HomeMy WebLinkAbout17969 ^---_��— CTI'Y OF DIAMOND BAR - �
DEPARTMENT OF COTRv1UNTI'Y&DEVELOPMENT SERVICES �
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�'���� BUILDING PERMTT APPLICATION FIRMLY
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� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDEfi PENALTY OF PEfL0.1RV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gef8J0/CBfPOR
W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSMlDPROFESSIONSCADE:ANYCITYOR (n
V COUNTVWHICHREWIRESAPERMRTOCONSTRUCT,ALTER.IMPROVE,DEMOIJSH,ORREPAIRANVSTRUC� W
w NRE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w P8�10/D6CI(
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO iHE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(C}iAPTER e(COMMENCINO WITH SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPB
0 FESSIONSCODE)OFTHATMEORSHEISE%EMPTTHEREFROMANDTHEBASISFOHTHEALLEQEDE%EMP- (�
V TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Raof
A CNIL PENALT/OF NOT MORE THAN FfVE HUNDRED DOLIARS(5500�.):
� ❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrt1rtIBfC18I
Z WILL DO hIE WORK NdD 7HE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7aa,BUSI� J �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OA IMPROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CL THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7T1AT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
0 OFFEREDFORS�LEIF,FIOWEVERTMEBUILDINQORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
� TION,THE OWNER-BUILDER WILL HAVE TFiE BURDEN OF PqOVING THAT HE OH SHE DID NOT BUILD OR
IMPROVE FOF 7HE PURPOSE OF SALE).
•W ❑I,AS OWNER OF THE PROPEHTY,AM EXCLUSNELV CONTRACTINO WRH LICENSED COMRACTORS
[C TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS M1D PROFESSIONS CODE:THE CONTRACTOFS LI� V01U8fI011 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOMMEROFAPROPERTVWHOBUIlDSORIMPROVESTHEREON,AND
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~ TORSUCENSEUW.). OUANTITY DESCRIPTION
� ❑I AM EXEMPT UNDER SEC. B.8 C.FOR THIS REASON Q
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� �HEREBV AFFIfUA UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCINO WfTH SECTION 7000)OF DfVI510N 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS W FULL FORCE AND EFFEC7. m
� LICENSE CLASS LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION Q
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF 7HE f-0LLOWING DECIAMTqNS: Z
� _I HAVE M1D WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' _
COM7ENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CAOE.FOR THE PERFORMANCE U
OF 7HE WORK FOR WMICH THIS PERMIT IS ISSUED. W
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Qw _1 HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN r�
3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHIC77 THIS PERMIT IS �' 4,�O
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �
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QPOLICV NUMBER ELECTRIC ., V
p (iMssEcitOMr�lE�pa7eEOJNi�ErmoFnEVEw.�riSFoaoNEFIRDREDoaiuslftoo)oaLEss� PLUMBING �
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Z I CERTIFV THAT IN THE PERFO{iMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL 1 h� /w�,a� � ' ' ,l
L}' SHALL NOT EMPLOY ANY PEfl50N IN ANY MANNER SO AS TO BECOME SU&1ECT TO THE ��-" � � �' � - � � �„i
(n WORKERS'COMPENSATION LAWS OF CALIFORNI/�AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE UBOR /�
CODE,I SHALL FORTHWfTM COMPLV WI7H THOSE PROVISIONS. ISSUANCE I 1/ 1
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p DATE: APPLICANT: SMIP
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J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNUWFUL,AND SHALL BE ENERGY P/C �
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� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT ��^�
DOLLARS(5100,000).IN ADDITION TO hIE COST OF COMPENSATION,OAMAGES AS PROVIDED FOR IN
J SECTION 3700 OF 7HE U80R CODE,INTEREST,AND ATTORNEV'S FEES.
OC RETENTION FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT EE: �-.O
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� 1 HEREBV AFFIRM UNDER PENALTV OF PEfiJURV THATTHERE IS ACONSTRUCTION LENDINO AGENCY �•
� FOR THE 7ERf-0RMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3007,CIV.C.�. �
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� LENDER'SNAME �J
H LENDER'SADDRE55
w ICERTIFYTHATIHAVEFEADTHISAPPLICATIONANDSTATEhNTTHEABOVEINFORMATqNISCARRECT. TOTAL FEES �� ��va /�S
� I AGREE TO CAMPLV WITH ALL CITV AND CWNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE �\�_�
Z ABOVE-MENTIONED PROPERTV FOR INSGECTION PURPOSES. �,J
� �rwr� COMMENTS
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� SIONANRE OF PERM EE DATE •
� RECPT.NO. PAID BY 0 VALIDATION
W TE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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ELECTRIC GROUND UNDER FLOOR DUCT �
GROUND PLUMBING UNDER FLOOR CURIDUIT
SlA6 GRADE � FIRERLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
W,4TER SERVICE ` ' MID HT. BOND BEAM
ROOF SHEATHING E _y __ � 8 FT. BOND BEAM
FRAMINGNENTIL(ATION I ' FINAL 80ND BEAM
ROOF COVER � PRE-GRA�ING
ROUCH HEATING BENCHING
ROUGH ELECTRIC RQUGH GRADING
ROUGH PLUNIBING FINISH GFiADING
SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATHISIDING POOL FENCING
WALL INSULATION POOL FINAL
CEII.ING INSULATION OFF SITE IMPS.
DRYWALL NAI�ItVG DEDICATIONS
SEWER FItVAL ENG.
SEPTIC TAM1lK �ANDSCAPE/IRRIG. �
SEEP PIT/LL. ON SITE IMPS. �
GAS AIR TEST FINAL ZONlNG
FINAL CONST. FIRE DEPT. FINAL
FlNAL HEATING HEAL7H DEPT. FINA�
FINA�ELECTRIC DEV. FEES PAID
FWAL PLUMBING ENERGY
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SEPTIC TAf�K SiZE
SEEP PIT/U SIZE
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