HomeMy WebLinkAbout17978 CITY OF DIAMOND BAR �x�� � `�Jl �
--- --��" — DEPARTMENT OF COIvIIv1UNTTY&DEVELOPMENT SERVICES I
21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRESS
��'%��^�+ BUILDING PERMIT APPLICATION FIRMLY
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ADDRESS I O 1 1 DATE 5/9�02 NUMBER �797$ #
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p I HEREBV AFFlRM UNDER PENALTY OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G9f89B/C8fF10ff
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w TURE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Patio/Deck
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO h1E PROVISIONS OF THE CANTMCTORS LI�
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � POOUSPB
� FESSIONS CODE)OR TFIAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� �
TION.ANVVIOLATIONOFSECTION7031.6BVANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Raof
A CIVIL PENAL7V OF NOT A/ORE THAN FNE HUNDRED DOlURS(5600�.):
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Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J
N NESS AND 7ROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV NT10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCN WORK HIMSELF OR HERSELF OR
CL THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERTMEBUIIDINGORIMPROVEMENTISSOLDWfTHINONEYEAROFCAMPLE-
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� I HEREBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWINO DECLARATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ �
� �PENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W
OF TME WORK FOF WMICH h115 PERMIT IS ISSUED. �
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w I HAVE AND WILL MAMTAIN WORNERS'COMOENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 OF TH OR R 7TIE PER RMANCE OF THE WORN f-0R WHICH THIS PEHMR IS
ISSUED.M NS SURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WOFlK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
� SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 37oa OF THE LABOR �J,
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� SUBJECTANEMPLOVEFlTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT
DOLLARS(f too,000),IN MDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES.
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O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CANSTRUCTION LENDING AOENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
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w I CERTIFV THAT I HAVE READ THIS APPLICATION IWD STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA L FE ES ��/ , / �
p. I AdREE TO COMPLV WITH ALL CITY AND CWNTV ORDINANCES AND STATE UWS RELATING TO BUILDING `�
� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOV JAENT ONE�P �ERTV FqR INS ECT ry puaaosEs. COMMENTS
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~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SLAB GRADE FIREPLACE F�UNDATION
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EX7. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL ~
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DRYWALL NAI�ING DEDICATIONS
SEWER FINAL ENG.
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SEEP PIT/L.L. ON SITE IMPS.
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FINAL CONST. ~ , FIRE DEPT. FIIVAL
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