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Home My WebLink About15007 (17)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES • 21660 E. Copley Drive Suite 196 g* (909) 860-3195 Fax (909) 861-3117 PRESS BUH DMV. ttkMtt X00f.f 1.WthN, <.... - , .. _ , . kIoul V j JOBSITE c�j ' Y fi: <' ADDRESS �3 ( � IV /1 ��L ATION IT P/C�:. NUMBER #ld" ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP j OWNER AMA ADDRESS ZONING SETBACKS CITYIP TEL. L FRONT RW ❑ APPLICANT a�►�- TEL.. L REAR ❑ CONTRACTOR !JL` 17r SIDE/SIDE STREET RW ❑ SIDE ❑ ADDR- ES CITY ZIP% TEL. PROPOSED USE sl I DES"� � 00alrll ;' DESIGNERGNER ADDRESS NO. DWEL. NO. 5 UNITS ST STORIES BEDROOMS CITY ZIP TEL n DESCRIPTION SO. FT. FACTOR PSF ADJ.AREAIVALUATION » r OWNER -BUILDER DECLARATION SFRIADD/REM I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACT8hS LI (Al Garage/Carport DENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONSOODE;ANYCITYOR W Patio/Deck 3 Z COUNTY WHICH RECUIRESAPERMIT TOCONSTRUCT. AI,TER, IMPROVE., DEMOLISH. FIR EPAIRANYSTRUC. TURF, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT YO FlI,E A SIGNEDSTATEMENT ll.l THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS 6F THE CONTRACYOIIS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS ANO'PRO- LL , POoVSpa FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP• Z Re -Root J TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERM IT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ❑I, AS OWNER OF THE PROPERTY. OR MY EMPLOYE ES WITH WAG ES AS THEIR SOLECOMPEN§AiION, D Commercial - WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE tSEC 7044; 9031- J_ n NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW GOES NOT APPLY TO AN OWNER OF Z PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIM5ELF OR HEA$tLF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT IUCH fMPR'dVsM1BNTSARENOTINTENDED bR M OFFERED FORSALE.IF, HOWEVER THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OFCOMPLE TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR - yL IMPROVE FOR THE PURPOSE OF SALE). II))�1.,, ❑1, AS OWNEROF THE PROPERTY, AM EXCLUSIVELYCONTRACTINO WITH LICENSED CONTAkYORS Valuation ADJ.AREA — x TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE.. THE CONTRACYORS LI. JU CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IM PROVES THEREON AND WHO CONTRACTS FOR SUCH TOWITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTPAC- -� QUAN DESCRIPTION FEE TORS LICENSE LAW.). I, !' 0 1 AM EXEMPT UNDER SEC. B. H P.C. FOR THIS REASON ccF- DATE OWNER W � LICENSED CONTRACTORS DECLARATION - - W e_[ S I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7DOD) OF DIVISION 3 OFTHE BUSINESS AND PROFESSIONS CODE, AND Z 00 MY LICENSE IS IN FULL FORCE D EFFECT LICENSE CLASS LIC. NO. 5_1p �+ ,-nl� 91 -` 0 DATE j� CONTRACTOR.^ �i a J JJ N ` WORKERS' COMPENSATION DECLARATION "-' I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: V:E_A _I HAVE AND WILL MAINTAIN A CERTIFICATE OF COISELFINSURE FOR WORKERS'COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. '1"I �I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BV Q 3700 OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS VYa Bl ISSUED. MY WORKERNS IINySUURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION j CARRIER PLAN REVIEW _ POLICY NUMBER , ELECTRIC � (fHISSECTICN NEEDNOT BE COMPLETED OFTHE PEPMfiS FOR ONE HURDREODOLIARS(51ao)oR LESS) PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL :f SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE ;i WORKERS'COMPENSATKON LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT OTHEWORXERS'"COMPENSATION PROVISIONSOF SECTION 3700 OFTHE LABOR CODE, i ALL RTHWITH COMPLY WI o PRGVIs1oNs: ISSUANCE w le 1 jj `` fj'''►yq�. }t...,.-� (� Ig�—L_��Y'4Yr� r–tl.� SMIP_fa 1-�� ®�^per? ® J DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE ENERGY PIC F �L i U_ SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRRD THOUSAND ENERGY PERMIT J DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN D SECTION 37N OF THE LADOR CODE, INTEREST, AND ATTORNEYS FEES. d RETENTION FEE:Lu CONSTRUCTION LENDING AGENCY PRE -ALT E: OC I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY Z FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). W LENDER'S NAME LENDER'SADDRESS I— TOTAL FEES ICERTIFYTHATI HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATIONISCORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENT EDDPaROPERTYFryOR INSPECTION PURPOSES.COMMENTS i II.I F m PEflMiyfE�E (PRINT) J) ) ems..►^'^ .. 1 CO RECPT. NO. PAID BY VALIDATION SIGNATORE OF PERMITTEE DATEI wHl I e—uepanment copy, TtLLV W—i-mance copy, FINK—ASaessor UOpy, UV WtNHUL?4-118 QOpy, GREEN—Applicanft Copy r