HomeMy WebLinkAbout11-649 _�`_ CITY OF DIAMOND SAR ���� �����
• DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVI
' ' 21825 Copley Drive,Diamond Bar,CA 91765 S
'� (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-70���� [����
��q�'��w BUILDING PERMIT APPLICATION E'�� LY
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FpOM TNE CONTRACTORS U- G8f8QB/C9�OR
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w TURE,PRIOR TO ITS ISSUANCE,ALSO NE�UIRES THE APPLICANT FOR SUC71 PERMIT TO FILE A SI�NED
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTMCTORS LI-
� CENSE UW(CHAPTEP c(CAMMENCiNp WITN SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRb u" POOUSPO
Q FESSIONSCODE)OP7}UTHEORSHEISE%EMPTTHEREFROMANDTNEBASISFORTMEALLEGEDEXEMP�
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� A CML PENALTV OF NOT MORE T11AN FIVE HUNDpED DOLLARS(S50o).):
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Z WILL�O TNE WOWC,AND 7F1E S7HUCTURE IS NO7 IMENDED OF OFFEFED FOR SAIE(5£C.7aa,BU51- J
NESS AND PROFESSIONS CODE:hIE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF
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Z TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SNE DIO NOT 9UILD OR
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' Q TO CONSTRUCT THE PROJECT(SEC.7aN,BUSINESS ANO PROFESSIONS CO�E'.THE CONTRACTORS LI� V01U8110f1 ADJ.AREA
� CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWFIOBUIIDSOFIMPROVESTHEFEON.AND
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� LICENSED CQNTRACTORS DECLARATION �j
� I HEREBY AFFIRN UNDER PEN�LTY OF PERJURV TNAT I AM UCENSED UNDER GROVISIDNS OF CHAP7ER �
a, B(COMMENCiNG WIT1i SECTION 7000)OF DIVISiON 30F THE BU51NE55 AND PROFESSIONS COOE,AND Z
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� 1 HEREHY AFFIPM UNDER PENALTY OF PERIURY ONE OF THE FOLIOWING DECIARAT10N5:
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� I NAVE AND W�LL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORNERS' S ' J�
� COMPENSATION,AS PROVIDED BY SECTION 3]00 OF THE LABOR CODE,FOR THE PERFORMANCE W
OF THE WOFH FOH WHICH THIS PERMIT IS ISSUED. �
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w �I HAVE AND W1Ll M/JNTAIN WOR)(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE LABOR CO�E,FOR THE PEfiFOi7MANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV.�WOg��RS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER AAE: CONSTRUCTION
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� POLICY NUMBER 'A � d ELECTRIC � �
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¢ PLUMBING �
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� 1 CER7IFV THAT IN THE PEFFORMANCE�F h1E WOR1(FOR ERMIT IS ISSUED,I MECHANICAL � ���
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(!j SHALL NOT EMPLOV ANV�ERSON IN ANV MANNER 50 A ECAME SU&IECT TO THE
� WOAKERS'fAMPENSATION LAWS 0F CALIFORNIA,AN �REE THAT IF I SHWLD BECOME INSPECTION FEE , _
SU&IECT TO THE WORKERS'CAMPENSATION PROVI NS OF SECTH7N 3700 OF T-IE LABOR /9�
� GODE,I SHALL FORTHWITH COMPLV WITH TNOSE P OVISIONS. ISSUANCE �-�
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p DATE:-�� APPLICANT: .
w ENERGY P/C
J WARNING:FAILURE 70 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
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� SUBJECT AN EMPLOVER TO CRIMINAL PENPLTIES AND CIVIL FINES UP TO ONE HUNORED THOUSMID ENERGY PEAMIT
DOLLARS(f 100.Oa0),IN hDDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN /�
� SECTION 3]OB OF THE LABOR CODE,INTEREST.AND ATTORNEVS FEES. RETENTION FEE: _L -�'O .
w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIFM UNDER PENALTV OF PEWUFV THAT THERE IS A CONSTRUCTION LENDING AQENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED(SEC.�OB7,CIV.C.).
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Q ICERTIFVTHATIHAVEREADTHISAPPLICATIONAN�STATETHATTMEABOVEINFORMATqNISCARRECT. TOTAL FEES / '
� I AOREE TO COMPLV WITH PLL CITY ANO CAUNTV ORDINANCES.WD STATE IAWS REUTINO TO 9UILDINO
CONSTRUCTION,AND HEREBV AU�-�ORIZE REPRESENTATIVES OF THIS COUIJTV TO EN7ER UPON THE
ZABOVE-MENTqNED PR07ERTV FOR INSPECTION PURPOSES. COMMENTS
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SET BACK • ��. FLOOR J015T " �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. �ATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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