The URL can be used to link to this page

Home My WebLink About10431CITY OF DIAMOND} BAR COMMUNDTY' DEVELOPMENT DEPARTMENT s' 21660 E, Copley Drive Suite 190 f (909) 5603195 Fax (909) 861-9117 ' w BUILDING PERMi'FL"TCtyi#fON j ADDRESS APN LOT TRACT OWNERJ267t / ADDRESS CITY ZIP TEL APPLICANT CONTRACTO ADDRESS _ rf CITY te_ a4lli4G ZIP TELARCHtENG DESIGNER DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT) AM EXEMPT FROM THE CONTRACTORS LI. CENSE LAW FORTHE FOLLOWING REASON (SEC 7MIS SUSINESSAND PROFESSIONS OODE:ANYCITY OR COUNTY WHICH REOUIRESAPERMITTOOONSTRUCT..ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUG TURF, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE 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- FFSSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- MON.ANY VIOLATION OFSECTION 7031,5 Y. ANYAPPLICANTFORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE}IUNDREDOIX.I,ARS WWI.): CU' AsamEnopTHEPROPERTY, OR MY EMPLOYEES WITH WAGESASTHEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7046, 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 THP0JGH HIS OR HEROWN EMPLOYEES, PROVIDED THATSUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF, HOWEVEATHEBUILDING ORIMPROVEMENTISSOID WRHINONEYEARQFCOMPLE TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID WT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} 0I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7064, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTSFOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). ❑ I AM EXEMPT UNDER SEC. 8. & P.C. FORT" REASON DATE OWNER LICENSED CONTRACTOR5 DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AN LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FILL FORCEAND EFFECT '5 - LICENSE CLASS LIC. NO. 4- 7 DATEa� CONTRACTOR - WORKERS'COMPENSATION DECLARATION I HEREBY UNDER P64ALTYOF PERJURY ONE OFTHE FOLLOWING DECLARATIONS; HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4MSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE QS�HE WORK FOR WHICH Tmt PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 9700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY/Wy�NXERS'CO PETISATIO SUTtANCB CA RIER AND POLICY NUMBER AFF, CARRIER (.m7:�/ POLICY NUMBER (jHISSECTIONt4EWNOT8EOW LEMOFTHE%RAYTISFDRONEH DXLARS(510PIOR[ESS} I CERTIFY THAT IN THE PERPORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PE" IN ANY MANNER SO AS TO BECOME SUBJECT TO Try£ WOPMERS'GOMPENSAnON LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD ECOME SUBJECT TO THE WORKERS, COMPENSATIONP V! SOF SECTKMV 3700 OF ElABOR CODE .1 HALL FORTHWITH COMPLY N HT S op DATE: APPLICANT: - WARN 'FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER 30 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI 00,000). IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 8708 OF THE LABOR OODE, INTEREST. AND ATTORNEY'S FEES, CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY 7HATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097. CIV. a). LENDERS NAME LENDMSIADDRESS E CERTIFY THAT N HAVE READ THIS APPLICATION AND STATETHJIT ME ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CDNSTRILKC DON, AND HEREBYAUT14ORIZE REPRESFMATIYES OF IS COUNTY TO ENTER UPON THE ABOVE -M PROPERTY FOR INS CNPy�OSES. PE I 5IGNATURED PERMITTEE DATE 6 -T PRESS FIRMLY PERMITr�� DATE NUMBER NU BER ISSUE TYPE OCC DATE / CONST, --GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEtSIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL - NO — NO. UNITS STORIES-' BEDROOMS DESCRIPTION SO. FT. FAC70R PSF ADJ. AREANALUATION SFRJADDMEM co Garage/Carport LLU Patiome& LL POOI/Spa ZRe -Roof 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE - CE77 :a W J W Z J Q U 2 U W CONSTRUCTION REVI ELECTRIC �, 5 PLUMBING 7q_ "3_S— MECHANICAL Z INSPECTION FEE ISSUANCE SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE TOTAL FEES COMMENTS .. RECPT. NO. PAID BY d 2coqVALIDATION / WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—Fie COW GREEN Applicants Copy 0,--, -DA-AU-41J6loX-:) VAR 7 )PEC'7710-11N Rz-,"M T' rip Xe T I S=T BA3s < I FLOOR JOIST F -EL EL=RC GROUND UNDER LCCR DUCT ?--5pcu,�D P, ; lvBf G K� r-, 11-ONDU7 7Z �'-A 3 --,-q A I =dRSRLACE -F0---N'DAT10,N 7 F -MF, PoVVER. FIREPLACE SON04 SEAM ER SF:RV�CE Br'N- E 8 77 2 CN' -1 3EAMi FNA, -E�&--D F',00F COVER FING" 3 NS R002H EL CTzi!c - --------- - P� UVSII,,!G I.J. FEN gr GRADING POOL ELECT RC ll --_i L, LAT!Vsi .'C 0 L _ E N G: N G -ztC:0,AL OcF �S 1TE W.PS. D'ZANVALL NA."-INNGM iDED]CATIONS TANK GAS AIR T QST N.� L ZONING F N A F. EAT, N. G DE 'AL L -F-L U K,i E, 1W