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Home My WebLink About15-0354 �R. _,,....... _ CITY OF DIAMOND BAR �' ' ' ��D • •.,:�. ,. *_. , ,: DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _. _ - 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 i JOB SITE ADDRESS � � ' � APPLICATION DATE: I P/C# ��—� �� i ISSUE DATE: �I� �a�� PERMIT# �f' 0��! 7 = APN� O UI(.O � TRACT ' � OWNER TYPE CONST. OCC GROUP: � � ADDRESS w'�� ZONING SEfBACKS I � CITY ZIP I��C .TEL. FRONT RW ❑ r APPLICANT '3 `v�� '�S TEL. JI -'zo�-rZGb�i REAR ❑ � � C[ SIDE/SIDE STREEf RW ❑ Q CONTRACTOR J r G� n. SIDE ❑ � ADDRES/S� � �' �y�q PROPOSED USE Gw. - \ S �,y, �'r� = CITY !�,,.1.�t ZIP�'�TEL. �IS�'Z��-�y.� ( N � � l I � � ARCH/ENG/DESIGNER Z L � ADDRESS #DWEL.UNITS #STORIES #BEDROOMS ¢ CITY ZIP TEL. I � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OWNEp-BUILDEH DECLAHATION r 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 next to the applicable item(s)[Section 7031.5,Business and Garage/Carport I '� Professions Cade:Any city or county that requlres a permlt to construct,alter,improve,demolish,or repair,any z struclu2,priar to its iuuance,also requires the applicant for the permit to file a signed sfatement that he or she � Patio/Deck I i Is licensed pursuant to the provisions of the Contractor's State License Law(Chapter 9)Commencing with Section W � 7000 of Divisian 3 ot 1he Busineu and Profeuians Code]or that he or she is exempt from licensure and the basis for � PooVSpa I � the alleged exemption.Any violation of Sec[ion 7031.5 by any applicant for a permit subjects the applicantto a civil penalty Z Re-Roof s of not more than five hundred dollars($500�. 0 I � (�I,as owner oT the property,or my employees with wages as their sole compensatlon,will do L)all of or(J portions � Commercial I • .� of the work,and the structure is not intended or offered for sale(Secfion 7044,Business and Professions Code:The m I ZContractors'STate License law does not apply to an owner of property who,through employees'or personal eftort,builds y or improves the property,provided that the improvements are not intended or oftered 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 property,am ezclusively cont2cting with licensed Contractors to construct the project(Section Z 7044,Business and Professions Code:The Contractors'State License Law does not apply to an owner of property who Valuation: bn Adj.Area: I n buildsorimprovesthereon,andwhocontractsforiheprojecCswithalicensedContractorpursuantrotheContractors'State QUANTITY DESCRIPTION FEE I License Law.). / _ I � (�I am ezempt from licensure under the Contmctor's State License law for Me following reason(s): a � � � Ll � 1' By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one w ,I � year prior to completion of the improvements covered by this permit,l canno[legally sell a structure that I have built as an w owner-builder if it has not been constructed in its entirety by licensed contractors.I undersTand that a copy of the applicable I � law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at I � the following Web site:http/vnvw.leginfo.ca.gov/calaw.html. � I z = DATE: SIGN: � — LICENSED CONTRACTOR'S DECLAMTION � I a I y I hereby affirm 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 � LICENSE C S: � L1C. 0.: Z(O/%�[ . z I �� = I z DATE: I �� CONTRACTOR� -�� .c�-� c.i'[st_. Gs� � ¢ WOfl1�H'S COMPENSATION DECLAMTION � • I y I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWWG DECLARATIONS: I � I have and will maintain a Certificate of Consent ta Self-Insure for Worker's Compensation,as provided by CONSTRUCTION: �� 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 6y Section 3700 of the La6or Code,for Z �e pertormance of the work for which this permit is issued.My Worker's Compensation Insurance Carrier and ELECTRIC: /�.q�� ¢ PolicyNumber�aj � PLUMBING: ZCARRIER �+t (r/ isrr.r,"<' �7.� � MECHANICAL: � POLICYNUMBEfi ��3,��' lo�?�D i Q I INSPECTION FEE: � (TFiIS SECIION NEED NOT BE COMPLEfED IFTHE PERMfT IS FOR ONE HUNDflED DOLLARS($10(p OR LESS�. = I cer�fy that in the perfortnance of the work for which this permft is issued,I shall not employ any person in any manner so as to ISSUANCE: � f � become subject to the WorkeYs Compensation Laws of Califirnia.Md agree that if I should become subjed to the Worker's SMI P: _ ,�Q � Compensation��visio sMSection3700ofthe rCode hallforthwith�l�pmvisions. ENERGY P/Q J � DA7E: l APPUCAN7: ENERGY PERMIT: I � WARNING:Failure to secure Worker's Compensation coverage is unlawful,and shall subject an employer to criminal ipenalties and civil fnes up to one hundred thousand dollars($100,000),in addition to the cost of the compensation, RETENTION FEE: � / v^ I � damages as pmvided for in section 3708 of the labor code,interest,and attorney's fees. PRE-ALT FEE: i i CONSTRUCTION LENDING AGENCY BSAF: ,�.�p I y I hereby affirm under penalty of perjury that there is a Construction Lending Agency tor the performance of the work for � which this permit is issued(Sec.3097,Civ.CJ. � LENDER'S NAME: Y LENDER'SADDRESS: i I cer6fy that I have read this application and state that the above information is correct.I agree to comply with all city and TOTAL FEES q�7•� �/►�//r/ Z county ordinances and state laws relating to building construdion,and hereby authorize representatives of this county to COMMENTS: � 6 � enter upon the above-mentioned property for inspedion purposes. � � - n ��K� �k' ¢ PERMITTEE NAME(PRINn � � �! � ' ^,�1 ,�r p ,� � '] O� -1 a � � � � � VALIDATION: = SIGNATURE OF PERMITTEE DATE RECEIPT# PAID BY: WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy �� CITY OF�D�/��l4OND BAR . INSPECTION RECORD e � � , . � o . � � , � . SETBACK/LEfTER • = TRACTAND LEDGER ,�,�.��,., > . _ SWITCN GEAR FOOTINGS FORMS �