HomeMy WebLinkAbout10515 CITY OF DIAMOND BAR
EXPIRED
COMMUNITY DEVELOPMENT DEPARTMENT Mqy 0 91003
;,.� 21660 E.Copley Drive Suite 190 PRESS
(909)86a3195 Fax(909)861-3117 '
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� I HEREBV AFFIRAI INIDER PENALTY OF PERIURY THAT I MI EJ(EMPT FROM THE CONTRACTORS LI� GB��•(�g�rt
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� 711RE,VRIOH TO ITS ISSUMlCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS LICFNSED PURSUNfT TO THE PROVISIONS OF hiE CONTRACTORS ll- �
� CENSE UW(CHAPTER i(COMMENdNO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE53 AND PRO- PooVSpe
FESSIONS OODE)OR 7HAi HE OR SHE IS IXEMPT THEREFROM AND THE BASIS FOR 7HE ALLEOED E%EAIP• C7
� TION.ANV VIOLATION OF SECTION 70J1.6 BV ANV MPLICANT FOq A PERMIT SUBJECTS THE MPLICANT T0 Z Re•Raof .
A GVIL VENALTV OF NOT AqRE TMAN FNE MUNORED DOLURS(i600).j:
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Z WILL DO TNE WORN,MID THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BU51� J �
N NE55 AND PROFESS�ONS CODE THE CONTMCTORS LICENSE LAW DOES NOT APPLY TO M!OWNER OF, j .
PROPEHfY Vh10 BU0.DS OR IMPROVES THEREON.M1D WHO DOES SUCH WO{iK HIMSELF OR HERSELf OR .
Q THROU6H HIS OR HER OVM EMPLOVEES,Pf�VIDED THAT SUCH UIPROVEMEMS ARE NOT WTENDED OR m
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W CEN$E UW DOES NOT APPLV TO AN OWNER OF A PROPERTV NRiO BUILDS OR IMPROVES THERC-0N,AND
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U DATE 7 .S� CONTRACTOR I'h- d
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� WORKERS'COMPENSATION LARATION � '
� I HEREB FIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLAWINO OEClAMT10NS: �
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0 I HAVE AND WILL MAINTAW A CEfRIFlCATE OF CONSENT TO SELF-IHSURE FOR yq{V(Ep$' � ¢ -
Q COMPENSATqN,AS PROVIpED BV SECTION�7000F THE UBOfi CODE,FOR THE PERFOqMANCE U ..� � _ _
Q OF THE WORK FOR WHKXi THIS PERMIT IS ISSUED. � /�. �N i��/.. �� f-, �
Qw _I HAVE MID WILL MAINTNN WORKERS'COMPENSATION INSURAfJCE,AS REOUIRED BV SECTpN u �,.�3y�
]70o OF THE LABOR COOE.FOR 7HE PERFORMANCE OF THE WORK FOR NM1ilqi 7HI5 PERMR IS
ISSUED.MV W WiK S' PE SATION IHSU CMRI R MID POLICV NUMBER ARE: CONSTRUCTION
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Z I CER7IFY THA71N THE PERFORMANCE OF THE WORN FOR WHIp1 THIS PERMI7 tS ISSUED,I MECHANICAL
U' SFIALL NOT EMPIOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE
(/� WOPo(ERS'CAMPENSATION UWS OF CALIFORNIA,AND AOREE TH i sNou�n eecoME � INSPECTION FEE '
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WARNINO: AILURE TO SECURE WORKERS'COI./PENSAT • RAOE IS UNLAN�FUL.,AND SHALL BE
LL SUBJECTAN EMPLOYER TO CRW INAL PENALTIES AND C�L ES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
D�LURS(i100,000).IN ADOfT10N TO THE COST OF CAMP SATpN,DAMAOES AS PROVIDED FOR IN
J SECTION 370!OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
W � RETENTION FEE:
0 CONSTRUCTION LENDINO AGENCY PRE•ALT FEE:
� 1 HEFEBV AFFIiW UNDER PENALT/OF PERtt1RV THAT THERE IS A CONSiAUCT10N LENDINO A(7ENCV
f-0R THE PERFORMANCE OF THE WORK FOR NM111q1 THIS PERMIT IS ISSUED(SEC.70i7,GV.C.).
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� LENDER'S NAME
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¢ I CERTIFY 7FIAT 111AVE READ TMIS MPLICA710N AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AOfiEE TO COMPLY WITH ALL GiY AND COUNTY OROINANCES AND STATE Uw5 REUTIN(i TO BUIl01N(7-
� CONSTRUCiION,AND HEREBYAU7HORIZE REPRESENTATNES Of THIS COUNTV TO ENTER UPON 7HE '
�. ABOVE NTIONED PROVEHTY FOR INSPECTION PURPOSES. COMMENTS
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GROUND PLUMBIi�IG ' UNDER FLOOR CUhIDUIT
SU4B GRADE FIFIEPLACE FOUNDATION
TEMP POUVER FIREPLACE BOND BEAAN'- .
NUATER SERVtCE ' '� , NiID HT. BOND BEAM � � ' ' �
ROOF SHEATHIMG 8 FT. BOND BEAM
FRARNIfVG/VEiVTILIATIOiV � � FINAL BOND BEAM
ROOF COVER � PRE-GRADING
ROUGH HEATING BENCHIIVG
ROUGH ELECTRIC ROUGH GRADING
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SHOWEF�TUB TEST POOL ELECTRiC
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DRY{ftIALL NAILING DEDICA710NS �
SE1/VER FINAL EPJG. •
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