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Home My WebLink About13020 (14)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 s ' OWNER ADDRE S CITY ZIP TEL. APPLICANT TEL. CONTRACT ADDRESS CITY ZIP 9j -'7—b? -TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER43UILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTT WHICH RECIJRESAPERMITTO CONSTRUCT,ALTER IMPROVE- DEMOLISH, OR REPAIRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT TWIT HE OR SHE O LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7600) OF DIVISION SOF THE BUSINESS AND PRO - REASONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM MID THE BASIS FOR THE ALLEGED EXEMP- TgN.ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACRAL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS (3600)-): OI, AS OWNER OF THE PROPERTY, OR MYEMPLOYEES WITH WAG ES AS THEIR SOLE COMPENSATION, WILL WDO THE WOAND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI- NESS AND PROFESSIONS CCE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYWHOSULDOR 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 WITHIN ONE YEAR OF COMPLE- TION. THE OWNER43UILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O I,ASOWNEROFTHE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044, BUSINESS AND PROFESSIONS LODE THE CONTRACTORS LF CENSE LAWDOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUSDS OR IMPROVES THEREON, AND WHOCONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTOTa:OONTRAC- TORS UCENSE LAW-). ❑ 1 AM EXEMPT UNDER SEC S. i P.C. FOR THIS REASON NATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER a IOMWENciNG WITH SECTION TOW) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FLAW FORCE AND EFFECT. LICENSE CLASS�11 C LIC. NO. DATE ?+' 10 CONTRACTOR r'51- felbt2 WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WALLMAIN'TAN A CERTIFICATE OF OONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BYSECTION 37MOFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I HAVE AND WALL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSAATTIION INSURANCE CARRIER D P LACY NUMSERARE: CARRIER POLICY NUMBER (DIE SECTIONNEEDNOT BEOOMPLETEDOFTE PER MITIS WRONE MACRFDOM ARS(S700) OR LESSI I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALLNOT EMPLOY ANY PERSON N ANY MANNER 60 AS TO BECOME SUBJECT TO THE WORKERV COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS• CDMPENSA1PROVIS IONS OF SECTION 3700 HE TABOR CODE.I SHALL FORTHcWITH COMPLY WITPROVISIONS. DATE; 2 _i -d t _1APPLICANT. WAFNING: 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 DOII.ARS (5100,000L NAGDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3101 OF THE LABOR CODE, INTEREST, AND 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. 3017, CIV C.). LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY 44TH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCT , AND HETIESYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOYE-ME ED PROPERTY FOR INSPECTION PURPOSES. it- YvER` ` A I PERMITTEE (PAIN 2 ^ I ) SIGNAe!f,GF PERMITTEE DATE EXP/RED NOV 2 j 1000 FIRMLY APPLICATION PERMIT 3 OZp P/C DATE//�� NUMBER ! ISSUE rr�� TYPE OUP DATE ' "t V. CONST. GROUP ZONING SETBACKS FRONT RW—[D— W❑REAR REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSEDUSE T1�-O it Ft' 1�iDp1�, `Z.g_: • • sc�1�l S1-earh czh'10 NO. DWEL. NO UNITS L STORIES E NO. BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM a) Garage/Carport WPailo/Deck u PoGUSpa ZRe -Roof Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE 9 U 2 F U LU W Z Z m J a Q U Z W U CONSTRUCTION PLAN REVIEW �1 ELECTRIC PLUMBING _ MECHANICAL INSPECTION FEES 1vv Q ISSUANCE -S:) v SMIP Qig ENERGY P/C RV ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID B VALIDATION WHITE—Department COW YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD -4919 Copy, GREEN—Applicant's Copy Fl GSl'F-)F%lS/STEEL. LLECTRIC GROUND P L LIMPING SLAB GRADE j:-'tj [71 OWE WATER SERVICE . ... .... ......... . ... ...... R,,X' SHE;vn-IING FRAM LIA i .......... �11VCD7 (',()vl-.R R.)!JG!l eff-P-71ING ROUGH ELECTRIC R:,)UGI-1 PLUMBING SHOWEr-AF1 UB TEST ... . . .. ........ �J'1.1 HI'S'd DING iNSULAPON CEILING 1'11'7,ULATION 0 R'ArVA 1..i_ N I'd I., I N Gi .... ... .. ..... . ....... SEPTIC IIANK . . ..... ....... 'E Pi T -1-INST I 4A'- HEA! HAG .......................... . ............ . ...... - F RIG' ... . . ................ EI'? 1 C TANK SIZE pl— tU slZf-- CITY OF DIAMOND BAR INSPECTION RECORD