HomeMy WebLinkAbout16328 _�� CITY OF DIAMOND BAR p
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERV��9 ����
21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 j�j j V � °� R�, PRESS
��'�*'� BUILDING PERMIT APPLICATION • FIR
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� I HEREBV AFFlRM UHDER PENALiV OF PEiW RV THAT I AM EXEMVT FROM hIE CONTAACTORS LI- G8f6g6/C6fP0lI
CENSEUWFORTHEFOLLOWINOREA90N(SEC.7071.6BUSINESSANDPROFESSIONSCODE:M1VqTVOR (n
COUNTYWIiI(]/REWIAE6APERMRTOCONSTAUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTAUG W Pa�b/Deck
7UR�7RIOR 70 179 IS9UANCE,�L50 REWIRES 7HE APPLICANT FOR SUCH PERA/1T TO FILE A SIONED w
� STATEAIEHT 7Y1AT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI�
CB1.4E UW(CFUPTER Y(CqAMENCINO WI7H SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- � POOI/SP2
FESSpNSCOD�OR7TUTHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEDEDE%EMP- (7
TION.ANYVIOLATIONOFSEC710N7031.60VANVAPPIICANTFORAPERMITSU&IEC7S7HEAPPLICANTTO Z Re-Rool
F ACIVIL PENALTY OF NOT MORE THAN FfVE HUNDRED DOLLARS(5600).):
� ❑I,tiSOWNEROFTHEPROPERTY.ORMVEMPLOVEESWITHWAGESASTHEIR50LECOMPENSATION, � CORIRIBfCIBI . -�
N91 DO 7HE WOPoC AND THE STRUCNRE IS NOT INTENDED OR OFFEHEO FOR SALE(SEC.701/,BUSI� J
� NESS AND PROFESSIONS CODE TNE COHTRACiORS LICENSE UW DOES NOT APPLY TO AN OWNER OF �
PROPEHTY WVq BU0.DS OR MPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF OR HER9ELF OR
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w CI I,AS OMRIER OF THE PROPERTV,MI E7(CLUSNELV COMRACTPlO N7TT1 UCENSED COPITRACTOPS
� TO CONSTRUCT TME PRQIECT(6EC.7oN,BUSINESS ANO PROFESSIONS CODE:THE CONTAACTORS LI- V81U9fI0f1 ADJ.AREA
CENSE UW DOE9 NOTAPPLY TOAN OWNER OFA PROPERTY NT10 BURDS OR IMPROVES THEREON,AND
' � WHOCOMRACTSFOqSUp1PRq1ECTSWITHACONTRACTOR(S)LICENSEDPURSUAHTTOTHECONT{UG Q�J(vfT�Ty DESCRIPTION FEE .
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1 MEREBY AF'FIRM UNDER PENALTY OF PERIURV THA7 I AM LICENSED UNDER PqOVI510NS OF CHA�TER �
(� Y(COMMENGNO WITM SECTION 7000)OF OIVISION 3 Of THE BUSINE55 AND PROFESSIONS CODE,AND Z ' � '
X MY LICENSE IS 91 FU.L FORCE AND EFFECT.
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� _I HAVE NID WILL AWNTAIN A CEHfIFlCATE OF CONSENT TO SE1.F-INSURE FOR WORKERS' � �
Q COMPENSATION,AS VROVIDED BY SECTION 77000F THE UBOR CODE.fOq THE PERFORMANCE U
OF THE WOPo(FOR NM111p1 THIS PERMIT IS ISSUED. W
� _I HAVE M!O WILL M.UNTNN WORKEf75'COMPENSA710N INSURANCE,AS RE�UIRED BV SECTION �
370o OF THE LA80R CODE,FOR THE PERFORMANCE OF THE WOHI(FOR WHICH hi15 7EFiA/R IS �
� �SSUm.MY WORICERS'COMPENSA710N INSURANCE CARRIER AND POUCV NUMBEH AAE: CONSTRUCTION
� CAAPoER � �I PLAN REVIEW
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p (nassEcraHr+FIDrarBE�rIDOFn��anis�oaor+Er+ix�or�000tieAs(nm)at�ssl PLUMBING
Z 1 CEHTIFY THAT W THE PERFORAIMlCE OF TME WORK FOH NM1iIp/1HIS PERMIT IS ISSUED,I MECHANICAL .
� SMALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME S BJECT TO THE
(/� WORNERS'COMPENSA710N LAWS OF CALI IA,AND AGREE TMAT I 5 LD BECOME INSPECTION FEE
S SU&IECT TO TNE WORKERS'COMPENSAT VISIONS OF SECT 7� OF Tl�,LA90P
cooE,i sruu.�wmrrvnna coua�v vnn� aao s. ISSUANCE �
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p DATE: �- �_�( APPLICANT: �SMIP
w ENEFGY P/C
� WARNINO:FAILURE 70 SECURE YlORKERS'COMPENSA710N COVERAGE IS UNLAWFUL,ANO SHKL BE
� SUBJECTANEMPLOYERTOCRIMIN/�LPENALTIESMIDCIVILFWESU7TOONEHUNDREDTFIOUSAND ENERGYPERMIT
DOILARS(f100.000�,W ADDITION TO hiE COST OF COMPENSATION,DAMAOES AS PROVIDED fOR IN
J SEC710N 37oe OF THE LABOR CODE.wTEPEST,ANO ATTORNEVS FEES.
� RETENTION FEE:
d CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBV AFFlRM UNOER PENALTV OF PERJURV THAT THERE IS A CONSTAUCTION LENDING A6ENCV
FOR THE VERFORMANCE OF THE WORK FOR WHICM THIS PERAl1T IS ISSUED(SEC.3007,GV.CJ. �
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- � LENDER'S NAME �
1— LENDERSADORESS
� TOTAL FEES /' �
� I CER7IFY 7}iAT I HAVE READ THIS MPLICATqN AND STATE THAT h1E ABOVE INFORMAiION IS CORRECT. ��, �JJl )
� I AOfiEE TO COMPLV WITH ALL CITY AND COUNTY ORDWANCES AND STATE LAWS REUTkJCi TO&IILDINO � %"
� CONSTRUC710N,AND HEREBv AUTHORRE RE7qESENTA7NE5 OF 7HI5 COUN7Y 70 EMER UPON THE '
Z ABOVE�MENTIONED PROVERT'fOR INSPECTION PURPOSES. COMMENTS "
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� WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessar Copy,GOLDENROD�ile Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL � FNA REOMTS
ELECTRIC GROUND ._ " UNDER FLOOR DUCT �
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GFtADE FIREPLACE FOUNDATION
TEMP POWER � ' FIREPLACE BOND BEAM '
WATER SERVICE • • MID HT. BOND BEAM ' � -
ROOF SHEATHING 8 FT'. BOND BEAM � � '
FRAMINGNENTILIATION FINAL BaND BEAM '
ROdF COVER PRE-GRADING
ROUGH HEATING BENCNING
ROUGH ELECTRlC ROUGH GRADING •
ROUGH PLUNIBING .• FINISH GRADING
SNOWER/TUB TEST • POOL ELECTRIC
EXT. lATH;SIDING - � � POOL FENCING ' � � ,
WALL INSULATION - POOL FINAL ',
CEILING INSULATIOiV ' OFF SITE IMPS.
�RYWAL.�f'�IAILING DEDICATIONS .
SEWER � FINAL ENG. � �i
SEP71C TAM1lK LANDSCAPE/tRRIG.
•SEEP PIY/L.L, t?N SITE ItviPS.
GAS AIR TEST ' FINAL ZONING
FIr3Al.CrJNST. FIRE DEPT. FINAL
Ff;'J�L HEATING � �f�-i�ALTH DFPT. FINAL
=4ivfi,L EI_ECTRIC DEV. FEES FAID -
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