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Home My WebLink About14671CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS ' BUILDING PERMIT APPLICATION FIRMLY JOBSITEa ADDRES L -Y APN LOTS RA T OWNER I.5 [-' ADDR CITY T Y APPLICANT CONTRACT e ADDRESL CI % ZIPGG� ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY 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 UW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ❑ 1, AS OWNER OFTHE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSb 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 HIMSELF04 HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED RORSALE. IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROFOOMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE UW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND VMO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE 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 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FUL FORCEAND EFFECT. D LICENS GLA LIC. NO DATE _ ��, CONTRACTOR- WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY CNE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _,1 HAVE AND WILL MAINTAIN 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' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER. POLIrYNUMSER (THISSECTI iM NERD N01 BE ODMPLE TEDOFTHE PERMIT IS "ONE HUNDRED DOLLARS ($100) OR LESS) I CERTIFY THAT M THE PERFORMANCE OF THE WORK F WHICH THIS P IT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANYMANNF.R S RECO _.,U CT TO THE WORKERS' COMPENSATKIN LAWS OF CAUFORN11 , AND REE T OU BECOME SUBJECTTO THE WORKERS'COMPENSATION OVIS SOF 37000E THE LABOR CODE, HALL/,R'T�H''W�ITM COMPLY YATHT SGP Vlu^IO DAT `-^'�/ APPLICANT, _ s WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAC IS U AWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP DONE NOREDTHOUSAND DOLLARS JS100,NX), IN ADDITION TO THE COST OF COMPENSATION, AMAGE AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FE S. CONSTRUCTION LENDING AG 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. 3097, CIV. C.). LENDER'S NAME ____ LENDER'SADDRESS _- CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFCRMATON IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTTRIUCCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOV E NED PROPERTY FOR INSPECTION PURPOSES. � PERMIT7 SNAM ' SINT Af 1 SIGrRIEOFVEFy P DATE APPLICATION j) d7 PERMIT I /�� P/C DATE NUMBERI �e # ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR O SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT, FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport W Patio/Deck W LL- Pool/Spa Z Re -Root J Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U W w d J Q U Z Q S W rd CONSTRUCTION PLAN REVIEW ELECTRIC PLUNIBIN MECHANICAL 31111 !n INSPECTION FEE ISSUANCE �• SMTP _ MMAQ 2000 ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT NO. 1 PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy �-' `31711-Y OF PlAfivIr.11ND BAR INSPECTK N RECORD ......... . . . .. .... .... . ... ... . ... . ....... . I, �A -AR DE CIM -PLACE ON ---------- -- ........ . . Fid, --PLA-C-: BOND R-Af . .. ....... .. ..... . . ------- F7 SOND BEAIM .100�1 . ...... . . ......... - ----- i:'!,W KND SFAM 5, - - -_--------- PRE-GFIADM R 5ENCHIN33 9 !RH x D'N� EL j,30C.L -FOMIC, rZ V' A'J INOIJUATION L, RNA, . ....... ...... M P-_ u Dt=C T ION,s ... . ...... ....... . . . ........... . ... ...... . ------ ... ...... . .. r- q --- -- ------------- T ----- -- . ...... . . .... .... ... B-D-Ril-I U,tl P L "'A Ei !,j E tj F RGY ---------- -tv a ..... ....... a to -- -------- .. ..... ... .. . . . ........ .. .. . ... ... . . .. .... ........ .. .......... .. . . .... .