HomeMy WebLinkAbout17053 _�� _ CTTY OF DIAMOND BAR
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES EXPIRED
21825 E.Copley Drive
� (909)860-3195 Fax(909)861-3117 APR 2 5 2003 PRESS
�'%��� BUILDING PERMIT APPLICATION FIRMLY
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' 0 I HEREBV AFFIRM UNDER 7ENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTMCTORS LI- G8f8gB/Cfl�OfS
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.6BUSINESSANDPqOFES510N5CODE:ANYCITYOR (J�
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w NRE,PRqR TO ITS ISSUANCE.ALSO HEQUIRES THE APGLICANT FOP SUCH PERA/1T TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO TME PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CNAPTER G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooUSpa
� FESSIONSCODE�OR1}UTHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEQEDEXEMP- (J
TION.ANY VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPIICANT TO Z Re-Roof
A CNIL VEN/LL.TV OF NOT MORE THAN FNE HUNDRED DOLLARS(f600)J: �
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Z WILL DO THE WORKµD THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a1,BUSI� J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNEF OF �
VROPERTV WHO BUILDS OR IMPROVES THEFiEON,AND YAiO DOES SUCH WOFN HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER OWN EMPLOYEES.PqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Q TO CONSTAUCT THE PROJECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V8Il18fI0f1 ,J ADJ.AREA
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WRH SECTION 7000)OF DNISION 3 0F THE BUSINESS AND PROFESSKKJS CADE,AND Z
OMV LICENSE IS IN FULL f-0RCE/J!D EFFECT. �� �
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� WORKERS'COMPENSATION DECLARATION Q
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� I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DEClAMT10NS: Z
�Z _I HAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' ¢
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COMPENSATION,AS PqOVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMMICE U
OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. w
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Qw _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION
3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS VERMIT IS ��-�(}
ISSUED.MV MlORKEflS'COMPENSATqN INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �
jCARRIER PLAN REVIEW �
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� (fF165ECIqNNE�NOTBECOA�I.ETIDOFTHEPEpMfTISFpqpNEFiIN�OfiEDDOLLMS(5700)ORLE55� PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C7 SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
(/� WORKERS'CAMPENSATION LAWS OF CALIFORNIA,lWD AGREE THAT IF I SFqULD BECAME INSPECTION FEE
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
�j CADE,I SHALL FORTHWITM COMPLY WITH THOSE PROVISIONS. ISSUANCE
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J WARNINQ:FAILURE TO SECURE M/ORKERS'COMPENSATION COVEqAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCNILFINESUPTOQ4EHUNDREDTHOUSAND ENERGYPERMIT
DOlURS(floo.oa0),IN ADDITION TO THE COST OF CAMPENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 3�OB OF THE LABOR CODE,MTEREST,AN�ATTORNEV'S FEES. ' O I
w RETENTION FEE:
O CONSTRUCTION LENDiNG AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNOER PEN/�LTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AOENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.).
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� LENDER'S NAME
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� TOTAL FEES �(J .
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE W FORMATION IS CORRECT.
w 1 AGREE TO CAMPLV WITH ALL CfTV AND COUMV ORDINANCES AND STATE UWS PELATING TO BUILDING •
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CWNN TO ENTER UPON THE � O( —
Z ABOVE-MEMIONED PROPERTV FOR INSPECTqN PURPOSES. � �
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� .RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SLAB GRADE ' FIREPLAGE FOUNUATION
TEMP POWER FIREPLACE BONL BEAM
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ROOF SHEATHIfVG 8 FT. B�ND BEAM
FRAMING/YENTfLIATION FiNAL BQtJD BEAM
ROOF COVER PRE-GRADING
Rt?UGH HEATING BENCHlNG
ROUGI-I ELECTRIC ROUGH GRADING
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SHdWER/TUB TEST PQOL ELEC7RIC
EX7. LATHJSIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPB.
DRYWALL NAILING DEDICATIOIVS
SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPE/IRRIG.
SEEP PIT/L,.L. � �N SlTE IMPS.
GAS AIR TEST FINAL ZONING
FINAL COPVST. G!RE DEPT. FINA�
FlNAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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