HomeMy WebLinkAboutNo Permit NumberCITY OF DIAMOND BAR.-
DEPARTMENT OF`COMMUNTTYrBt DEVELOPMENT SERVICES
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HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE COHFRACTORS U `
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CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE ANYCITYOR
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COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT. ALTER, IMPROVE, DEMOUSH. OR REPAIR ANY. STRUC•
TURE;:PRIOR THE APPLICANT FOR. SUCH PERMIT TO FILE A SIGNED
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TO ITS ISSUANCE: ALSO REQUIRES
STATEMENT THAT HE OWSHE MrUCENSFA PURSUANT TO THE, PROVISIONS OF THE CONTRACTORS Llw
- DIVISION OF THE BUSINESS AND PRO,;
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CENSE LAW (CHAPTER i'(COMMENCING WITH SECTION 70DO)OF 3
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP.
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TION. ANY VIOLATION OF SECTION7031.5 BY ANY APPUCANT FOR A PERMIT SUBJECTS THE APPLICANT TO
DOLLARS ' •'�'^ `^
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A CML PENALTY OF NOT MORE THAN FIVE HUNDRED (f500) J: •.: a ,. : ..
. °,.: OI; AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATIOIN
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' WILL DOTHE WORK; AND THE STRUCTURE!IS NOT INTENDED OR OFFERED FOR SALE (SEC.70N4; BUST
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:. NEW AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY :TO AN OWNER OF
" WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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PROPERTY WFK)BUILDS OR IMPROVES THEREON. AND
THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
THROUGH HIS OR HER OWN EMPLOYEES: PROVIDED
OFFEREDFORSALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE ,
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.� TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PRO VWG THAT HE OR.SHE DIDNOT BUILD OR
- IMPROVE FOR THE PURPOSE OF SALE):
= 13LABOWNEROFTHE PROPERTY,AmE%CLUSMIYCONTRACTWG WITH LKXNSEocoNTRACTORS
TO CONSTRUCT THE PROJECT.(SEC. 7044, BUSINESS AND PROFESSIONS. CODE THE CONTRACTORS U
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r CENSE LAW. DOES NOT APPLY. TO AN OWNER OF A PROPERTYWHO BUILDS OR IMPROVES THEREON, AND
_ WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTMCTOR(S) LICENSED PURSUANT TO THE CONTRAG
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¢UCENSED CONTRACTORS DECLARATION;h T w
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;I HEREBY AFFIRM -UNDER PENALTY OF PERJURY THAT I AMLICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF TRIE BUSINESS AND PROFESSIONS CODE. AND
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MY.LICENSE MIN FLAT FORCE AND EFFECT �. �' yt
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WORKERS COMPENSATION DECLARATION
OF PERJURY ONE OF THE FOLLOWING DECLAMTNS
I HEREBY AFFIRM UNDER PENALTY KO
TO SELF-INSUREFORWORKERS
1HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT
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COMPENSATION, AS PROVIDED BY SECTKNN3700 OF THE LABOR CODE FOR THE PERFORMANCE.
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OF THE WORK FOR WHISH THIS PERMIT LS ISSUED. -
I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE AS REQUIRED BY SECTION-
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3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WOfB(ERS'. COMPENSATION INSURANCE CARRIER AND POLICY NUMggE�R ARE., •`
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CONSTRUCTION.
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PLUMBING
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' - - I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT Is ISSUED. N •.. f
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• R �"` '`�• -
MECHANICAL „" \ h.-..'.
- SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE' :
- WORKERS COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME
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.I NSPECTION.FEE -
_
" . SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
COPE,ISN/ALL FOATFTWITH COMPIYWITH TH09�.PROVISKM. r.
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ISSUANCE -
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.DATE _APPLICANT:
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WARNING: COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
ENERGY PIC
FAILURE TO SECURE WORKERS'
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES' AND CML FINES UP TOONE HUNDRED THOUSAND
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ENERGYPERMIT `
DOLLARS( 100,000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
.
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I SECTION 37W OF THE LABOR COOS, INTEREST AND ATTORNEY'S FEES.'-
' RETENTION FEE: - t^
PRE -ALT FEE `
CONSTRUCTION LENDING AGENCY "
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-I HEREBY AFFIRM UNDER PENALTY OF PERJURY.THAT THERE -ISA CONSTRUCTION LENDING AGENCY
t"? .i t' F.il
• FOR THE PERFORMANCE OF THE WORK FOR WHICH THLS ERMIT IS'IIIS-SUED is C S0Y7
LENDERS NAME e� Ni
41.
LENDERS ADDRESS `• "
TOTAL FEES
j 1 CERTIFY THAT 1 HAVE READ THt9 APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
APPLICATION
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELAT WO TO BUILDING
CONSTRUCTION; AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
-
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ABOVE.MENTKONED PROPERTY FOR INSPECTION PURPOSES
COMMENTS
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PERMITTEE NAME (PRINT)
9 SKONAWRE OF PERMIT� DATE
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- ,. WHITE—Depattment Copy, YELLOW—Finance Copy PINK—Assesses Copy GOLDENROD—Elle Copy, GREEN—Applicant's Copy, -; -
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