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Home My WebLink About15-0637 (8) -=-.°'�"�`? .........::.-.. CITY OF DIAMOND BAR •-� ' ; 1 DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES F�NA�p . t �'` 21810 Copley Drive,Diamond Bar,CA 91765 PRESS \`,��,,,�� , (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY BUILDING PERMIT APPLICATION � � APPLICATION DATE: P/C# L JOB SITE ADDRESS G � - fj ` �+ �q /1 z APN LOT TRACT ISSUE DATE:;�/ / �[ �I.� PERMIT# �J � V 4�7 � OWNER IYPE CONST. OCC GROUP: � n ADDRESS \ � S ZONING SEfBACKS � CITY Z P TE . FRONT RW ❑ r APPLICANT ` LG TE . REAR ❑ � n ` SIDE/SIDE STREET RW ❑ � CONTRACTOR ^ � CG � SIDE ❑ I � ADDRESSI / '►�_ � � PROPOSED USE = CITY�LI�''�-P I /�'�1P O E . � ARCH/ENG/DESIGNER � = ADDRESS � #DWEL.UNITS #STORIES #BEDROOMS z CITY ZIP TEL. Q DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION � OWNEH-BUILOER DECLANATION � I hereby affirm under penalty of perjury that I am exempt from the Contractor'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)[Sectlon 7031.5,Business and Garage/Carport I '-� Professions Code:Any city or couMy that requlres a pertnit to construct,alter,Improve,demolish,or repair,any L struclure,priar to its Issuance,also requires U�e applicant for the permit to file a signed statement that he or she � Patio/Deck � is licensed pursuant to the provisions of the Contractor's STate License Law(Chapter 9)Commencing with Section W � 7000 of Division 3 oT the Business and Professions Code]or that he or she is exempt from licensu2 and the basis for � Pool/Spa I � the alleged exemption.My violation of Section 7031.5 6y any applicant for a permit subjects the applicant to a civil penalty C7 = of not more than five hundred dollars($500). ZQ Re-Roof I � U 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 � Contractors'Sta�License Law does not apply to an owner of property who,through employees'or personal ettort,huilds � or improves the pmperty,provided that the improvements are not intended or offered for sale.It however,the building or I � improvement is sold within one year of completion,the Owner-Builder will have the burden ot proving that it was not built � or improved for the purpose of sale.). I � _ (,I,as owner ot the property,am exclusively contmcting with licensed Contracrors to construct the project(Section ValuatiOn: Ad Afea: Z 7044,Business and Professions Code:The Contractors'State License Law does not apply to an owner of property who 1� I � buildsorimprovesthereon,andwhocontractsfortheprojectswithalicensedContractorpursuanttotheContracrors'State QUANTIIY DESCRIPTION FEE I Y License Law.). � U I am exempt from licensure under the Contrac[or's State License law for the following reason(s): � x 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 j year prior to completion of the improvements covered hy this permit,l cannot legally sell a structure that I have built as an w owner-builder if it has not been constructed in its entirety by licensed contradors.I understand that a copy of the applirable n I � law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at I X the following Web site:http/www.leginfo.ca.gov/calaw.html. � I z � DATE: SIGN: � — LICENSED CONTHACTOH'S DECLAMTION � I a I � I hereby atfirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sedion 7000) � of Division 3 of the Business and Professions Code,and my license is in full force and effect. J I � LICENSF� SS�C� LIC.NO.: C � �� z I Z DATE: fANTRACTOR: � � I ¢ WOHI�R'S CO PENSATION DECLAHATION . � I y I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: i � I have and will maintain a Certificate of Consent to Self-Insure for Worker'S Compensation,as provided by CONSTRUCTION: � �Section 3700 of the Labor Code,for the pertormance 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 of the La6or Code,for Z the pertormance of the work for which this permit is issued.My Worker's Compensation Insu2nce Carrier and ELECTRIC: ¢ Poli�y Num er e: • _ , PLUMBING: .�,7 y CARRIERIj ' y �/Ll7`�� MECHANICAL: � PouCYNUMeER� G �� ,� (L �Q��j INSPECTION FEE: n (THIS SECTION NEED NOT BE CAMPIEfED IFhIE PERMR IS FOR ONE HUNDRFD DOLLARS($100)OR LESS). r � .� ISSUANCE: �� = I cer6ry that in ihe pertortnance of the work for which this permft is issued,I shall not employ any person in any manner so as to � bewme subject to ihe Worker's Compensation Lavrs of Califomia.Md agree ihat if I should become sub'ct to the Worker's SM IP: JCompensatio`p visions ction 370 Labor Co ,I�Shall fo ' compty ' hose prov'' . ENERGY P/C: -' 1 DA7. APPUCANT:' m ENERGY PERMIT: I � WARNING:Failure to secure Worker's Compensation coverage is unlawful,and shall s ect an employer to criminal �.Q O y penalties and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of the compensation, RETENTION FEE: = damages as provided tor in section 3708 oi the labor code,interest,and attorney's tees. PRE-ALT FEE: i CONSTHUCTION LENDING AGENCY BSAF: = I hereby affirm under penalty of perjury that there is a Construc[ion Lending Agen�y for the Derformance of the work for � which this permit is issued(Sec.3097,Civ.C.�. ' LENDER'S NAME: = LENDER'S ADORESS: i I certfy that I have read this applicatlon and state that ihe above information is correct.I agree to comply with all city and TOTAL FEES � f�� / � '7 Z county ordinances and state laws relating to building construction,and he2by authorize 2presentatives of this county to COMMENTS: � e�ter upon the above-mentioned property or inspection purp J � � S ZcO�� ¢ PER AM Nn � . � � = OF ERMITTEE �� DAlE RECEIPT# r�� pAID BY:�,�� / VALIDATION: WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy