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Home My WebLink About17008 (40)CITY OF DIAMOND BAR DEPARTMENT OF CON04UNITY & DEVELOPMENT SERVICES I rc 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY ADDRESS 22.9 2} ADDRESS_ L TYPE OCC ISSUE�� n `I 6/' ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ F-1 SIDE ❑ APN LOT - TRACT -}�— OWNER Uj:K /L I ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY' ZIP �2Q7 TEL.15J ��l ARCH/E GI DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER P NALTY OF PERJURY THAT] AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOFIT FEASON(SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR THE FOLLOWIN'FE COUNTYWHICHREOUIRESAPPIR ITTO CONSTRUCT, ALTER. IMPROVE. DEMOLISH, ORREPAIRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, F LSO 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 9 (COMMENCING", WITH SECTION 7300) OF DIVISION 3 OF THE BUSINESSAND PRO- FESSIONSCODE) OR THATHEOR �HE IS. EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION7031.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (III 0 I, ASOWNEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYVJHO BUILDS OR IMPRQVES 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, �PE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAROF COMPLE TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). LAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTSWITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- ONTRACTORS TORSLICENSE LAW.). ❑ I AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 700)) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. qq d LICENSE CLASS C f0 LIC NO. ''it J" oy. DATE /J I CONTRACTOR. WORKORS'COMPENSATION DECLARATION ONE OFTHE FOLLOWING 1 HEREBYAFFIRM UNDER PENALTY OF PEDECLARATIONS:-] �RJURY HAVE AND WILL MAINTAIN A CER, TIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROV'DED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH, THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIf WORKERS'COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' CyMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICYNUMBER I __''. I THIS SECTION NE®NOT BE��,COMry.EiED OFTHE PERMIT IS FOR ONE HUNDRED DOLLARS (51 D3)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF TFE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSO IN ANY MANNER SO AS TO BECOME SUBJECT TO THE EMPLOY WORKERS' COMPENSATIO LAW OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT-ToTHE WORKS PENSATION PROVISIONS OF SECTION $700 OF THE LABOR CODE, 1 SHALL FORTHWITH COM LY WITH THOSE PROVISIONS. DATE: APPLICANT; WARNING: FAILURE TO SECURE WORKE S' COMPENSATION COVERAGE ISUNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYEfl TO CRIMINfNAL PgJ}NALilES ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAflS (51 MOM) IN ADDITION TO TH5 COST OF COMPENSATION, DAMAGESAS PROVIDED FOR IN I SECTION 3705 OF THE LABOR COD!, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS isSUED (SEC. SOU, CIV. C.). I LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLI TION AND STATETHAT THEAROVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CIT1� ANCOUNTY ORD:'NANCE$ AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. f � ,, ",d,. : /"A-, 3 PERMITTEE N PINT) - v PLAN REVIEW SIGNAr PERM, EE DATE APPLICATION C%' '} PERMIT P/C DATE D L NUMBER TYPE OCC ISSUE�� b DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ F-1 SIDE ❑ e C759CG oyl PROPOSED USE DeCl NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION` SFR/ADD/REM co Garage/Carport WPatio/Deck V- Pool/Spa 0 Z Re -Roof 0 Commercial - 5 m Valuation ADJ,AREA QUANTITY DESCRIPTION FEE _j Q U U W w 0 Z DO J EL Q U_ Z 4 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL SPECTION FEE _ 0o 186w, BE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: _ TOTAL FEES VZA , C9 COMMENTS RECPT NO. PAID BY VALIDATION � WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy "IC 111 ll�,iiZF�';Y&') A WAR M =jQgmjxz CTIMA Aw", "-Vyg 0 0" 1::d d""A"TWom- -mm"mmy-sy —or -rn-nm,- v -w Mww vir xv"=*jjD' 1 Am-mv.-Ig w ..Ov itll Aj TH 14 rat? FLO COMET . ....... . . . . ....... ....... — ----- wyawlym ....... WOMAN ay p c"aE.i --- -----------.. . . . ...... 32K FWANC Q WZ . .. . . ........ ------ — ------ , MAN ------ . ........ . .. . ..... GASA, P TEW DEP 11 L. P� - - - -- - - - - - "IC 111 ll�,iiZF�';Y&')