HomeMy WebLinkAbout18450 (26)i - - -
CITY OF DIAMOND BAR
'- --�� �- � DEPARTME?eTT OF COMMUNTfY&�DEVELOPMENT SERVICES
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21825 E.Copley Drive �—
'�- (909)860-3195 Fax(909)861-3117 PRESS
�`'%H���.� BUILDING PERMIT APPLICATION � �'�P�j FIRMLY
o� JOBSITE j� r APPLICATION �/ PERMIT f�A ,\ P/C I �
ADDRESS_ �✓ � � DATE � !� NUMBER �"T�V # ���1�
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APN OT TRA DATE C�l I S I�C�CONST. GROUP
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�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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I HEREBY AFFIRM UNDER PENALTV OF PERIURV THA7 I AM E%EMPT FROM 7HE CONTRACTORS Lb Gel29B/CBfpOR
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w �
� STA7EMENT THAT HE OR SNE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- . � �
� CENSE LAW(CHAPTER Y(CAMMENCING WITH SECTION 7000)OF DIVISION]OF THE BUSINESS AND PRO� POOVSpB
FESSIONSCODE)ORTHATHEORSHEISE%EMP77HEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (�
� TION.ANVVIOUTIONOFSECTION7037.SBYANYAPPLICANiFORAGERMIT5U9JEC'f5-MEAPPLICANTTO Z Re-Roof �
A CIVIL VENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f500�.J: '
Z ❑I,ASOWNEROFTHEPROPERTV.ORMVEMPLOVEESWi7HWAGE5A5THEIRSOLECOMPENSA7iON, O COrtIrtlCfdel
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEND[D OR OFFERED FOR SALE(SEC.7oa�,BU51� J
� NESS AND PROFESSIONS CODE:TNE CONTRACTORS LICENSE LAW DOES NO'APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR MEHSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT�UCH IMPROVEMENTS APE NO71N7ENDED OR m
w OFFEREDFORSALE.IF,HOWEVER711EBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING'MA7 HE OR SHE�ID NOT BUILD OR
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= OI,ASOWNEROFTHEPROPERTV,AME%CLUSIVELVCONTRACTINGWITHLICENSEOCONTRACTORS
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� TO CONS7RUCT THE PRQIECT(SEC.7o1a,BUSINESS AND PROFESSIONS CODE:7HE CON7RAC70R5 LI� V81UBl10(1 "'� � ADJ.AREA -
W CENSE UW DOES NOTAPPLV TOAN OWNER OF A PROPERTV WHO aUII.DS OR IMPROVES THEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�1.ICENSC-DPURSUAN7TO7HECON7RAC� QUANTITY DESCRIPTION FEE
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� ❑I AM EXEM7T UNDER SEC. B.6 P.C.FOR 7HI5 REASON Q
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DATE OWNER _ � -
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� LICENSED CONTRACTOFiS DECLARATION w ,
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM UCENSED UNDEfl PROVISIONS OF CHAPTER �
� i(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PP.OFESSiONS CODE,AND Z
X MV LICENSE IS IN FULI FORCE AND EFFECT.
� IICENSE CLLIJ���$$S O �/V LIC.NO. � �� �
U DATE ���=���r� CONTRACTOR a
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� WORKEFiS'COMPENSATION DECLARATION ¢
� I HEREBY AFFIRM UNDER 7ENALTV OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z
0 I HAVE AND WILL MAINTAIN A CERTIfICATE OF CONSENT 70 SELF�INSURE FOR WORKERS' a
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¢ COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WOFK FOF WHICH THIS PERMIT IS ISSUED. �
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w �IHAVEANDWILLMAWTAINWORKERS'COMPENSATIONINSURANCE,ASREOUIREDBVSECTION
Q 7700 OF THE UBOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �r�O
ISSUED.MV WORKERS'C PEN TION IN ANCE CARRI AND POIICY NUMBERARE: CONSTRUCTION �__
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� CARRIER ����. L//If�y� PLAN REVIEW �Q ..-�.
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� ((HISSECTqNNE�NOTBEQ'JMPLEfEDOFTHEPEW.1fTISfOFONEHUI�DREDD011ARS(f100)ORLESS). PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOFi WHICH THIS PEFlMIT IS ISSUED,I MECHANICAL
(} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
(n WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INS?ECTION FEE
'� SUBJECT TO THE WORKERS'COMPENSATION PROVI,S�ONS OF SECTION 3700 0F THE U/BO�R � ♦eV
� CODE,I SHALL FORTHWITH COMPLV WITH THOSf��ROVISIONS. � ,`� ISSUANCE n
p DATE:� APPLICANT: /C . ,/L� SMIP � ..�✓
J WAFNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,�ND SHALLBE ENERGY P/C
� SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100.000).IN ADDI710N 707HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN /���
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: •/�A'l
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDEF PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF TFIE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.9087,CIV.C.�.
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2 LENDER'S NAME
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F- LENDER'SADDRESS
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� I CERTIFV THAT I MAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. c/ �
w I AGREE TO COMPLY WITH ALL qTV AND COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING ' v
� CONSTRUCTION,AND HEREBV AUTHOFIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ,
� ABOVE�MENTIONED PROPERTVFORINSPEC7ION PURPOSES.
Z COMMENTS
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ELECTRIC GR�UND i ' UNDER FLQGR DUCT '
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GROUND PLUMBING ( ; UNDE�R FLOOR CU�iDtJIT_--'��- ,
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SLAB GRADE ; � ; F1REP�ACE FOUNDATION � �
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T EMP POWER ____ I � FIREPLACE BOP�D BEAM i �
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WATER SERVICE �__�_ MIG HT BOND BEAM �
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FRAMING/VENTILIATION I FINAL E30ND BEAM ;
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ROOF COVER i � PRE-GRADING �___ I___^ I
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ROUGH HEATING _ ; BENCHING _ !
ROUGH ELECTRIC I � RC�UGH URADING
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ROUGH PLUMBING ; FINISH iaRADING
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SHOWER�T'UB TEST —�- ; POOL ELECTRIC
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EXT. LATH/SIDING � ; POOL FENCING _ ;
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WALL INSULATION , ? POOL FiNAL ';
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CEIUNG IN�ULATION i ; OFf=SITE IMPS. �
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DRYWALL NAIUNG __ _ � DEDICl�TIONS __
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SEPTIC TANK LANDSCAPE/IRRIG. j ^
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SEEP PI7/LL. ' ON SITE iMPS.
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GAS AIR TEST ; FINAL ZONING
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FlNAL CONST. � , :. F�RE DEPT. FINAL
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FINAL HEATlNG � ' HEALTH t�EP-f. FINAL ___
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