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Home My WebLink About15065 (8)r 0 C.1 w zd Lu Lu or O in UJIZ V CL 0 Z Uj Uj ¢ 3 co LL O U W co Cn 0 0 f— Q �Z 4 0 W Z C:3 to W LJ_. J Cr I CJ_ O CC Z ¢ W LL U Z im J_ Go Go Q Cn CO h _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES _w 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 w`?�",.. BUILDING PERMIT APPLICATION ADDRIESS (e� i ^ "-�� '4/� b o APN! OWNER CITY DESIGNER CITY ZIP TEL. OWNER -BUILDER DECLARATION THEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWIRES A PERMITTTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUG TURF, 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 B (COMMENCING WITH SECTION 7000 OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED FXEMP. TION. ANY VIOLATION OFSECTION 7031.5 BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICA14T TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ❑ I,AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATCN, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, 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 MS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED POR SAE W,, HOWEVER THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OF CCMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH L ICENSF_D CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS COO E: THE CONTRACTORS LI- CENSE UW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WH OCONTRACTS FOR SUCH PROJECTS WITHA CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- ToRS LICENSE LAW.). ❑ IAM EXEMPT UNDER SEC. 8, A P,C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER o (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. f UCENS . LASS `S' LIC. NO. '^- -54F DATE . CONTRACTO WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: —1 HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED SY SECTION 3700 OF THE LABOR OODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED RYSECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' OOMPENSATK7N INSURANCE CARRIER AND POLICY NUMBF_R ARE CARRIER PO.K:YNUMBER (PHIS SECTION NEEDNOT BE OOMPLErMOF THE PEPUT IS FOR ONE HUNDRED DCLLAPS(VOO) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WO R ICH EFWI IS ISSUEO, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNE OAST BE ME S TO THE WORKERS' COMPENSATION LAWS OF CALIFO A, AND REE OULD BECOME SUBJE/CT, TO THE WORKERS' COMPENSATIO ROVISI S • N 3700 OF THE LABOR �///C��OD/��,��yySH FORTHWITH COMPLY WITH S IS DATEVCj#: APPLICANT: I i WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I N UL, AND SHALL BE SUSJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T ONEHU REDTHOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DA GESAS ROVDEO FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJJRY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESATATIVES OF THIS COUNTY TO ENTER UPON THE ARl1VF.MFNT1MYFD PRGPFRTY FORINSPECTION PURPOSES. PERMITTEE PRESS FIAMLY APPLICATION✓ / PERMIT P!C DATE v " NUMBER/_ # ISSUETYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ _ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES 13EDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Cn Garage/Carport W Patio/Dock LL PooUSpa ZRe-Rooi Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE V F W J W Z zza4 m Ji J 4 U_ Z Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING if1 i -Y,,I MECHANICAL INSPECTION FEE p g$ �gB B1IN 6"SMIP ISSUANCE V ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES -70 COMMENTS RECPT. NO. f PAID BY VALIDATION PINK—Assessor Copy, GOLDtNHUU--FIIe copy, UrlttN—APpacanrs copy