HomeMy WebLinkAbout17660 (44) `----�� — C1TY OF DIAMOND BAR I
DEPARTIv1ENT OF COARv1UNTI'1'&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860.3195 Fa�c(909)861-3117 PRESS
"'-��� BUILDING PERMIT APPLICATION FIRMLY
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o ADDRESS ZONING SETBACKS
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p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFlRM UNDER PENALTV OF PEFiNRV THAT I AM EXEMPT FROM THE CONTfiACTORS LI� Gflf8Q0/CBfPOfI
W CENSELAWFORTHEFOLLOWINOHEASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVqTVOR (n
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� w TURE,PRIOfl TO ITS ISSUANCE,/�150 RE-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS LICENSE�PURSUMIT TO THE PROVISIONS OF THE CONTRACTORS LI� �
g CENSE lAW(qiAPTER B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
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TION.M/VVIOLATIONOFSECTION7031.6BVANYAPPLICANTFORAPERMITSU&IECTS7HEAPPLICANTTO Z Re-Roaf
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Z WILL DO THE WORK,Ml�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�a,BU51- J �
N NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � I
PROPERTY WFIO BUILDS OR IMPqOVES THEREON,AND YA-10 DOES SUCN WORN HIMSELF OR HEHSELF OR
WTNROUGH HIS OR HER OWN EMPLOVEES,PROVIDEO 7HAT SUCH IMPROVEMENTS ARE NOT IMENDED OR m
� OFFEREDFORSALEIF,HOWEVERTMEBUILDIN60HIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
Z TION,THE OWNER�BUILAER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� UAPROVEFORTHEPURPOSEOFSALE).
w ❑I,AS OWNER OF THE PROPERTY,AM EXCLUSNELY CONTMCTWG WfTH LICENSED CONTMCTORS
� TO CONSTAUCT THE PROJECT(SEC.70N,BUSINE55 AND PROFESSIONS CADE 7HE CONTRACTORS LI� V0111Bt1 ADJ.AREA '
W CENSE UW DOES NOTMPLV TO AN OWNER OFA PROPERTV NR10 BUILDS OR IMPROVES THEREON,AND
� WF�OCONTRACTSF9RSUCHPRQIECTSWITMACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION � y FEE'
TORS 4CENSE LAW.).
� ❑I AM E%EMGT UNDER SEC. 8.d P.C.FOR THIS REASON Q
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� DATE OWNER �F
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�¢ LICENSED CONTRACTORS DECLARATION W
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I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISKKJS OF CHAPTER � `1
� e(COMMENCIN(i WITH SECTqN 7000)OF DNISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS W FULL FORCE AND EFFECT. m
� UCENSE C`LASS LIQ NO._/ �,�� ' � .
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� WOAKERS'COMPENSATION DECLARATION Q
� I HEREBYAFFIRM UNDER PENALTV OF PERIUf1V ONE OFTHE FOLLOWING DECLARATKKJS: Z
� _1 HAVE M1D WILL MNINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOflKERS' _
Q COMPENSATqN,AS OROVIDED BV SECTION 37oa OF THE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
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Qw I HAVEAND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION ,.�/]"\ ,`
37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS 9 ,{/� J U
J ISSUED.MV WORKE/R^S'COMPENSATION INSURANC�E/CAR^R�IER AND POLICV NUMBER ARE: CONSTRUCTION � / �
j CARRIER ,z� �N/J PLAN REVIEW
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Z I CERTIFV THAT IN THE PERFORMANCE OF TIE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C`} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE
(/j WOHICERS'COMPENSATqN LAWS OF CALIFORNIA�ND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
S CODE.I SNALL FORTHWITH CAMPLY WITH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: SMIP
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J WARNIMO:FAfLURE TO SECURE WORKERS'CAMPENSATION COVEHAGE IS UNLAWFUL,AND SHALL BE ENEFGY P/C
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� SU&IECTANEMPLOVERTOCRIMWALPENPITIESANDCMIFINESUPTOONEHUNDREDTHOUSAND ENERGYPEFMIT
OOLLARS(f 700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CADE,INTEREST,AND ATTORNEVS FEES. RETENTION FEE: .
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIqM UNDER PENALTV OF PERJUqV THAT THERE I$ACANSTRUCTION LENDINQ AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICM TMIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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�Z LENDEi75 NAME
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F- LENDER'SADDRE55
w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTIiEABOVEINFORMATqNISCORRECT. TOTAL FEES i � �
� I AGREE TO COMPLV WITH ALL CITV M1D COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE-MENTpNED PP PERTY FOR INSPECTION PURPOSES. COMMENTS
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= RECPT.NO. PAID BY VALIDATION
~ WHITE—DepeAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENRO File Copy,GREEN—AppllcanYs Copy
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GROUND PLUMBING UNDER FLQOR GO�IDUIT
SLAB GRADE FIREPL.AGF_ FOUNDAT�ON
TFMP POWER FIREPLACE BOND BEAM ^
WATER SERVICE MID HT. BOND BEAM •
ROOF SHEATHING �'j vZ �`��f%C�'�"' �• ,.8 FT. BOtJD B�AM
FRAMINGNENTILfATtON ' � i ' FtNAL BOND BEAM
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ROUGH NEATING BENCNING
ROUGH ELECTRIC ROUGH GRADIiVG
ROUGH PLUMBING FINISH GRADING
SHOWERJTUB TEST POOL ELECTRIC
EXT. LATHISIDING POOL FENCING
WALL INSULATION PQOL FIRIA�
CEILING IN�ULATION OFF SITE iMPS. -
DRYWALL iVAILIh1G QEDICATIONS
SEWER FINAL ENG.
SEpTIC TANK ;', LARlDSCAPE/IRRIG.
SEEP PIT/L.L. � ` ON SITE IMPS. '
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINA�
FINAL ELECTRIC DEV. FEES PAID
FIN/aL PLUMBING ENERGY
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