HomeMy WebLinkAbout15827 (9) � ��
% ��i _`� CITY OF DIAMOND BAx ��, ����
`� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� � 21660 E.Copley Drive Suite 190 '���`��� ��vv�,� PRESS
� (909)860-3195 Fax(909)861-3117
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�' JOBSITE I (J f1 r I J ��p APPLICATION Z/� � PERMIT 1 JCQ�1 P/C
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER OECLARATION SFR/ADD/REM
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p I HEREBV AFFlHM UNDER PENALTV OF PERNRV THAT I AM EXEMP7 FROM THE�CANTRAC70R5 LI- G8f09B/CflfpOfl
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUIlfYWHICHRC-0UIRESAPERMRTOCONSTRUCT,ALTER,IMCROVE,DEMOLISH,OfiFEPAIRANYSTRUC• W P8110/DBCk
Z NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIHES THE APPLICANT FOH SUCM PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- W
� CENSE LAW(qiAPTER Y(COMMENCIN4 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PFlO- LL' POOVSPe
FESSqNS OODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANYVIOLATIONOFSECTION7o91.5BVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
Y � A CIVIL FENALTV OF NOT MORE THAN FNE HUNDRED OOLLARS(f5o0�.):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COR1fI1BfClel �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.70u,BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER�OF
� PROPERTVWHOBUILDSOHIMPROVESTHEREON,ANDVhiODOESSUCHWORKHIMSELFORHERSELFOR �
Q THROUGH HIS OR HER OMM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
GOFFEREDFORSALEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE-
Z TION,THE OWNERAUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR • -
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑1,AS OWNEROF THE PROPEHfY,AM EXCLUSIVELY CON7pACTINO WRH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81118�1011 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPHOPERTYWHOBUILASORIMPROVESTHEREON,AND
� NMOCONTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG �UANTITY DESCRIPTION F
� TORS UCENSE LAW.). '
Q ❑I AM E%E1APT UNDER SEC. B.6 P.C.FOR THIS REASON U I 1 -
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� DATE OWNER �"'
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIfUI UNOER PENAIiY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WITH SECTqN 70D0)OF DIVISION 9 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS IN FULL F C AND EFFECT. m
0 LICENSE C S LIC.NO. � � _ �
V DATE CONTRACTOR_ a �---�
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a� WORKERS'COMPENSATION DECLARATION , Q
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� I HEREBY AFFIRM UNDER PENALTY OF PEiUURV ONE OFTHE FOLLOWING DECURATIONS:
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� I HAVE AND WILL MNINTAIN ACEHf1FICA7E OF CONSEM TO SELF-INSURE FOR WORKEHS' 2 � �
� COMPENSATION,ASPROVIDEDBYSECTION37000Fh1EUBORCODE,FORTHEPERWRMANCE W i
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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W _I HAVE AND WILL MAIHTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION
Q 37o00F THE LABOR CODE,FOR THE PERWRMANCE OF hiE WORK FOR WHICH 7HI5 PERMIT IS
ISSUED.MYWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION
jc�RqiER PLAN REVIEW
� aaucrnuMeEA ELECTRIC
� �nss�crqra�wrgeod.w��poFn�pEwertswpoa¢FnxnaEooau�psRim)oq�ssy PLUMBING
Z I CERTIFY THAT IN THE PERFORMANCE OF RK FOR WHICH 7HIS PERMIT�S ISSUED,I MECHANICAL
(} SHALL NOT EMPLOY ANY PERSON IN ANY NE 50 AS TO BECOME SU&IECT TO THE
� WORKER'COMPENSATION UWS OF CAL ORNI ,AND AGREE THAT IF I SHOULD BEWME INSPECTION FEE
S SUBJECT O THE VYOHNERS'COM7ENSA7 N PR VIS NS O ION 3700 OF THE LABOR I
COaE�I ��HWITHCOMPLV 1 TH R� ISION. ISSUANCE � • D
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J p OATE: APPLICANT: . SMIP
� ENERGY P/C
J WARNINO:FA�LURE TO SECUHE WORNERS'CAMPENSATION CAVERAOE I UNLAWFUL,AND SHALL BE .
� SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN�RED THOUSAND ENERGY PERMIT
DOLLARS(i100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN �
J SECTION 3708 OF 7HE LABOR CODE,IN7ERE5T,AND ATTORNEI"S FEES. RETENTION FEE:
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pw_, CONSTRUCTION LENDING AGENCY PRE-AlT FEE:
� I HEREBY AFFIRM UNDER PENAI.TY OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PER W RMANCE OF 7HE WORK W R WHICH THIS PERMIT IS ISSUED(SEC.3oB7,CIV.C.).
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� LENDER'S NAME
� LENDER'SADDRESS O •
W ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOHMATIONISCOHRECT. TOTAL FEES . • �
� I A4REE TO COM7LV WIiH/�LL CI7Y AND COUNfY ORDINANCES AND S7ATE UWS RELATINO TO BUILDING
� CONS7RUCTION,AND HEREBV AU7FIORIZE REPRESEN7A71VE5 OF THIS CAUNTV TO ENTER UPON THE .
Z ABOVE•ME IONE O ERTY FOR INSPECTION PURPOSES. COMMENTS
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N SIONATUREOFPERMITTEE DATE
� RECPT.NOr PAID BY VALIDATION I
WHITE�epartment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL� ,•t :-; �, , FHA REQMTS � 7 :
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GROUND PLUMBING ����--� UNDER,FL.O,OR'CUMDUI.T : � � .-� � T�, - �'`-'
SLAB GRADE FIREPLACE FCJIJ�tDA�ION:. •' - ' }`�'`'�' `�•'
TEMP POWER �-1� � FIREPLACE BO.ND BEAM � � � i � " '
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WATER SERVICE MID HT. BONC�'BEAM:_-� ' '- • ' + ` �
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ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH EL.ECTRIC ROUGH GRADING
ROUGH PLUMBING ' FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXI: LATH/SIDING � POOL FENCING
WALL INSULATION POO�FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDI.CATIONS
SEWER FINAL ENG.
SEPTIC TAfVK LANDSCAPE/IRRIG. .
SEEP PIT/L.L. ON SITE IMPS.
,GAS�AIRTEST; , ..;. , - ;• FINALZONING
FINAL GOi�lST.' ' .:." , '. ,` � ' .;,` '_ � :.'"�; .`' FIRE DEPT. FINAL
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FIf�AL H A7i1VG ". ' � "' '�' " �- �:HEALTH DEPT. FINAL
FINAL ELECTRIC "'� � � ' •-•'DEV. FEES PAID
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