HomeMy WebLinkAbout17134 CITY OF DIAMOND BAR ;-"���
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w TURE,PRIOR TO ITS ISSUANCE,AL50 RE4UIqE5 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PfiOVISIONS OF THE CONTRACTORS LI� � D
� CENSE LAW(CHAP7ER B(CAMMENCING WI7H SECTION 7000)OF DIVISION 3 OF 7HE BUSINE55 AND PRO- POOVSpB
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP� (�
V TION.ANV VIOLATION OF SEC710N 7037.5 BV ANV APPLICANT FOR A PERMIT SU&1EC757HE APPLICANT TO Z RC-ROOi
� A CIVIL 7ENAL7Y OF NOT MORE THAN FIVE HUNDRED DOLLARS(t500).): '.
ZOI,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSATION, � COrt1rtIBfCi81
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a�,BU51� J �
� NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF
— PROPERTVVrtiOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORNHIMSELFORHERSELFOR � I
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIOE�7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m �
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Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR -
� IMPROVE FOR 7HE PURPOSE OF SALE). �
w ❑I,AS OWNER OF THE PROPEHTY,AM E%CLUSIVELV CON7RACTING WI7H LICENSED CANTRACTORS �
Q TO CONSTRUCT THE PRQIECT(SECJOa�,BUSINESS AND PROFESSIONS CODE:THE CON7RACTORS LI- V21U2�1Of1 < ADJ.AREA
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CL I HEREBY AFFIRM UNDER PENALTV OF PERIURV 7HAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � q
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z 'v' ` 0
`X MV LICENSE IS IN FULL FORCE AND EFFEC7. m
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� I HEREBYAFFIRM UNDER PENALTV OF PERIUPY ONE OFTHE FOLLAWING DECLARATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICA7EOFCANSEN7TOSELF-INSUREFORWORKERS' 2
¢ CAMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CADE,FOR THE PERFORMANCE �U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w 1 HAVEAND WILL MAWTAIN WORKERS'COMPENSATION INSURANCE,AS REOl11RED BV SECTION
Q 370o OF THE LABOR CADE,FOF THE PERFOFiMANCE OF THE WONK FOR WHICH 7HI5 PERMIT IS O
ISSUED.MV W KERS'COMPENSATION INSURANCE CA RIER AND POIICV NUMBER ARE: CONSTRUCTION
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Z I CER7IFV THAT IN THE PERFORMANCE OF THE WORK FOP WHICH THIS PERMIT IS ISSUED,I MECHANICAL ��•e /
C} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE
� SU&IECT TO THE WOFKERS'COM7ENSATION PqOVI510NS OF SECTION 3700 OF THE BOR /'�
� CAO,I SH LL FORTHWITH COMPIY WITH THOS ROVISIONS. � ISSUANCE V.
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p DATE: �� D qPPUCAN. � .
J WAHNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAW AND SHALL BE ENERGY P/C �
� SUBJECTANEMPIOVEfiTOCRIMINALPENALTIESANDCIVILFINE5UP700NEHl1NOREDTHOUSAND ENERGYPERMIT �
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AN�ATTOFNEYS FEES. RETENTION FEE: O
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' � .
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� I HERE6V AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV �
FOR THE PERFORMANCE OF THE WORK F R WHICH THIS PERMIT IS ISSUEO(SEC.3097,CIV.C.).
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� LENDER'S NAME �
H I.ENDER'SADORESS
� TOTAL FEES S � � ` I �� c�Z•�
� I CERTIFY THAT I HAVE READ TFIIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
� I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING � ��U
� CONSTRUCTION,AND HEREBV AUTHOFIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE �'
Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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m PERMITTEE N E(PRINT) �
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Uj SIGNATUREOFPERMITTEE DATE
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TEMP POWER i � FIRE�LAGE BCJi�D BEAiVi
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FRAMINGNENTILIATION ! FINAL BOND_BEAM _ _____ ' ______
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DRYWALL IVAIUNG DEDiCATit�NS
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B�WER FINA�E�1�. '
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SEPTIC TANK LANDSCAP�IIRRIC.
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SEEP PIT/L.L � ON SITE SMP�. i
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FINAL CONST. I FIRE DEPT�. FlNA�
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