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Home My WebLink About10741 (5)CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT :nC 21 60 E. Copley Drive Suite 190 (909) (9D9) 860-3195 Fax (909) 861-31-31 17 BUILDING PERMIT APPLICATION JAOBDRIES DS.2071{0 NE Rim 44-x+ APN LOT -✓3 TRACT a OWNER ADDRES - CITY ZIP TEL D -f APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI• CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.68USINE3SAND PROFESSIONS CODE: MIYCITYOR COUNTY WHICH REOUIRESAPERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRAHY aTRUC• TUBE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PRONSIONS OF THE CONTRACTORS LU - CENSE LAW (CFYIPTER S (COMMENCING WITH SECTION 7800) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION ANY VIOLATION OF SECTION 70.71.6 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CMM L PENALTY OF NOT ORE THAN FIVE HUNDRED DOLLARS O L AS OWNEROF 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 (BEC 7041, BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WFO BUNDS OR IMPROVES THEREON, AND WHO DOES SUCH WORKHIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF HOWEVER, THE BUALDNGOR IMPROVEMENT 16 SOLD WITHINONE YEAR OFOCNPLE- TON, TH OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMR THE PURPOSE OF MLLE). OWNEROF THE PROPERTY, AM EXCLUSIVELYCONTRACTING WITH LICENSED CONTRACTORS STRUCT THE PROJECT (SEC. 701/, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACTSFOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TOTHE OONTRAC- TONS LICENSE LAW.I. ❑ IAM EXEMPT UNDER SEC. B. i P.C. FOR THIS REAST DATE OWNER X;2 lrti LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECIMATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION WOO OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVEAND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 4 ISSUED. MY WORKERS' OOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (t secrioNNFFD NOTBECOLFFTIDOFTE PERMIT 6 PORONE HL DREDDOLIAR6 C11W)ORLM 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AD REE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PAOVISONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV. C.). LENDERS NAME LENDER'SADDRESS 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HERESY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE#1 ED!2PRrY INSPECTION PURPOSE P.WONAT.R-E (PRDM w RMITTEE TE '/ PRESS FIRMLY APPLICATION PERMIT �77 / PIC DATE NUMBER ISSUE/ TYPE OCC 6 DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ �+ WROPOSED USE 3 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTIONSO. FT. FACTOR PSF ADJ. AREANALUATION $F AD EM � ¢arape/CBIpDR WOatio0ack V" . PDOVsPm ZAle -Roof :(Ammarcial m Veluallan ADJ.AREA QUANTITY DESCRIPTION FEE U UQ W LU 0 Z m J� a U z U W ONSTRUCTIova - PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUAN A PAn MI Z • Yu ENERGY P/C ENERGY PERMIT SEP i 6 Mir RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY [.IC . VALIDATION WHI I k—wpanment Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --Fie COW GREEN—AppllcenCs Copy CITY OF DIAMOND ®AR INSPECTION RECORD - COMMENTS ECORD COMMENTS-__..-- .. -- _ - _ .- - ---