OMPII, ADS"' 'VEHA,,EISITS,A0FIIIANDSHALLBE SUBJECTAMEMPLOYERIll : HIMINALPENAL11FSANDiV'L = it,FUPTOONEHUNDREDTHOUSAND DOLLARS ($1'.COW) INADU~ \[IONTOIHE -OSTOFCOMPENSAlION. DAMAGESASPROVIDEDFORIN SECTION3716OFTHELABORCODEINTF. RESTAPL) ATIORNEY5FEES IHEREBY AFT- IRMUNUEHPENAL11131IEHIUH, THAT \[HEREISACONSTRUCTIONLENDINGAGENCY FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPIHMI' ISISSUED (SEC3097CIVC) I. ENL, EH'SNAME LENDER' SADDRESS CERTIFYTHATIHAVEREADTHISAPPI. CATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT AGREE70COMPLYWITTIAILCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION, ANDHEREBYAUTHORIZERI "REST-NTATVT-SOT- THISCOUNTYTOENTERIIPONTHE ABOVEMENTIONFDPROPEFTVFORINSPCCTIONPIIHPOSEi w` J , tJOKD2P4 0 PRESS FIRMLY PERMITiII< /C NUMBER-___ TYPEOCC CONSTGROLP DESCRIPTIONSOFT. FACTORPSF SFR/ADDiREM Garage/Carport -= Valuation QUANTITY -TIE-SCRIPTION CONSTRUCTION PLANREVIEW ELECTRIC PLUMBING MECHANICAL INSPECTIONFEE ISSUANCE SMIP ENERGYP/i; ENERGYPERMIT RETENTION FEE. PREALTFEE TOTALFEES COMMENTS ADJ. AREANALUATION N RECPTNO -_.-___-_-_--- PAIDBY -__- __VALIDATION WHITE--- DepanrnentCopy, YELLOW--FinanceCopy, PINK-AssessorCopy, GOLDENROD--FileCopy, GREEN-Applicant'sCopy y,` OVI ~~ ASAS