HomeMy WebLinkAbout18296 CITY OF DIAMOND BAR �
�----�� --� DEPARTME?�'T OF COMIvIUNI"I1'&�DEVELOPMENT SERVICES
21825 E.Copley Drive
- (909)860.3195 Fax(909)861-31 l7 PRESS
��'%��� BUILDING PERMIT APPLiCAT10N FIRMLY
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Q 1 HEREBV AFFIRM UNDEF PENAITV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTOqS LI- G8f89B/C9fpOh
W CENSE UW FOR THE FOLLOWINO REASON(SEC.�031.5 BUSINE55 AND FWOFESSIONS CODE:ANV CITV OR (n
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w TURE,PRIOR TO ITS ISSUANCE,ALSO RC-0UIRES THE APPLICANT FOR SUCN PERMIT TO FILE A SI�NED w PatlolDeck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI� .
� CENSE UW(CHAPTER G(COMMENCINQ WITM SECTION 70oa)OF DIVIgpN 3�C1F THE BUSINESS AND PRO� � POOUSpB
� FESSIONSCODE)ORTHATHEORSMEISEXEMPTTH�REFROMANDTHEBASISFORTHEALLEGEDEXEMP� (!�
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� A CML PENALTV OF NOT AqRE THM!FNE MUNOHEO DOlLARS�f5o0).): �
� OI.ASONRJEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASIHEIRSOLECOMPENSATiON, � COrt1rt18fCi81
Z WILL DO THE WORK,AND THE STRUCNRE IS NOT IN i ENDED OR OFFEFED FOR SAIE(SEC.7o�a,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO'APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HEROVM EMPLOVEES,7ROVIDE�THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEAEDFORS�LEIF,HOWEVE{�THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPI.E- '
Z TION,TME OWNER-BUILDER WILL NAVE TME BURDEN OF PROVINO'NAT HE OR SHE DID NOT BUILA OR
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� TO CANSTRUCT THE Pq0.1ECT(SEC.7oaa,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U3f1Of1 ADJ.AREA '
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Q ❑I AM EXEM7T UNDER SEC. 8.8 P.C.FOR THIS REASON Q
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I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM UCENSED UNDER PROViSIONS OF CHAPTER �
d, o(COMMENCING WITH SECTION 7a00)OF DIVISION 30F THE BUSINESS AND PP.OFESSiONS CODE.AND Z
X MV LICENSE IS IN FULL FOqCE AND EFFECT. m
� LICENSE�C—L7ASS C 1 1� LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOW�NG DECIARATIONS: Z
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� I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT 70 SELF�INSURE FOR NqRKERS' _
Z COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFOqMANCE U
Q OF TME WOFK FOR WHICH THIS PERMIT IS ISSUED. w
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w _I HAVE AND WILL MAINTAW WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR TME PERFORMANCE OF THE WORI(FOR WHICH THIS PERMIT IS � Z 0
455UED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �
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Z POIICV NUMBER 1 G�G L:/ ICG�I 7 ELECTRIC
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SMALL NOT EMPLOV ANY PERSON IN ANY MlWNER 50 AS TO BECAME SU&IEf.T TO THE
(/) WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INS?ECTION FEE
SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 9700 OF THE LABOR
S CODE.ISHALLFORTHWITHCOMPLYWITHTHOSEPqOVI510N5. ISSUANCE '
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p DATE: APPIICANT: SMIP � �
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J WAANIN(i:FAILURE TO SECURE WORNERS'COMPENSATqN CAVEHAGE IS UNLAWFUL,ANO SHALL BE ENERGY P/C
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� SU&IECTANEMPLOYERTOCRIMWALPENALTIESANDCIVILFINESUFTpONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f 100,000).IN ADDITION TO THE COST OF CAMPENSATION,DAA/AOES AS PROVIOED FOR IN
J SECTION 3700OF 7HE LABOR CADE,INTEREST,AND ATTORNEV'S FEES.
w RETENTION FEE: .�. ��
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
� I MEREBV AFFIRM UNDER PENALiV OF PERIURV 7HAT THEFE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH iHIS VERMIT IS ISSUED(SEC.700],CIV.C.).
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� LENDER'S NAME .
1— LENDER'SADDRE55
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA F E ES OZ • • O' � I .�
� I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS CWNTY TO ENTER UPON THE. �r,��+ /'i ��/ �� I
Z ABOVE�MENTIONEO PROPERTV FOR INSPECTION PURPOSES. COMMENTS � LJ./ •�— (.�,
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~ ' WHITE—Department Copy,VELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Co GREEN.
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SLAB GRADE ' ~ � FIREPLACE FOUNDATION -
TEMP POWER FIREPLACE BOND BEAM �
WATER SERVICE � MID HT. BONb BEAM --
ROOF SHEATHING ! � 8 FT. BOND BEAM
FRAMINGNENT'ILIATIUN ----� FINAI_BOND BEAM
ROOF COVER PRE-GRADfNG �
ROUC,,H HEATING BENCHING `
ROUGH ELECTRIC ROUGN GRADING
ROUGH PLUMBING ` �INISH GRADlNG '
SHOWER/TUB TEST � POOL ELECTAIC
EXT. LATH/SlUING I POOL FENCING
WALL INSULATION POOL FiNAL
CEILING INSULATION OFF SITE IMPS. �
DRYWALL NAILING DEDIC�,T{ONS
SEWER FINAL ENG.
SEPTIC TANK • LANDSCAPE/IRRIG.
SEEP PIT(L.L. � ON SITE Ii�IPS.
GAS AIR TEST � � FINAL ZQNING
FINAL CONST. FIRE DEPT. FINAL
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FINAL HEATING � HEALTH DEP'f. FINAL
FiNAL ELECTRIC � DEV. FEES PAID `
FIfVAL PLUMBING ENERGY
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