HomeMy WebLinkAbout16592 (22) CTTY OF DIAMOND BAR l `
^---��`— DEPARTMENT OF COI�RvIUMTY&DEVELOPIviENT SERVICES / �
21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
��'�:�� BUILDING PERMIT APPLICATION FIRMLY
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� I HEREBV AFFIRM UNDER PENN.TV OF PERIURV THAT I AM E%EMPT FROM THE COMRACTORS LI- G8f99B/CBfPOfI
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w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck '
� STATEMENT THAT HE OR SHE IS LICENSED PURSUMfT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOUSPB
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U TION.ANY VIOLATION OF SECTfON 7031.5 BY ANV APPUCANT FOR A PERMIT SU&IECTS THE APPLICANT 70 Z Re-Roof
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Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.70u,BU51- J �
� NESS AND PROFESSIONS CODE:THE CONTPACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
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Q THROUGH HIS OR HER ON?J EMPLOVEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR m
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W CENSE LAW DOES NOTAPPLY TO AtJ OV/NER OF A PROPERTV WHO BUILDS OR IMPROVES TMEREON,AND
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� LICENSED CONTRACTORS DECLARATION w .
� I HEREBV AFFIRM UNDER PENALTV OF PE0.IURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� G(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �
�� MY LICENSE IS IN NLL FORCE AND EFFECT, m
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� � � � I� WORKERS'COMPENSATION DECLARATION Q ��
� I HEREBV AFFIRM UNDER PENALTV OF PEFJURY ONE OF THE FOLLOWINO DECURATKKJS: �
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� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR VqRKERS' _
� COMPENSATqN,AS PROVIDED BV SECTION 3�00 OF THE LABOR CODE.FOR THE PERFORMANCE U
OF THE WORK FOR WHlpi 7HIS PERMIT IS ISSUED. W
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QW _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATqN INSURANCE,A5 RE�UIRED BV SECTION
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J ISSUED.MY W-`O�RN,E_RYS'C1OM�PENSATION INSURfWCE CARRIER AND POLICY NUMBER AAE: CONSTRUCTION
j CARRIER ��7'�T'Y�"�, f I�i. GQ � �� ��"'17�MGt4 PLAN REVIEW
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w S�Z I CERTIFV TH�T IN THE PERFORMAtJCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
U' HALL NOT EMPLOV ANV PERSON IN MANNER SO AS TO BECOME SU&IECT TO THE
(/� ERS'COMPENSATIONIAWSOF ORNIqANDAGR THATIFISHOULDBECAME INSPECTIONFEE
&IECTTOTHEWORKERS'COMP I NPROVISION50 TION37ooOFTHELABOR (-�
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p 1DATE: S '3` APPLIC SMIP /, •.. • .,�
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�y SUBJECTANEMPLOVEFTOCRIMINALPENALTIESlWDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT •i •� /I �
DOLLARS(f10o,000),IN ADDITION TO 7HE COST OF CAMPENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTOHNEV'S FEES.
oC � RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV ;-,��
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.CJ.
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� LENDER'S NAA/E
� LENDER'SADDRE55
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TNAT 7HE ABOVE INFORMATION IS CARRECT. TOTAL F E ES ��, �J U
� I AGREE TO COMPLV WITH ALl CITV AND COUNTV ORDINANCES AND STATE LAWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE AEPRESENTATIVES OF THIS CWNTV TO ENTER UPON 7HE
Z ABOVE-MENTIONE�PROPER7Y FOR INSPECTION PURPOSES. COMMENTS
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51 F PERMITTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—DepeAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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GROUND P�UMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE B�ND BEAM
WATER SERVICE MID HT. BOND`BEAPvI
ROOF SHEATHING 8 FT. BOND BEAM
FRAMING�NENTILIATIO(V FINAL BOND BEAM
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ROUGH HEATlNG BENCHING
ROUGH ELECTRIC ROUGH GRADING
FiOUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCIIUG
WALL ItJSULATI(�iV POOL FINA� �
CEI�IIVG INBULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATI�NS
SEWER FINA�ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
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FINAL ELECTRIC DEV. FEES PAfD
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