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Home My WebLink About13230 (16)CITY OF DIAMOND BAR - DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 J (909) 860-3195 Fax (909) 861-3117 ((( PRESS ;.s BUILDING PERMIT APPLICATION t` FIRMLY JOBSITE `2- ADDRESS r L `.1 F'041 APN LO OWNER ADDRESS CITY e ZIP TEL APPLICANT L. CONTRACTOR C, ADDRESS CITY ZIP f 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 LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031 S BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH gEOUIRESA PERMITTOCONSTgUGT,ALTER, IMPROVE.OEMOLISH, OR REPAIRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FDR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE 1.5 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SWOM: I7 LAS OWRIEROF THE PROPERTY, CR 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- NESSAND 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 OFFERED FOR SALE. IF, HOWEVULTHE BU:UDING OR IMPROVEMENT IS SOLD WITHIN ONFYEAROF COMPLE. TION, THE. OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 I.ASOWNEROFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE.: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS TOR SUCH PROJECTS WITHACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRA[ TORS LICENSE UW). U IAM 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 S (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. !��r LICENSE CLASS LIC. NO.Y�/�_—�_ _ DATE_. _=�i—�'_; � CONTRACTOR 1] WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSL'NT TO SELF -INSURE FOR WORKERS COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE ,4F THE WORK FOR WHICH THIS PERMIT IS ISSUED. --I HAVEAND WILL MAINTAIN WORKERS' COMPENSATION INSUPANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INS RANCEE CCAAARRR,IIEER ANNDjP�OLICY NUMBERARE. CARRIER "WSJ ®.----_. POLICY NUMBER ^ A'�" (THISSEC )ONINEED NOTBE COMIPLEfEDOFTHE PERMITS FOR ONE HUN IREDD7U_ARS ($1001 OR LESS). I CERTIFYTHAT IN THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT FMPLOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA,ANU AGREE THAT IF I SHOULD BECOME SUBJE TT THE THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OFTHE LABOR CODE /S/HALL F RTHWITH COMPLY WITH ROVISIONS. DATE. S Q PPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSAT ION COVERAGE: IS UNLAWFUL, AND A SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THCUSAND DOLLARS ($100,000), IN ADDITIONTO THE COST OF COMPFNSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3097, CIV. C.). LENDER'S NAME IENDER'SADDRESS.--.._- I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE I AWS AELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIV S OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR IINNS ICTION PURPOS —_ A----F--b.J —. PERMITTEE N 5 f �f I SIGNATURE OF PER MEE DATE APPLICATION PERMIT, P/C DATE NUMBER ISSUE t`� TYPE OCC DATE ' -� I CONST. GROUP ZONING SETBACKS FRONT RW U _ REAR 1'l SIDE/SIDE STREET RW LJ SIDE n PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport WPatio/Deck LL Pcol/Spa U Z Re -Roof Commercial Valuation .. _. ... _ ADJ.AREA _-- .— QUANTITY DESCRIPTION FEE J 4 tr H U W LU t� _ t Z m '_'0 M �_ a ._J Q U_ Z Z 2 W CONSTRUCTION PLAN REVIEW—_— ELECTRIC PLUMBING -----_- —_._-- _ q, MECHANICAL —• -_�— -- INSPECTION FEE.k____ -- .._'•'''y`�1 ISSUANCE �� " Y. SMIP ENERGY P/C '�•' ._ .. _ _ ..... _ ENERGY PERMIT • y- _ .__—_—_ _ .._. ___ RETENTION FEE: PRE -ALT FEE: �•-y�'a�____ __ _ __ TOTAL FEES COMMENTS atill _J L RECPT NO. __-- PAID BY VALIDATIO WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicants Copy