HomeMy WebLinkAbout11918 CITY OF DIAMOND BAR
--�- " - - DEPARTMENT OF COMMUNITY&DEVELOP'MENT SERVICES •''r—_�
21660 E.Copley Drive Suite 190 ��r" f PRESS
� (909)860-3195 Fax(909)861-3117
'��'£W BUII.DING PERMIT APPLICATION ����w FIRMLY
N JOBSITE _ � •• APPLICATIO ,.. PERMIT P/C
o ADDRESS � �� C�n. � DATE NUMBER #
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v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER�ECLARATION SFR/ADD/REM
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0 I HEREBV AFFIRM IINDER PENALTY OF PERIURY THAT 1 AM E%EMPT FROM THE CONTRACTORS LI- � Garage/Carport
W CENSEUWFOHTHEFOLLOWINGREASON(SEC.7o31.5BUSMESSANDPROFESSIONSCOOE:ANVCINOR
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z TURE,PfiIOR TO ITS ISSUANCE,RLSD RE�UIRE5 THE APPLICANT FOR SUCH PEAMIT TO FILE A SIGNED
w STATEMENT 7HAT HE OR SHE IS I.ICENSED PURSUANT TO THE PROVISIONS OF THE CONTfiACTORS U- W
� CENSE LAW(CMAPTER B(COMMENCINO WITH SECTION 70D0)OF OIYISION 30F THE BUSINESS AND PRO� u' POOVSP9
FESSqNS OODE)OR THAT HE OR SHE IS EXEMPT iHEREFROM AND THE BASIS FOR iHE ALLEGFD EXEMP-
V TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPENMITSUBJECTSTHEAPVLICANTTO Z e-Roof
AGML PEfJKTY OF NOT MORE TMAN FIVE HUYDRED DOLLARS(5500).�:
� ❑I.A50NMEHOFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIPSOLECAMPF.NSATION, ❑ CommefClal
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE{SEC.7044,6U51� J
� NES.AND PROFESSICt�'3 CODE:TNE WNTRACTORS LICEYSE LAW DOES NOT APPLY TO!�"!OWVER OF �
VqOPERTY NhiO BUIL�S OH IMPROVES THEREON,AN�WHO WES SUCH WORK HIMSELF OR HERSELF OR
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W CII,ASOWNEROFTHEPROPERT/,AMEXCLIISIVEIYCOMMCTINGWITHLICENSEDCOMRACTORS
¢ TO CONSTRUCT TMG PRQIECT SEC.701/,BUSINE55 PNO PROFESSIONS CODE:THE CONTfl0.CTOF5 ll� l �
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O �IHAVEANDWILLMAINTNtIACERTIFICATEOFCANSENTTOSFLF-INSUREFORWORKF,RS' i �
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Of THF.WORK FOP WHICH THIS PF.RMIT IS ISSUEO. �
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� _IHAVEANDWILLMAINTAINWORKEf;S'COMPENSATIONINSUR�IvCE.A5HE0UIHEDBYSECTION
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ISSl1ED.MY WOP. R' PENSq[{�M INSURANC CARR�ER ANU POLICY NUMBER ARE: CONSTRUCTION �.S 1�
jCARRIER=�__,�� � a� PLAN REVIEW -------------.- ...
ZPOUCYNUMBER - °"' �" ELECTRIC �
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Z ICERTIFYTHATMTNEPERFORMANCEOFTHEWORKFORWHICHTHISPEHMII'ISISSUE0.1 MECHANICAL __,_,._.,,__ .__
�} SHALLNOT EMPLOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJeCTTO THE '
� WOFKERS'COMPENSATIONLAWSOFCALIFOHNIA,ANDAGFlEETHATIFISHDULD�CCOME INSPECTIONFEE _____.,.,_,,....
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CaDE. SH FO HWI7HCOMPLYWITH SEPRO ISIONS ISSUANCE __________________ =_,. a yyy���
O DATE: _: APPLICANT: �r �,�9�/ SMIP � �
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J WARNING:FARUHETOSEGUR[WORKEFS'COMPENSRTIONCOVF.RAGF.ISUNLAWFUL,AND3HALLBE ENERGYP/C __ _
_._._. _ .._ __ _
� SU&IECTANEMPLAYER70CRIMINALPENALTIESANDCIVIIFINESUPTDONEHUNDRE�7HOU5A�U ENERGYPERMIT
DOLLARS(iloo.aou),IN PDDITION TO THF.COS(OF COMPENSATION,OAAAAGES AS PROVIDED FOR IN ------------- - -- - ----- - - -�--'- �
J SECTION 37oe OF THE LABOR CO`�E,INTEREST,ANDATfOFNEY'S FEES. RETENTION FEE: IR
O CONSTRUCTIONLENDINGAGENCY �� r �� �d
PRE-ALT FEE:
� i HEREBY AFFIRM UNDEfi PENALTY OF PEflJURY THAT THEflE IS ACANSTRUCTION IENDING AGENCY ___ __ � ___ _ �
FOR THE PERFORMANCE OF TiE WOf1K�OR WIIICH THIS PERMIT IS ISSUED(SEC.3097,CIY.CJ. �
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� LENDER'SNAME_.__ ._--------.--.---
F- IFNDER'SADORESS .__.._...._-_.___._-..__
W ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFUHMATqNISCORRECT. TOTCL FEES �
p I AGREE TO COMPLY WITH ALL CITY PN�COUNTY ORDINANCES AND 5iATE LAWS REIATING TO BUILDING r-'') `' /��
CANSTHUCTION,AND HEFiEBV AUTHORIZE REPRESENTATIVES OF Tf IIS COUNTY TO ENTEfl UPON THE i/� �� S� /�)
A80VE-ME NFA PR�RTV FOR INSPECTION PURPOSES.
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Q � COMMENTS
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