HomeMy WebLinkAbout05-314(8) ^ .�,� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
_ 21825 Copley Drive,Diamond Bar,CA 91'765
- (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
��`'•9�'� � BUII.DINGPERMITAPPLICATION FIRMLY
yN, JOBSITE APPLICATION �� ��� �� PERMIT P/C ' ` (��
o ADDRESS DATE NUMBER # ��m �I�- ` �
� ISSUE TYPE OCC
APN LOT ����� TRACT DATE CONST. �"'�� GROUP :, � ��
p OWNER �[��t tm� �t� �t� �� e�«r
� ADDRESS '� � ���5 �,. S°j°' , Sttt°�'E. ZONING F ONTCKS s t�'�"PE � �rl�W�( �Ew�❑ �.�"���°
oCITY ��5�° ZIP `� TEI. '�C�• °t-�"G REAR ❑
p APPLICANT TEL. SIDE/SIDE STREET RW ❑
Q CONTRACTOR SIDE ❑ '
� ADDRESS PROPOSED USE ��� �"�i� C
� CITY ZIP TEL
w ARCH/ENG/
z DESIGNER .���" �'��� �" ��'`�� NO.DWEL. NO. NO.
a ADDRESS G'�a� t�1 �v�°t°�d �� �1�`�� � UNITS �� STORIES���` BEDROOMS �'C�
= CITY t�..U�P��. ZIP �`LfeC�"1 TEL.�$� �tC�I���C.�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
O OWNER•BUILDER DECLARATION SFR/ADD/REM C� Co��
p I HEREBY AFFIPM UNDER PENALTY OF PERAIRY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI• � Gef8Q8IC8R.10f1 ��s�9°� ��
W CENSEUWWRTHEFOLLOWINOREASON(SEC.7031.68USINESSANDPROfESSIONSCODE:ANYCITYOR
C.� CIXINTYWHICHRE�UIflESAPERMITTOCONSTflUCT,AI,TER,IMPROVE,DEMOLISH,ORREPNRANYSTRUC W Patio/Deck ��,� �
WNRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W ' �
� STATEMENT THAT HE OR SHE IS 110EN5E0 PURSUANT TO THE PROVISIONS OF TNE CONTRACTORS LI-
� CENSE UW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OP DIVISION 3 OF THE BUSINESS AND Pfl0• LL' PooVSpa .
. � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISPoRTHEALIEGEDEXEMP-
V TION,ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFOqAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� ACMLPENALTYOFNOTMORETHANFIVEHUNOREDDOLLAFiS(S50o).): '
o ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITH3�'JA(iESASTHEIRSOIECOMPENSATION, 0 Commercial .
Z WILL DO iHE WORK,AND THE STRUCNRE IS NOT INTENOED Oq OFFEREO FOR SALE(SEC.�7044,BUSI- J
� NESSAND PROFESSIONS CODE:THE CONTfUCTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF ? .
PROPEHTY WHO BUILDS OR IMPROVES THEREON,AND VhiO DOES SUCH WORK HIMSELFOR HERSELF OR
� THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m �
WQ OFFEPEDFORSALEIF,HOWEVER7HEBUILDINGORIMPROVEMENTISSOIDWflHINONEYEAROFCOMPLE
,Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID Op
= IMPROVE FORTHE PURPOSE OF SAL�.
❑I,AS OWNER OF THE PROPERTV,AM EXCLUSNELY COMRACTING WITH LICENSED COMRACTORS
� TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:THE COMRACTORS LI- V81Ue�IDf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANONRJEROFAPROPEHTYWHOBUILDSORIMPROVESTHEREON,AND
� NRIOCONTRACTSFORSUCHPR0.)ECTSWITHACONTRACTOR(5)IICENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE �
Y TORS 110ENSE LAW.).
