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Home My WebLink About13351C LL Q C Z v CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-.3195 Fax (909) 861-3117 BUILD114G PERMIT �kft ]UCA'rION' JOBSITE ADDRESS i, TG � APN LOT TRACT OWNER ADDR S CITY ZI TE . APPLICANT _ TE CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ 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 (SEG 7031.5 BUSINESS AND PROFESSIONS CODE: ANYCITYOR COUNTY WHICH REQUIRESA PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOUSH,OR REPAIRANYSTRUC- 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 U - CENSE LAW (CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS 411) PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VKXATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF MOT MORE THAN FIVE HUNDRED DOLLARS ($500).): ❑ 1, AS OWNEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 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 IMPROVEMENTSAnE NOT INTENDED On OFFERED FORSALE. IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT RE OR SNE DID NOT BUILD' OR IMPROVE FOR THE PURPOSE OF SALE). n 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70", BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,.AND M -IO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTOTHE CCNTRAC- TORSUCENSELAW.). ❑ 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE: AND EFFECT. LICENSE CLASS ?7 LID. NO. DATE ai �� CONTRACTOR_ CA WORKERS' COIMPENSATION DECLARATION I HFREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE 1/ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION (J A 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORK'CO}A�SA7QN INS U -FgCAR ND POLICY NUMBER ARE: CARRIER 77 _ .8�ii 4(ii�� POLICY NUMBER O < 5l —L (WESECTION NEEDNOT BEOLY.FLETEDOFTHE PERMITIS FOR ONE HUNDRED DOLLARS (5100) 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 I SHOULD BECOME SUBJECT? -!W WORKERS'COMPENSATI PRO`JISIO SOF SECTION 37000E THE LABOR COD �I S }) F In." COMPLY WI P ISIONS. DATE: ,lY.) APPLICANT WARNING: FAILURE_'�O SECURE WORKERS' COMPENSATION COVERAGE M UNLAWFUL, AND $HALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE$ UP TOONE HUNDRED THOUSAND. DOLLARS ($1D0,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 1 CONSTRUCTION LENDING AGENCY i I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3D97, CIV. C.). I LENDER'S NAME LENDERSADDRESS i 1 CERTIFY THAT I HAVE READ 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 ASOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTE SIGNATU PERMITTEE DATE PRESS FIRMLY APPLICATION 4_2A—q_9PERMIT 53�l #/C DATE 1 ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM C/3 Garage/Carport W Patio/Deck LL Pool/Spa ZRe -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE N&F .4 Q B U 3 CJ j�W L CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING' • M, tufECHANIC INSPECTION FEE e` ISSUANCESMIP i � v ENERGY P/C ,} �' p,�,•' "� b ENERGY PERMIT RETENTION FEE: PRE -ALT FEE:�'.�, TOTAL FEES ouI S V COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy C I T Y 0 F D k A Rl 0 Mil B AR MSPEC, RON RECORD E�A -- ----- . ..... . . . ..... ......... �, . ... ...... FFARMIATS .. . .... .... ;-.;NDE-T�. FL,7,(—)R 7-- ... . . ........... V�R -IR-7 . . ......... %AIC: -117 50 U3 R, 1 I LAT . . . ... ....... -,q" ED . . . . . .. ........ . .. . . .... ... . . . . ....... ----- ----- "Iv GRAIUNT, . ........ .. :al" TE L, E- ECTIC .. . . .......... E POOL FQW, <...i ................ .... .. .. ------ Em.:2' . . . . ... . 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