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Home My WebLink About15082 (22)CITY OF DIAMOND BAR EXPIRED DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 0 C T Z PRESS (909)860-3195 Fax(909)861-3117 5 1002 BURMING PERMIT APPLICATION FIRMLY JOBSITE '" ADDRESS S h h le APN LO TRACT OWNER ADDRESS 1 z CITY D_jw&j IPAl7g.r TEL -&70Z APPLICANT TEL.G1 !j(PS'Be zo CONTRACTOR Ey Un tc�iiS..J ADDRESS 14 ZgDn '�w.n K , % CfTY Pem.,linj ZIP TEL.f, `fks_$e%Z ARCFVENG1 DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I NEREBY AFFIRIA UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSNESSARD PROFESSIONS COOE.ANY CITY OR COUNTY WHICH REGUNES APERMrTTO CONSTRUCT,ALTER. IMPROVE.DEMOUSH, OR REPAIRANY STRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER a (COMMENCNCI WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS WOE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED MMP- T10N. ANY VIOLATION OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (6600).): 13, LAS 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. 7044.BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND VMO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFEREDFORSALE IFHOWEWR,THEBULDNGORIMPROVEMENTISSOLDWRHNONEYEAROFCOMPLE- TON, THE OWNERBUIWER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} O t AS OWNEROF THE PROPERTY, AM EXCLLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLYTO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAO TORS LICENSE LAWI. O 1 AM EXEMPT UNDER SEC. B. a PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION TWO) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS �Z7 LO. NO. 71 rtV a DATE G /'�/ Z"" CONTRACTOR' WORKERS' COMPENSATION DECLARATIO 1 HCREBY AFF1RM TINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENt TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTICN VW OF THE LABOR CODE, FOR THE PERFORMANCE V OF THE WORK FOR WH(N THIS PERMIT IS ISSUED, I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37000E THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOOR'KE�RS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER ! ✓rT O �N-t �^ I, POLICYNUABER G12 R2T (M56ECRONHEEDNOTBE Cd.RETEDOFTHE PERMIT IS FORCHE WtD REDOOLIAnS (5100)CRLESS) 1 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 TO TME WORI(ERS' COMPENSATION LAWS OF CALIFORNIA UL AND AGREE THAT IF 1 SHOD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROMS S OF SECTION 3700 OF THE LABOR I SHALL FORT�MI�COMPLY WITH TH P NSIONS. DAn�lk� Z' gAPR'LICANr. WARM FA.URE TO SEWRE WORKERS' PENSATON RAGE IS UNLAWTkAND SHALL BE SUBJECTAN EMPLOYERTO CRIAAVAL PEN TIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 370E OF THE LABOR CODE, MEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i I HERESY AFFIRM LNOER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION . 097. NG AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 70Y7, CN. C.). LENDER'S NAME LENDEMSADDRESS I 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDNANCES AND STATE LAWS RELATING TO BUILDING yCONSIRUCTION.AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTERUPON THE ABOVE.MENTONED PROPERTY FOR INSPECTION PURPOSES. L N MN vj i � PERMITTEE w SIGNATLIR OF FERMITTEE DAM APPLICATION UU PERMITP/C /1/, DATE NUMBER N ISSUE 10_/Yj ` ' TYPE - ' . OCC DATE V CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ 7_8 6 a•�<"� PROPOSED USE P�L'Fti NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRtADDIREM Garage/Carport W Palb/Deck LI" PooUSpa 0 Z Re -Roof 0 CO I - Tuu- m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U W LU W 0 Z m J o. J U 2 a x U W CONSTRUCTION PLAN REVIEWS F ELECTRIC PLUMBING MECHANICAL!8 INSPECTION FEE �Jo ISSUANCE SMIP v ENERGY PIC �•� - j yr MOND P AD ENERGY PERMIT .Ulil RETENTION FEE: u � 111 `J AND IZ,=m4 PR TOTAL FEES /5777 F DG Ni$ 41" h till RECPT. NO. PAID BY - VALIDATION / I WHITE—Dep6Kment Copy, YELLOW—Finance copy, PINK—ASSBSSO LiM, uuwt;Nm n ue A opy, um=n nppi0 n%s wiry