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Home My WebLink About14963 (20)06 0 w w O -o 0 .y or O N Z �Y 3 IA.. F5 CIL. W O U w en 0 wwr D LU W CD CD Cn ff O w J O d W U. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suitc 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS x'31 63 �" APN - - LOT TRACT OWNER g=o .14 0 LOL',7.-D+JL) ADDRESS CITY V_KN 11.19 P_1,0'- ZIP TEL.96 4 - APPLICANT TEL." CONTRACTOR lCAii COdI. -- ADDRESSj& A,AC7j CITYLfGTf�7� ZIP TEL ay4�O L ARCRIENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANYCITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCLALTER. IMPROVE, DEMOLISH, OR REPAIRANY STRUC- TURE, PRIOR TO RS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE M LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LJ• CENSE LAW (CHAPTER 9 (OOMMENCNG WITH SECTION T000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS000E70RTHAT HE OR SHE IS EXEMPT THE RE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF HOT MORE THAN FIVE KINDRED DOLLARS (ISM). 1: 0 L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WOW, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 70". BUST. NESS AND PROFESSK)N9 CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WAD 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 OA OFFERED FOR SALE IF,IIOWEVERTHE BUILDING OR IMPADVEAIENTtS SOLD WIT4N ONE YEAROF COMPLE- TION, THE OWNERNYJILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7014, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCO TRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW). O 1 AM EXEMPT UNDER SEC. S. l P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION IHERERY UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0 CND WITH SECTION 7000)OF DMSIIN3OF THE BUSINESS AND PROFESSIONS CODE, AND L 5 LS N FULL FORCE AND EFFECT. ENSE CLASS/_ Z� C. LA0.T,7 DATE X /l oLl CONTRACTOR PtO F WORKERS' COMPENSATION DECLARATION 1 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' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAYEAND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37000 TNELABORCOOE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS LSSU MYWORKEASCOMP NSATION INSURANCE CARRRRIERAND POLICY NUMSERARE: NUMBER �Y .► (MS SECTION NEED NOT BECOMPLETEDOFT/E PERMFT IS FOR ONE HUNDREDDQWUS(SI(C)OR LESS} I CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CCOZ1 SHALL FORTHYATH COMPLY WITH THOSE PROVISK)NS. DATE: T� APPLICANT: WARNING: FAILURE TO SECURE WOAIERS COMPENSATION 0PI.TOAGE3ASPROVIDEDIFORIN UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND C NE HUNDRED THOUSAND DOLLARS (3100,00]), N ADDITCH TO THE COSTOFCOMPENSAT SECTION 7700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 300. CN. C). LENDER'S NAME LENDERSADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. m PERMrTTEE NAME (PRINT) Q N C70 SIGNATURE OF PERAOTTEE DATE APPLICATION PERMIT q '3 P/C DATE NUMBE 8 ISSUETYPE OCC DATE 5- 16 —Oy CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Tn Garage/Carport W Palio/DDCK LL PooVSpa ZRe -Roof OJ Commercial - M Valuation ADJ.AREA OUANTITY DESCRIPTION - - FEE U 0 W J W a _2 3 ZLJ oi.J C�D/JDt�rtsfi� �/o z 0Lu J. C_v CONSTRUCTION PLAN REVIEW ELECTRIC, PLUMBING MECHANICAL INSPECTION FEE A GI ISSUANCE SMIP ENERGY PIC ENERGY PERMIT Tn 1AM Th n 1JINGA T� RETENTION FEE: Nin PRE -ALT FEE: - 1 TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE—Department Copy. YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy