The URL can be used to link to this page

Home My WebLink About15162 (19)III 1NU►ll ItIU. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY do DEVELOPMENT SERVICES 21660 E. Copley !hive Suite 190 (909) 660-3193 Fax (909) 861-3117 BURRING PERMrr APPLICATION JOBSITE ADDRESS APN LOT TRACT OWNER ADDRESS CITY 6.TEL. APPLICANT TEL CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I FEAEBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLI.1"11 REASON (SEC. 70.71.6 BUSINESS AND PROFESSIONS CODE: ANYCITY OR COUNTYWHKHREOURESAPERMRTOCONSTRUCT,ALTER,APPROVE.DEMOUSK,ORREPAIRANYSTRUC- TURE, PRIOR TO ITS 6SUANCE, 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 tM APTER 61DOMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TON.ANY VIOLATION OF SECTION 7081.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (860011: O L ASOWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR GALE (SEC. 70". BUSI- NESS AND PROFESSIONS DOD& THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BULLS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERGELF OR 7HR000H HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORBALE IF IOWEVERTHE BALING ORIMPROVEMENT DSMD WFTHN ONE YEAROFCOMPLE- TON, THE OWNER'SUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEI- o L AS OWNER OF THE PROPERI Y,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 704. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR($) LICENSED PURSUANT TO THE CONTRAIL TOA.. LICENSE LI1W L 01 AM EXEMPT UNDER SEG S. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER S (OOMMENCNG WITH SECTION 70M) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS ^ `e ' q3- Bg- LIC. NO. S I DATE ` �' -2N ® 0 CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 7700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION W 57000E THE LABOR OE. FOR THE PERFORMANCE I THE WORK WNI6T7 THIS PERMIT 15 ISSUED. MYWORK ' P APSA �^ CARRIER AND ICY NUMBER ARE. CARRIER POLICY NUMBER (TM SECTION NEEDNOTBE COLPLETEDOFTIEPER I T IS FOR ONE HINDREODOLLPRS MOD)OR LESSI I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA 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 SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (6100,W0), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37DI OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE 0 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3007, CIV C.). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I NAME READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I 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-MENTIONED PROPERTY FOR INSPECTION PURPOSES. v PERIIITTEENAME(PRI C _ SIGNATURE(/ NATVRE OF DATE ma PRESS FIRMLY APPLICATION 6-O PERMU 51 jg P/C DATE NUMBER III ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE • NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADN. AREA/VALUATION SFRIADD/REM Garage/Carport WPatWDsck LL POOVSpe Z Re -Roof d QCommercial Valuation OW ADJ.AREA QUANTITY DESCRIPTION FEE Q 2 F W W 0 2 a U 2 a U2 W CONSTRUCTION T ✓_D PLAN REVIEW ELECTRIC ° "I' 7 PLUMBING MECHANICAL INSPECTION FEE `! ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 1 / COMMENTS RECPT. NO. V 1 PAID BY VALIDATION WHITES -Department Copy, YELLOW—FNtance Copy, PINK—Assenor Copy, GOLDENROD—File Copy, GREEN—App! nt's Copy