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Home My WebLink About14920 (20)Im CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION; JOBSITE ADDRESS �•C_-09 APN L T TRACT OWNER ADDR SS CITYZIP TEL. APPLICANT TEL.eCj CONTRACTOR ADDR SS CI ZIP ARCWENG/ 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 (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH REQUIRESAPERMRTO CONSTRUCT,,ALTER, IMPROVE, DEMOLISH, OR 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 LAW (CHAPTER a (COMMENCINO WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSKNIS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORETHAN FIVE HUNDRED DOLLARS ($500).): ❑ I, AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE 13 NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSK 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 IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDINGOR IMPROVEMENT 15 SOLD WITHIN ONE YEAROFCOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID N01 BUILD CR IMPROVE FOR THE PURPOSE OF SALE). ❑ 1, AS OWNER OFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH AOCNTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS IICF.NSE LAW.). 0 1 AM EXEMPT UNDER SEC. _ ,.. B. S P.C. FOR THIS REASON DATE _ OWNER___._— _._—... �— LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CCDF, AND MY LICENSE IS W FULLjLFFOR�CEE D EFFECT. (CENSE CLASS Lim LIC. NO. L ATE y CONTRACTOR—�t WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. IVE AND WILL MAI—!N WORKERS'COMPENSAT!ON INSURANCE. AS REQUIRED BY SECTION .-'.F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 15E NE®NOT RECq.PLElEOOFT)¢PERNST LS FOR ONE HUAO4�DDQIARS IS,m)Oq LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 1551110, 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 TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT:_—__— WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SICG,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30.7, CIV: C.). LENDER'S NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE ION INFORMATIS CORRECT. I AGREE TO COMPLY WITH ALL CITU AND COUNTY ORDINANCFSAND ST EIAWS RF.LA7ING TO BUILDING CONSTRUCTION, AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS OUNTY TO ENTER UPON THE ftE(p FORT PE/CTION`TURPOSF$,�� -. DATE f r� PRESS FIRMLY AP LIGATION PERMIT P/C DATE NUMBER ISSUE r �j TYPE OCC DATE % ~� CONST. GROUP ZONING SETBACKS FRONT , RW U _ REAR F1 _ SIDEISIDE STREET RW , U SIDE F1 PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM In GaragelCarport W Patio/Deck LL Pool/Spa Z Re -Roof Commercial 7 Valuation __ _ "`� _._ AOJ.AREA_..__-. _..____ _ QUANTITY DESCRIPTION FEE y U W W 0 Z m D_ Q _U Z 2 U U, t CONSTRUCTION PLAN REVIEW. -- ELECTRIC PLUMBING __�_� __ -� i•� -p7 MECHANICAL --. INSPECTION FEE f ISSUANCEy" ____Z'/_ SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS ^/ RECPT. NO. 7 PAID BY VALIDATION _ WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy