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Home My WebLink About14957 (34)1 _ CITY OF DIAMOND BAR ^ DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS._ APN LOT TRACT OWNER 2, - ADDRESS iL CITY IP TELTVI C, APPLICANT TEL / CONTRAC R ADDR SS- CITY � S CITY ZIP TEL. ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT i AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FORTHE FOLLOM AIG REASON (SEC. 7431.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY NMICH RTOUIRESAPERMITTOCONSTRUCT ALTER IMPROVE, DEMOLISH, CR REPAIRANYSTRUC- TURE, PRIOR TO ITS RSUANCE, ALSO REOUNES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. CENSE LAW (CHAPTER" (COMMENCING WITH SECTION 7000) OF DIVISION 3 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 7037.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (8500)J: O 1, AS OWNER OF THE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUSI- NESS AND PROFESSIONS OODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BU LOS 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 FORSALE IF, HOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE. TION, THE OWNERBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D 1, AS OWNEROF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHDOONTRACTSFOR SUCH PROJECTS WITHACONTRACTOR(S)LICENSED PURSUANT TOTHF-00NTRAC- 7GNR5 LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. 5 P.C. FOR THIS REASON DATE OWNER _ LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IMI LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE 15 N FULL FORCE AND EFFECT. UCENSISWSS 3— LIC. NO.Q—Lr DATE — ck gn, CONTRACTOR WORKERS' COMPENSATION DECLARATIO I �� I HEREBY AFFIRM TINDER PENALTY OF PERJURY ONE OF THE FOLLOWING^CLARA N . _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO BEL -INSURE RWORKER' OOMPENSATION.AS PROVIDED BY SECTION 370DOF THE LABO CODE,FORTHE PER RLIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WALL MAINTAIN WORKERS' COMPENSATION INSURAICE, 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH PE M. S ISSUED. MY WORK SrSATION IN TRANCE CARRIER AND POLICY BER ARE. CARRIER POLICY NUMBER fFMSEMM EMNOTBEODMPLET;OOFTHEPEFMt BFC NE HUNDRED DO 010D) ESSy I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FO WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS O BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA ANDA IEE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' CCMPENSATON PROVISIONS SECTION 3700 OF THE LASO CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (8100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THE RE B A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED IS EC 3087, CIV- C.). LENDER'S NAME LENDERBADDRESS I CERTIFY TWIT 1 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#fENTONED PROPERTY FOR INSPECT PURPO S. PERMITTEE NAME (PRINT) 65v SIGNA RE OF PERMI E �� AT PRESS FIRMLY APPLICATION PERMIT P/C DATE NUMBER 0 ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW p REAR p SIDEISIDE STREET RW SIDE p PROPOSED USE. ZSsS NO. DW L. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Palio/Deck LL POOVSPa ZRe -Roof gCommercial - Valuation ADJ.AREA QUANTITY III DESCRIPTION FEE J Q U V w UU C7 2 m J Q y CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBIN M NICAL INSPECTION FEE ISSUANCE SMTP ENERGY PIC ENERGY PERMIT RETENTION FEE: p�TT11 of ANIWOND� BAR PRE•ALTFEE: TATTY � G ANRIW- E TOTAL FEES /a3 COMMENTS RECPT NO. PAID BY VALIDATION All -14 WHITE—Department Copy, YELLOW—finance Copy, PINK Copy. GOLDENHULP telae Copy, GREEN --Applicant's Copy