HomeMy WebLinkAbout17567 C1TY OF DIAMOND BAR
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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� I HEREBV AFFIRM UNDER PENAL7Y OF PERJURV THAT I AM E%EMPT FqOM THE CONTRACTORS LI� G8f89B/CBfpOfS
W CENSE LAW FOR THE FOLLOWING REASON(SEC.7031.6 BUSINESSAND PROFESSKKJS CODE:ANV CITV OR (n
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w TURE.PRqR TO ITS ISSUANCE,�150 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpe
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TION.ANYVIOLATIONOFSECTION7031.5BVANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Root
A CNIL PENAL7Y OF NOT MOFE iHAN FIVE HUNDRED DOLURS(f500).):
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Z WILL DO THE WORK,AND THE STRUCTURE IS NO71N7ENDED OR OFFERED FOR SAIE(SEC.7oaa,BUSI- J
N NESS AND PROFESSIONS CqDE:THE CANTRACTOFiS UCENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV NR10 BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER ONR!EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERT1iEBUILDINOORIMPROVEMENTI550LDWfTHINONEYEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
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� ❑I AM EXEMPT UNDER SEC. B.8 7.C.FOR THIS RFASON Q
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� � LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIfUA UNOER PENALTV OF PEiiJURV THAT I AM LICENSED UNDER PROVISqNS OF CHAPTER �
d G(COMMENCINO WfTH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLAAATION Q
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� I HEFEBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWING DECLARATIONS: Z
0Z _I MAVE AND WILL MAINTPJN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' a
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Q OFTHE WORK FOR WHICH THIS PEfU11T 19155UED. �
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BY SECTpN
Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS L�//� �
ISSUED.MV WOR)(ERS'COMPENSATION INSUHANCE CARRIEF AND POLICV NUMBER ARE: CONSTRUCTION �JV�.
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Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE K'ORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
('J SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE d� � �� � � ���/
(/� WORKERS'COMPENSATIONIAWSOFCALIFORNI0.ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE II
SU&IECTTO THE WORKERS'COMPENSATION P QVISIONS OF SECTqN 37ao OF THE UBOR F
�j COD,I S f-0RTHWITH COMPLV WITH f P O ISIONS. ISSUANCE � •� �
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p DATE: ` APPLICANT: SMIP I �.
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION VERAGE IS UNIAWFUL,AND SHALL BE ENERGY P/C ID'.6T. I
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� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSMID ENERGYPERMIT — —"
DOIURS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oB OF THE LABOR CODE,INTEREST,AHD ATTORNEV'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO A�ENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,CIV.CJ.
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� LENDEFTS NAME
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w I CERTIFY THAT I HAVE READ THIS APPUCATqN AND STATE THAT 7HE ABOVE INFORMATKKJ IS CARRECT. TOTA L FE ES /O « I
� I AaREE TO COMPLV WITH ALL CfTY AND COUNTY ORDWANCES AND STATE UWS REIATIN6 TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CWNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PR TV FOR INSPECTION PURPOSES. COMMENTS �
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~ WHITE—DepeAment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD—File Co GREEN—
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ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR GUt�IDUIT '
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREP�ACE BOND BEAM + �
WATER SERVICE MID HT. 60ND BEAM �
ROOF SHEATHING ' 8 FT. BOND BEAM ��
FRAiVlIfVGNEfVTIL(ATiON FINAL BOND BEAM i
ROOF COVER PRE-GRADfNG
ROUGH HEATING • BENCHING
ROUGN ELECTRIC RUUGH GRADING
ROUGH PLUIVIBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDII�G POC?L FENClNG
WALL.INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS. . -
DRYWALL NAIUMG DEQICATIONS
SEWER FiNAL ENG.
SEPTfC TANK LANDSCAPE/IRRIG.
SEEP PiT/l,.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONlNG
F1NAL CONST. . FlRE DEPT. FINA�
FINAL HEATING HEALTN DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAlD
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