� O IAM EXEMPT UNDER S�C. B.8 P.Q FOR THIS HEASON � �
� �
� DATE ONMER �
U
� LICENSED CONTRACTORS DECLARATION �j
� 1 HEREBYAFFIRM UNDER PENALTY OF PERJUflYTHAT IAIA LICENSED UNDER PROVISIONS OF CHAPTER � . .
d 9(COMMENCINOWITHSECTION700D)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z
� MV LICENSE IS IN FULI FORCEAND EFFECT. m
o L�CENSE CLASS � LIC.NO. °'"+��'"��� � �
U DATE � �� �� CONTRACTOfl ��� � �K� ' � �-
W
� WORKERS'COMPENSATION DECLARATION Q
�. U
N 1 HEREBYAFfIRM UNDER PENALTY OF PERJURV ONE OFTHE FOLIOWING DECLARATIONS: Z
Q
� _IHAVEANDWIILMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
COMPENSATION,ASPROVIDEOBYSECTIONaI000FTHELABORCODE,FORTHEPERFORMMICE U
Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSVED. � �
0
W _IHAVEANOWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASRE�UIREDBYSECTION
Q 37000FTHELABORCODE,FORTNEPEPFORMANCEOFTHEWORKFONWHICHTHISPERM1T15
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
jCAPRIER PLAN REVIEW
Z POLICYNUMBER ELECTFIC
¢ (fNISSECfIQJNE�NOTBE001.ff'I.EfEDOF7HEPEFiAMTiSFOPONEMN�DRED00tLNLS(5700)OqIESS� PLUMBING -
�
w MECHANICAL
Z' 1 CERTIFYTHAT INTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUE0,1
(,�} SHALLNOTEMPLOYANYVEHSONINANYMANNERSOASTOBECOMESUBJECTTOTHE
� WORKERS'CAMPENSATIONLAWSOFCALIFOPN10.ANOAOREETNATIFISHOULDBECAME INSPECTIONFEE
SUBJECTTO THE WbRKERS'COMPENSATION PROVISIONS OF SECTION a7oo OF THE IABOR
= CODE,�SHALLFORTHWITHCOMPIYWITHTHOSEPHOVISIONS. ISSUANCE
O SMIP
p DATE: APPLICANT: , �
� ENERGY P/C
WARNINO:FAILURETO SECURE WORKERS'CAMPENSATION COVEFAGE IS UNIAWFUL,AND SHALLBE
�y SU&IECTANEMPIOYERTOCRIMINALPENALTIESANOCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT .
DOLLAPS(St00,0a0),IN AD�ITION 70 THE COST OF CAMPENSATION,DAMAGES AS PROVIDEO FOR IN
� SEOTION37080FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. � RETENTIONFEE: .
w CONSTAUCTION LENDING AGENCY PRE-ALT FEE:
a
� 1 HEREBYAPPIRM UNDER PENALTY OF PERJURYTHATTHEpE IS ACONSTRUCTION LENDINO AGENCY �
FOR hiE PERFORMANCE OF THE WORK W fl WHICH THIS PERMiT IS ISSUED(SEC.3097,CIV.C.).
Z
W
� LENDER'S NAME
F- LENDER'SADDRE55
WICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATKKJISCARRECL TOTAL FEES ��,` ��� �
� IAGREETOCAMPIYWITHALLCITYANDCOUMIYORDINANCESANDSTATELAWSRELATINOTOBUIIDINO .
CANSTRUCTION,AND HEREBY AUiHORIZE REPRESENTATNES OFTHIS COUNTYTO ENTEq UPON THE �� -
ABOVE-MEMIONED PROPERTY WR INSPECTpN PURP0.SES. �� �� .��P � ��L�'�
Z COMMENTS � �����r-g
� �s If���-i�� �.:� "�'� 1P�C �F QS'� �1�-��'- E�5 •�14-�1��
_ —`
m PERMITTEE NAME(PRitin '
Q
�
� SIONATUREOFPEflM17TEE DATE � � �
= RECPT.NO. PAID BY VALIDATION