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Home My WebLink AboutPR 11-1639CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 Copley Drive, Diamond Bar, CA 91765 r (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION E ADDRESS 9' ,0q nf r ADDRE APN LOT ACT OWNER cS AD ESS CI 1 APPLICANT ` T CONTRACTOR a ADDRES CITY ZI T ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 70.31.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRES A PERMIT TO CONSTRUCT ALTER, IMPROVE DEMOLISH, OR REPAIR ANY STRUG TURF PRIOR TO ITS ISSUANCE, ALSO RECUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF OMSION 7 OF THE BUSINESS AND PRC- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXENP- TION. ANY VIOLATION OF SECTION 7W1.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): 1. AS OWNER OF THE 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. 704A, BUSI- 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 HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WnH W ONE YEAR OF COMPILE. TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS I.I. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A COTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). I AM EXEMPT UNDER SEC. 8. A PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS 3 LIC. NO. DATE CONTF C' T WORKERS' COMPENSAT CATION 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 WORKERS' MPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORT FOA 5'h11CH THIS PERMIT IS ISSUED. IH AVE 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 WORXERS' COMPENSATIO—N (INSURANCE CARRIEjTya.ND OLpICY NUI.!BER ARE CARRIER _ C6-4 11 C 1 I W" I Z POLICY NUMBER i/ro PHIS SECTION NEED NDT BE CO I LETEDOF TIE PERI.Tr IS FOR CNE H1LINCA'D DOLLARS (5100) O7 LEss I CERTIFY THAT M THE PERFORMANCE OF THE WORK FO H IT B D, 1 SHALL NOT EMPLOY WM PERSON IN ANY MANNER TO B O THE WORKERS'COMPENSATION LAPIS OF CAUFO ANDA T HOULD BE SUBJECT TO THE WORKERS'COMPENSAT PROVI N3700 OF LABOR C`/ODE.I SHALL FORTHWITH COMPLY THO S DAT / If APPLIC T. WARNING FAILURE TO SECURE Y!O ERSCO EI75 COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRI.MVN PEN IES VIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS IS 100.000), IN ADDITION TO OST O MPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE INTEREST O ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097 CIV. C.). LENDER'S NAIJE LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDIN CES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY A AI I E REPRE Ajj OF S COUNTY TO ENTER UPON THE ABOVE-MENTIONED P PE FOR INSPECTb FIDOS PERMITTEE N (PRI SIC RE OF P RTE DATE Vv"' "__Department Copy, YELLOW—Finance Copy, PINI PRESS FIRMI V APPLICATIOtJ PERMIT VrOX DATE t J- C I , NUMBER \ \- VP x/ C ISSUE TYPE OCC DATE_ 1 ( p % \ \ CONST. GROUP ZONING SETBACKS FRONT RW REAR 0 SIDE/SIDE STREET RW p SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport WPatio/Deck LL PooUSpa Z Re -Roof 0 Commercial 5 C9 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE JQU ccI— UWJW z JQ- JQU Za2UW CONSTRUCTION V PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. ism_ PAID BY qe$ VALIDATION 1.11 y, UnEEN—r ppucant s Dopy