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Home My WebLink About15-0361 . l � � -::.'�_� CITY OF DIAMOND BAR �y _:-._ _ DEPARTMENT OF COMMLJIVITY&DEVELOPMENT SERVICES 21810 Copley Drive,Diamond Bar,CA 91765 PRESS ,,„� (909)839-7020 Fax:(909)861-3117 Building Inspection HoNine(909)839-7027 FIRMLY �I''�R'' BUILDING PERMIT APPLICATION i JOB SITE ADDRESS ��lo ��/L / APPLICATION DATE: ��l� (.�P/C# I � APN S�bI'63�'OGSLOT TRACT ISSUE DATE: I �J PERMIT# �„�' Q �6 � � OWNER �gIC Lo K Y�`n TYPE CONST. OCC GROUP: I �, ADDRESS I 4.S`(o L.�.��,�/i�e..J� ,j CITYI,�c..�,._...,._f �ZIP �e TEL. ZONING F ONTCKS RW ❑ = APPLICANT S e� S G TEL. Sr��-yl.S-O.S"f� REAR ❑ l, SIDE/SIDE STREEf RW ❑ � CONTRACTOR /' SIDE ❑ � ADDRESS % ��--a H�/L {2c/ , � CITY ZIP b�- TEL. .SG�'��I�3��-�Y 3 PROPOSED USE . ��l XW cJ� ,I �f'al�vt �Y � ARCH/ENG/DESIGNE � �� a `�y�� ADDRESS ��°3.� I #DWEL.UNITS #STORIES #BEDROOMS � z CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I, OWNEH-BUILOEH DECLAHATION Y I hereby affirm under penalty of perjury that I am ezempt from the Contrador's State License Law for the reason(s) SFR/ADD/REM . I � � indicated below by the checkmark(s),I have placed ne#to the applicable item(s)[Section 7031.5,Busineu and Garage/Carport I � Professions Code:Any city or couMy tliat requires a permit to construct,alter,Improve,demolish,or repair,any z struclure,prior to ifs issuance,also requires 1he applicant far ttie permit to file a signed sfatement that he or she � Patio/Deck I i is Iicensed pursuantto the provisions aTthe Contractor's State License Law(Chapter 9)Commencing with Sec[ian w � 7000 of Divislon 3 ot the Business and Professions Code]or that he or she is ezempt from licensu2 and the basis for � Pool/Spa I n the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjecis the applicant to a civil penalty C7 � Z Re-Roof = of not more than five hundred dollars($500). � � (�I,as owner of the property,or my employees with wages as their sole compensation,will do(,all of or(�portions � Commercial I y of the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The m I Z Conhactors'State License Law does not apply to an owner of property who,thmugh employees'or personal effort,huilds � or improves the pmperty,provided that the improvements are not intended or offered for sale.If however,the building or I � improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was not built � or improved for the purpose of sale.). I '� I,as owner of the ro e (� p p rty,am exclusively contracting with licensed Cont2ctors to construct the project(Section Valuation: 2 Ouo Ad Area: Z 7044,Business and Professions Code:The Contractors'STate License Law does not apply to an owner M property who 1� I � buildsorimprovesthereon,andwhocontractsfortheprojectswithalicensedContractorpursuanttotheContractors'State QUANTIIY DESCRIPTION FEE I ,� ucense law.). � U I am exempt from licensure under the Contrador's State License law 1or the following reason(s): � � O� I � � I 1 By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one � I = year prior to completion of the improvemenTs covered by this permit,l cannot legally sell a structure that I have buift as an w owner-builder if it has not been constructed in iTs entirery by licensed contradors.I understand that a copy of the applicable I � law,Section 7044 of the Business and Professions Code is available upon request when this aDPlication is submitted or at I � the following Web site:http/www.leginfo.ca.gov/calaw.hhnl. z I = DATE: SIGN: � LICENSED CONTHACTOH'S DECLAHATION � I d I� I hereby attirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Section 7000) � of Division 3 of the Business and Pmfessions Code,and my license is in full force and ettect. J / �] (/ a � LICENSE CLASS: e-��/C�Y LIC.NO.: /��( z I � DATE: � -�I.�-�I,r CONTRACTOR: <S'Cqt7r'cv�.� � I ¢ WOHI�H'S COMPENSATION DECLAHATION � I y I HEREBY AFfIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: � I have and will mainTain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION:_ �� 7 a. � Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. p�,,,qN REVIEW: > I have and will maintain Worker's Compensation Insurance,as required by Section 3700 ot the Labor Code,fur ;� Z the performance of the work for which this permit is issued.My Worker's Compensation Insurance Carrier and ELECTRIC: t� ¢ PolicyNumberare: PLUMBING: � CARRIER �_��-I.NL C� z MECHANICAL: � POUCYNUMBER G ' 3L�(oo� INSPECTION FEE: r' (THIS SECIION NEED NOT BE COMPLETED IFhIE PERMR IS FOR ONE HUNDRFD DOLLAAS($700)OR LESS�. ISSUANCE: '7/�J � I cerGfy that in the pertortnance of the work for which ihis permd is issued,I shall not employ any person in any manner so as to �p � become subject m the Worker's Compensation laws of Calitomia.Md agree that rf I should 6ecome subject to the Worker's SMIP: J Compensation pmvisions of Sec6on 3700 of the Labor Code,I shall firthwith compty witl�those provisions. ENERGY P/C: � y DATE: APPUCANT: ENERGY PERMIT: � WARNING:FaiWre to secure Worker's Compensation coverage is unlawful,and shall subject an employer to criminal RETENTION FEE:_ /�n y penalties and civil fines up to one hundred thousand dollars(5700,000�,in addition to the cost of the compensation, w� 1 damages as provided for in section 3708 of the labor code,interest,and attorney's tees. PRE-ALT FEE: � i CONSTHUCTION LENDING AGENCY BSAF: 1'Mt y I hereby aRirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for � which this permit is issued(Sec.3097,Civ.C.). LENDER'S NAME: = LENDER'SADDRESS: � i I certity that I have read this application and state that the above information is correct.I agree to comply with all ciry and TOTAL FEES fn.�'�� I I/V � county ordinances and state laws relating to building construction,and hereby authorize representatives of this county to COMMENTS: z � enter upon the above-mentioned property for inspection purposes. J 7 b ¢ PERMI �A E(PRI � ' � � = SIGNA E PERMITTEE�� DATE RECEIPT# PAIDBY� VALIDATION: WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy