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Home My WebLink About19075C LL Z L U. r c G LL ll CL C a 13 TSZ 5 F- a 13 C i F CITY OF DIAMOND BAR V DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive PRESS (909) 860-3195 Fax (909) 861-3117 BUILDING PERhUT APPLICATION FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER cl/LING f d'�'i�G�r a ADDRESSA- Q,4T Ll�i . ate/. CITY �j2r�L-I"�ta1'BdC' ZIP 9i7STEL.�9�fJ��l� APPLICANT : ( %j r7Gt (1 d TEL. aT,I -W -414 CONTRACTOR _ ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. �'•`"�� OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U, CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PF_RMITTO CONSTRUCT,ALTER, IMPROVE, DEMOUSH,OR REPAIR ANY STRUC- TURE, 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 LAW (CHAPTEH 9 (CUMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSK)NS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($SW).); ❑ 1. AS OWNER OF 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 (SEC. 70AA 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 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 OFCOMPLE- TKMI, THE OWNEROUILDER 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 LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LF CENSE LAW DOES NOT APPI-V TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. S. & P.C. FOR THIS REASON ATE // 0 ' OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECORATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION 37W OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. CARRIER POLICY NUMBER _ (IRIS SECTONNEED NOT BECMU- EDOF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($I001 OR LESS), I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TOTHE WORKERS' COMPENSATION LAWS OF CALIFORMA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: _. _ APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN I SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSLENDING AGENCY FOR THE PERFORMANCE OF THE WORK WA WHICH THIS PERMIT IS ISSUEDUED (SEC. 3097, CIV. C.). I LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING S CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. i J i PERMITTEE N IN Eu ,jz G U OF PERMITTEE DATE APPLICATION I d 1j^�PERMIT ��(� DATE UMBER COLS V # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW O REAR SIDEISIDE STREET RW ❑ SIDE O PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport WPatio/Deck LL POOUSpa Z Re -Roof Commercial to Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q T-) Q U W W 0 Z m CL a J Q _U Z Q 2 W 4 1y1 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES Ut COMMENTS RECPT. NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor COPY, GOLDENHOD—Hie L:opy, GREEN —Applicant's copy 1 : i C . s ff a S I i iw 3 i 1 CTI'1' OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERNIIT APPLICATION PRESS FIRMLY v; 0 0 0 w z 9 z 0 0 w 0 w rn rn 0 0 w U Z W 0 V 0 Z t' Z 0 d 0 H H U W D Z Q W Q D J r'-] Q W C7 WHITE -Department Copy, YELLOW --Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy