HomeMy WebLinkAbout16993 CTI'Y OF DIAMOND BAR 6���'r� /�,�
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21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 PRE$$
�'%9��+ BUILDING PERMIT APPLICATION FIRMLY
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p I HEREBY AFFlRM UNDER PENALTY OF PEFLIURV THAT I AM E%EMPT FROM THE CONTRACTORS L6 G8f89B/CefPOfl
W CENSEUWFORTHEFOLLOWINOflEASON(SEC.70.71.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n
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w NRE,PqIOR TO ITS ISSUANCE,AL50 REOUIqES THE APPLICANT FOR SUCH PEFMIT TO FILE A SIONED W P8I10/DBCK
� STATEMENT THAT HE OR SHE IS LICENSED WflSUANT TO THE PROVISIONS OF THE CONTMCTORS LI�
CENSE LAW(CHAPTER G(COMMENCINO WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PRO- � POOUSPB
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROM/JlDTHEBASISFOR7HEALLEGEDE%EMP� (�
V TION.ANV VIOLATION OF SECTION 7031.6 BV ANY APPLICANT FOR A PERMIT SU&IECTS 7HE APPLICANT TO Z Re-Roof
A CNIL PENALTY OF NOT MORE THAN FIVE NUNDRED DOLURS(f500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1rt10fCi8I
Z WILL DO THE WORK�ND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a�,BUSI- J �
� NESS AND PHOFESSIONS CODE:THE CONTqACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NM110 BUILDS OR IMPROVES THEFEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q 7HROUGH HIS OR HER OWN EMPLOVEES,PqOVIDED THAT SUCN IMPROVEMENTS ARE NOT IMENDED OR m
Q OFFEREDFORSPLEIF,FqWEVER,iHEBUILDINOORIMPROVEMENTI550LDWITHWONEVEAAOFCOMPLE�
Z TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT 9UILD OR
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w ❑I,ASOWNEROFTHEGROPERTV,AME%CIUSIVELVCONTRACTINOWITHLICENSEDCONTRACTORS
[C TO CANSTRUCT THE PROJECT(SEC.7w�,BUSINE55 AND PROFESSIONS CODE:THE CON7MCTORS LI- V8II18�1Of1 �" ADJ.AREA
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� O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� DATE OWNER ¢
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� G(COMMENCINO WITH SECTION 7000)OF DIVISKKJ 9 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
X`� MY UCENSE IS IN FULL FORCE AND EfFECi. m
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V DATE �ISI��) GONTRACTOR SP1.�����H��L d
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� WORKERS'COMPENSATION DECLAAATION Q
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� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a
� COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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Qw �I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
37000F hiE LABOR CODE,FOR THE PERFORMANCE OF THE WORK f-0R NM1iICH 7HI5 PERMIT IS i�"�A /�
ISSUED.MY M10RKERS'CAMPENSATION INSURANCE CAARIER AND POLICV NUMBER ARE CONSTRUCTION 'I���� ' �L b LI L
� CAARIER S�� �yy�Z. PLAN REVIEW
Z POLICV NUMBER XvK�d U� .V� ELECTRIC
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� (iHISSECTqNN�NOTBENNPLEfIDOfhEPERMfriSFORpNEFiINDFEDDq1AAS(fiao)ORtFSS} PLUMBING
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Z I CERTIFV THAT IN THE PERFORMAtJCE OF THE WORK FOR WHICN h115 PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE �.--�— �y�
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPEC OI I N EF E7 �1�� � I I J J
~ SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTqN37000FTHEUBOR �.�.�--' ��m--/� � ' . "�-�'
� CODE,I SHALL FOFTHWITH COMPLV WIh1 THOS PROVISIONS. ISSUANC� �
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p DATE:��� APPLICANT. � SMIP n 1'�q��n n� I ♦C�
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J WAiiNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,NJD SHALL BE ENERGY'/C I
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�y SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTFKKISAND ENERGYPERMIT I
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAQES AS PROVIDED FOR IN
J SECTqN37080FTHELABORCODE.INTEREST,ANDATTORNEV'SFEES.
wRETENTICd FEE�_. a-----�'–'�- °
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENPLTY OF PERIURY THATTHERE IS ACANSTRUCTION LENDING AGENCV
FORTHE PERf-0RMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
H LENDER'SAOORESS
w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES 2�2� �J Z �`�� O
� I AGREE TO CAMPLV WITH ALL CITV AND CAUNTV ORDINANCES AND STATE LAW$RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON 7HE
Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURP0.5E5. COMMENTS
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� RECPT.NO. PAID BY VALIDATION _
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assassor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIRE9'LAGE FOUNDATION
TEMP POWER � FIREPLACE BOND BEAM
WATER�ERUIGE MID HT. 80ND BEAM
ROOF�SHEA7HING� ', ' ' 8 F�'. B�ND BEAM
FRAPvIltVGNENTILIATiON FINAL BO(VD BEAM
ROOF COVER PRE-GRADING A
RUUGH HEATING BENCHlNG
ROUGH ELECTRIC ROUGH GRADING
ROUGFi PLU(UIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALI IAlSULATION POOL FINAL �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAfLING DEDICATIONS
S�WER FINAL ENG. �
SEPTIC TANK LANDSCAPE/IRR(G.
SEEP PIT/Ll.. ON S17'E IMPS.
GAS�IR TEST �lNAL ZONlNG
FlNAL CONST. . FlRE DEPT. FINA!
FiNAL FiEATING HEAL7H DEPT. FINAL
F1NAL ELECTRIC DEV. FEES PAID
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