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Home My WebLink About15093 (20)J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 14 21660 E. Copley Drive Suite 190 (909) 860.3195 Fax (909) 861-3117 BUHMING PERMIT APPLICATION JOBSITE �/ ^n`e ADDRESS 2 7 3 7- 1%L f i`- l/ t�j� APN LOT 1 TRACT OWNER €L!E'111 ADDRESS_21it e -(C CITY AW 1-4-d 15VC ZIP TEL. t? APPLICANT TEL. CONTRACTOR llI ` f c ADDRESS CITY C I ZIPT/71 TEL i ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LH CENSE LAW FOR THE FOLLOWING REASON (SEC. 70.77.6 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOURESA PEAMRTO CONSTRUCEALTER, IMPROVE, DEMOUSKOR REPAIRANY STRUC- 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 LI- CENSE 4CENSE UW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR TION. ANY VTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- IOLATION OF SECTION 701.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A OPAL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (s 500),): O L AS OYNEROF THE PROPE PITY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". 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 HS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT MENDED OR OFFERED FORSALE 6. HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION, THE CANERIUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS COCE: THE CONTRACTORS LI- CENSE LAW DOES NotAPPLYTOAN OWNER OFAPROPERTYW HO BUILDS OR IMPROVES THEREON. ANO WHO CONTRACTS FOR SUCH PROJECTS WJTHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONT RAG Tons LICENSE LAW.). O IAM EXEMPT UNDER Si B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF DIE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE`MISS LIC. NO. / DATE C — G0- coNTRACTOR v-^ WORKERS' COMPENSATION DECLARATION •,/^.) 3 I HERESY AFFIRM FOLLOWING PENALTY OF PERJURY ONE OF THE FOLLOWG DECLARATIONS! ✓ _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PFOVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. -+� I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 310 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS OOMPENSATJON INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER ��►�'ET-a �' r%✓ 5 Y l �l'1 �`44IL� POLICY NUMBER, OOO'U ! %Nt (MSSECTID WMNOTBEOO.PLE7EDOFTIEKAWTISFOROIEKPMDDMLNS(SIOO)CRLM 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSAr10N LAWS OF CALIFORNIA A.ND AGREE THAT IFI SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 370 OF THE LABOR CODE.I SHAdLFOI THWITHOOMPLY WITHTIIOSE P ISIONS. DATE: I3 '20OV APPLICANT: -� C WARNING: FALURETO SECURE WORKERTCOMP NSATON COVERAGE IS UNLAWFUL. AND SMALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS (FIo0,00). INADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRA7 UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERPORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30P7. CIV. C.). LENDERS NAME LENDERSADDRESS I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BULDINo CONSTRUCTION. AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR NSPECTION PURPOSES. jZ��re T zrt— foe( (a. c r a PERMITTEE N � r 2aoa '.'��sC�C�lI�—�-G 6�l3 I SKLNAT OF PERMITTEE DATE EXPIRED JUN 191002 PRESS FIRMLY APPLICATION r „ PERMrr % FIX DATE V/ NUMBER p ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR p SIDEISIDE STREET RW ❑ SIDE p PROPOSED USE inc t/0 - g& ^ - � / r n t !x• s NO. DWEL. UNITS NO. - STORIES IC66 EDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ, AREA/VALUATION SFR/ADD,1REM U) .Garage/Carport WPatioMeck L POOUSpa Re -Roof Z J Commercial - m Valuation 5 CC), (:'0 ADJ.AREA OUANTITY DESCRIPTION FEE J 4 U F- U W W w 213 Z E U Z d 2 U W 1 CONSTRUCTION I PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE i SMTP' ENERGY P/C ENERGY PERMIT 8 A t RETENTION FEE: j2 I u PRE -ALT FEE: CITY nr Ill !T�,zn`om Ti AR RT ITT DTrTf: Cl,Tm-ry TOTAL FEES r COMMENTS 1 RECPT. NO. ! �G PAID BY 17 VALDATION WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD --File Copy. GREEN—Applicant's Copy