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Home My WebLink About15007 (19)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES • 21660 E. Copley Drive Suite 196 (909) 860-3195 Fax (909) 861-3117 PRESS gM, BUH DMV. ttkMtt X00f.f 1.WthN, <.... - , .. _ , . kIoul V j JOB81TE c�j ' Y f is <' ADDRESS 13 ( IV /1 AI ii PERMIT NUM 0 P/C ISSUE TYPE TYPE OCC APN LOT TRACT 9 DATE CONST. GROUP j OWNER JTAP MAVAMA ADDRESS ZONING SETBACKS CITYIP TEL. L FRONT RW ❑ APPLICANT nwa�►�- TEL.L REAR CONTRACTOR �LR - [� SIDE/SIDE STREET RW ❑ SIDEADDR❑ ES Aj'7rLk1 Ail CITY ZIP% TEL. PROPOSED USE sl �-� ARCH/ENG/ ! � DESIGNER ADDRESS NO. DWEL. NO. NO. 5 UNITS STORIES BEDROOMS CITY ZIP TEL n DESCRIPTION SO. FT. FACTOR PSF ADJ.AREA/VALUATION » r OWNER -BUILDER DECLARATION SFR/ADD/REM I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE OONTRACT8hS LI (Al Garage/Carport CENSE LAWFORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE; ANYCITYOR W Patio/Deck 3COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT. AI,TER, IMPROVE., DEMOLISH. RREPAIRANYSTRUC. JUIZ TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT �'O FlI,E A SIGNED Ll.l STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACYOIIS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS "'Pno- LL , POoVSPa FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- Z Re -Root TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANTTO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): ❑I, AS OWNEROFTHE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLECOMPEN§AiION, D Commercial - WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE tSEC 7044; BUM- 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 HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPRdVEMENYSARENOTIWENp'ED OR M JJ OFFERED FORSALE. IF, HOWEVER THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OF tMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � - yL IMPROVE EORTHE PURPOSE OF SALE). I j)�'1.,, ❑1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELYCONTRACTINO WITH UCEr4SED CONTRACTORS; ValuationADJ.AREA — x TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE: THE CONTRACIORS LI- L CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON AND WHO CONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5) LICENSED PURSUANT TO THE CONTRAG QUAN DESCRIPTION FEE TORS LICENSE UAW.). U 1 AM EXEMPT UNDER SEC. B. H P.C. FOR THIS REASON cc DATE OWNER F- W � LICENSED CONTRACTORS DECLARATION - - W e_[ S I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION ?D00)OF DIVISION 3 OFTHE BUSINESS AND PROFESSIONS CODE, AND Z m MY LICENSE IS IN FULL FORCE D EFFECT LICENSE CLASS LIC. NO. 5_1p �+ ,-nl� 91 -` 0 DATE j� CDNTRACTOR.^ li IL J JJ N Q ` WORKERS' COMPENSATION DECLARATION "-' I HEREBYAFFlRM UNDER PENALTYOF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SEURNSURE FOR WORKERS' Z W COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. jL1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION Q 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS /� �j%9 ff Bl ISSUED. MY WORKERS' L�PENSATION IINyS�URANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION j CARRIER �"1F4' PLAN REVIEW _ POLICY NUMBER , ELECTRIC � (fHISSECTK7N NEEDNOT BE COMPLETED OFTHE PERMRS PJfi 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 _ _ viWORKERS'COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT OTHEWORKERS'" COMPENSATION PROVISIONS OF SECTION 3700 OFTHE LABOR CODE, i ALL RTHWITHCOMPLY WI o PREVISIONS: ISSUANCE 1 SNIP_fa 1-� ® J DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE ENERGY PIC t." (: �L i Li_ SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND ENERGYPERMITily J DOLLARS ($100,000), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN _______ SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. d RETENTION FEE:UJI CONSTRUCTION LENDING AGENCY PRE -ALT E: M Qi I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION 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— A TOTAL FEES • �1. �^` ICERTIFYTHATI HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATIONISRRECT. CO I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENT EDDPaROPERTY FOR INSPECTION PURPOSES. COMMENTS AA. m PERMIyfEE�4ME lPRINT) CO RECPT. NO. PAID BY VALIDATION SIGNATORE OF PERMITTEE DA wHl I L—uepanmem copy, TtLr vW—i-Inance copy, I-INK—ASS6SSOr UOpy, UV WtNHUL?4-118 UOpy, GREEN—Applicanft Copy r