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Home My WebLink About15011 (32)C^� INN1y11l1U Ii,U. t; CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 13UELDING PERMIT APPLICATION JOSSITE ADDRESS 15 Kr APN LOT TRACT OWNER ADDRESS CITY QV - ZIP gEL APPLICANT _ TEL 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 L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANYCITY OR COUNTY WHICH REQUIRESAPERMITTO CONSTRUCT.ALTER IMPROVE, DEMOLISH, On REPAIRANY STRUO TURF, PRIOR 70 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 LAV (CHAPTER 0 (COMMENCING WITH SECTION 70DO) OF DIVISION 3 OF THE BUSINESS AND PRO- !SESSIONS RO•! ESSIONS CODE)OR THAT HE OR SHE IS EXEMPTTHEREFRO I AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICArr FOR A PERMITSUBJECTS THE APPLICANT TO ACRAL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (8500).k AS OWNER OFTHE PROPERTY,OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS OWE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVESTHEREM. AND WHO DOES SUCH WORK HIMSELFOR 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 18 SOLD WITHIN ONE YEAROF OOLHPLE- TION, THE OWNER-SIRDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT SUM OR WPROVE FOR THE PURPOSE OF BALE) ❑ 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC, 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES MOTAPPLY TO AN OMER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WNDCONTRACTS FOR SUCH PROJECTS WITH AODNTRACTOR(S)LICENSED PURSUANT MTHE CONTRAC. TOMS LICENSE UAW.). O 1 AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER a(COMMENCING WITHSECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LS N LICENSE IFULL FORCE MID EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ I HAVE AND WILL MOUNTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS OOMPENSATON INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER "SECTONNEED NOT BECOAVLETEDOFTFE PERIAT c FOR ONE HUNOREDDOLLARS (111100)OR LESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, I SHALLNOT EMPLOY ANY PERSON IN ANY MAKER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT lb THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR 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 M CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS 16100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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 1513SUED (SEC. 3007, CIV C.). I LENDERS NAME LENDERSADDRESS i I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMAT4UPONTHE I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELAT CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EN ABOVE-MENTIONED PROPERTY FORT SPECTION PURPOSES. 1 � PERMITTEE NT) 1 1 S URE fW PERMITTEE DATE PRESS FIRMLY APPLICATIO /"/n '�j� J P/C /� 1r 1 NPERMITUMBER— It v 6 y DATE VV `"' NUMBER ✓✓ 1 ISSUETYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE PROPOSED USE NO. DWEL. NO. NO. -t/&-W UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM N Garage/Carport W PatiolDeck =� PooVSpa z RB -ROOT Commercial 5 m Valuation 2 ADJ.AREA QUANTITY DESCRIPTION FEE J Q - U_ U W J W C9 2 m J CL U Z Q U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE MAY 2 6 2000 t ISSUANCE CITY OF�DIA'.N��TTI BAT? SMIP BUI DING Ik z�A qy l �� ENERGY P/C U 1irLii`I ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES '- COMMENTS . G6 f RECPT NO. 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