HomeMy WebLinkAbout17500 (58) CITY OF DIAMOND BAR �
`-----�F�"-- DEPARTIvIENT OF COrRv1UNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive EXPIRED
- (909)860-3195 Fax(909)861-3117 PRESS
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p 1 HEREBV AFFlRAI UNDER PENALTV OF PERJUFV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8 0/C8 OR
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W TURE.PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHAPTEF B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � Pool/Spa
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A GVIL PENALTY OF NOT MOFE THAN FIVE HUNDRED DOLLARS(f500).):
Z~ ❑I,ASONTJEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, �
WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a1,BUSI� J COrtIrtIBfC18I �
N NESS AND PROFESSIONS CODE THE CONTqACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPEHTI'N?i0 W ILDS OR IMPROVES THEREON.AND MM110 DOES SUCH WORK HIMSELF OR HERSEIF OR
w TMROUGH HIS OR HER OVM EMPIOVEES,PROVIDED THAT SUCH IMPFOVEMENTS AFE NOT INTENDED OR m
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TION.7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAi HE OR SHE DID NOT BUILD OR
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w ❑I,ASOWNEROFiHEPROPERTV,AME%CLUSIVELYCANTRACTINOWITHLICENSEDCONTRACTORS
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� VAfOCONTMC7SFORSUCHPROJEC7SWIh1ACON7RACTOR(S)LICENSEDPURSUANTTO7HECONTiUC- QUANTITY DESCRIPTION � FEE
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� I HEFiEBV AFFIFiM UNDER PENAL7Y OF PERIURV THAT I MI LICENSED UNDER PROVISIONS OF CHAPTER � �
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� WOFKERS'COMPENSATION DECLARATION Q
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N I HEREBV AFFIRM UNDER PENALTV OF PEiiIURV ONE OF THE FOLLOWING DECURATIONS: Z
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0 _I HAVEAND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
� COMPENSATION,AS PROVIDED BV SECTION 370a OF TFIE LABOR CODE,f-0R THE VERFORMANCE U
Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED.� �
w _I HAVE ANO WILL MAINTAIN WORKEfiS'COMPENSATION INSURANCE,AS REOUIRED BY SECTqN
Q 3700 OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I$ �O�J,1/�
� ISSUED.MY WOLgI�ER--��S'C//O��M�_PENSATION IN CE C�p�q���c�R AND POLICV NUMBER AAE: CONSTRUCTION _ ( 7
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL ��'
� C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATqN UWS OF CALIFORNIq AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE I I
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE UBOR �
CODE.ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISKKJS. ISSUANCE � ^� I �
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p DATE: APPLICANT: � j
w ENERGY P/C I�RV• I
� WAANINO:FAILURE TO SECUflE WORKERS'COAIPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ��_
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESMIDClVILFINESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT ��-�� —� '
DOLURS(f1o0.o00).IN ADDITION TO THE COST OF CAMPENSATqN,DAMAGES AS PROVIDED FOR IN
� SECTION370BOFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ��
� I HEREBV AFFIfiM UNDER PENALTV OF PERIURV THAT THERE IS�CANSTRIJCTION LENDING AOENCY
FOR iHE 7ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
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� 1 CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES / ��� ,�
w I AGFEE TO CAMPLV WITH ALL CfTY AND CAUNTY ORDINANCES AND STATE LAWS RELATINO TO BUILDING
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� CANSTRUCTION,AND HEREBV AUTFIORIZE REPRESEMATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE-MENTIONED PROPE FO INSPECTION PUR SES. COMMENTS
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= RECPT.NO. PAID BY�10 VALIDATION
~ WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK � FLODR JOIST � .
FTGS/FORMS/STEEL � FHA RE�MTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUNQ PLUIVIBWG UNDER FLOOR CU�IDUIT , . � � � .
SLAB GRADE FlREPLAGE FOUNDATION� '
TEMP POWER FiAEPLACE B�ND BEAM i
WATER SERVICE M1D HT. BOND BEAP/I '
ROOF SHEA�'HING . ��D� 8 Ff. BOND BEE#tvl •
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING �
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GRADING
ROUGH P�UNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION � POOL FINAL
CEILING IiVSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. �
SEP7fC TANK LANDSCAPE/iRRIG.
SEEP PIT/LL. ' ON SITE IMPS.
GAS AIR TEST FINAL ZO(VING
FINAL CONST. �IRE DEPT. FINAL
FINAL HEATING HEALTH DEP�. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBItJG ENERGY
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COMMENTS
SEPTIC TAi�IK SIZE
SEEP PIT/U SIZE
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