HomeMy WebLinkAbout17701 (42) CTI'1'OF DIAMOND BAR �r I
`�----��`--- DEPARTMENT OF COMMUNITY&DEVELOPIvIENT SERVICES �
21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 P(�E$$
�`'-9*" BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE APPLICATION PERMIT y P/C
ADDRESS DATE G� NUMBER / 70 #
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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p I HEREBY AFFlRM UNDER PEWLLTV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- GBfaJB/Cef()OA
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w TURE,PHIOR TO ITS ISSUANCE.ALSO REW IRES hIE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W P0U0/DBCK
� STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTMCTORS LI� �
� CENSE UW(CHAPTEP i(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPO
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V TION.ANV VIOLATION OF SECTION 7031.6 BV ANV APPUCANT FOR A PERMIT SU&lECTS THE APPUCANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLqqS(5600�J:
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Z WILL DO THE WORK,AND THE STRUC7URE IS NO7INTENDED OR OFFERED FOR SALE(SEC.7a4,BU51� J
� NESS AND PROFESSIONS CADE:THE CANTRACTOFS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WFIO BUILAS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORS�LEIF,HOWEVER711EBUILDIN60flIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� UAPROVEFORTHENRPOSEOFSALE).
w ❑I,AS OWNER OF THE PROPERTY.AM EXCLUSNELV CANTMCTINO WRH LICENSED CONTRACTORS
� TO CANSTRUCT THE PROJECT(SEC.70M,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- VBIUetlOfl .ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
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� LICENSED CONTRACTORS DECLARATION W �
� 1 HEREBY AFFIRAI UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � '
� B(COMMENCINO NTTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
�� MY LICENSE IS IN NLL FOF7CE AND EFFECT. . m
� LICENSE CLASS �+ UC.NO. �
� V DATE � CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION � ,
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� I NEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSEIf-INSUREFOflWORKERS' a
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Q COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE.FOR THE PERFORMANCE U
OF THE WORK FOR WHIC}I THIS PERMIT IS ISSUED. w
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w _I HAVE AND WILLMAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF hIE WORK FOR WHICH THIS PERMIT IS �D/7 �b
ISSUED.MY WORICERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION 7
� CARRIER PLAN REVIEW
0 POLICV NUMBER
7.a ELECTRIC
� (i}pSSECTIONNE�NOT8E00MPLEfEDOFTHEPERIMISFbRONE11lFDREDDOILNiSK10010RLESS? PLUMBING -
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Z I CERTIFV THAT IN THE PERFORMANCE OF iHE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ���-� --� - �
CJ SHALL NOT EMPLOV ANY PEFSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE �L�-��r-1� ( �
(,/) WORKERS'COMPENSATION IAWS OF CALIFORNIA,AND A6REE THAT IF I SHOUID BECOME INSPECTION FEE � t
�� SU&IECTTO7HEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000F7HELABOR • �
� CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE I � �.
p DATE: APPLICANT: SMIP � I r r �� a ^`t�S^ D
w ENERGY P/C I �
J WARNINQ:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAOE IS UNUWFVL,AND SHALL BE
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� SUBJECT M!EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND ENERGY PERM�T � . Y '
DOLLARS(f 100.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37oeOFTHELABORCOOE,IN7EREST,ANDATTORNEV'SFEES. RETENTIONFEE: �`�_-� � P
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: /•
� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THATTHERE IS ACONSTqUCTION LENDINQ AOENCV � ,
FOR THE PERFORMANCE OF7HE F�WHICH iHIS PERMIT IS ISSUED(SEC.30B7,CIV.C.).
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� LENDER'S NAAIE
� LENDERSADDRESS
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES I 3� i �O
� I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATINO TO BUILDINO �
� CONSTRUCTION,AND HEREBV AUTFIORI2E REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PROPERTV F-0R INSPECTION PURP/OySES. COMMENTS
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m PERMITTEE NAME(PRINT)
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� SIGNATURE OF PERMITTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �
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FfGSIF�pMS/STEEL FHA REC�MTS
ELECTRIC GROUND UNDER FLOOR DUCT
GR�UND PLUMBING UNDER FLOOR GU�IDUIT �
SLAB GRADE FIREPLACE F�I�NDATION
TEMP POWER ; FIREPLACE BOND BEAM
WATER SERVICE � � � MID HT. BOND BEAM �
ROOF SHEATHIfVG _��O . ��%/`'' . � 8 F-f. �ONQ [3EAM '
FRAMINGNEN�ILIATtON � FINAL BOND BEAM
ROOF COVER _/L i�' PRE-GRADING
ROUGH HEATlNG SENCHING
ROUGH ELECTRIC ` R�UGH GRADING
ROUGH PLUNIBING FIPJISH GRADING
SHOWEH/TUB TEST POQL ELECTRIC
EX7. LATH/SIDING pOOL FENCING
WALL INSULATION POOL FINAL
CEIIING INBULATION OFF SITE IMPS.
DRYWALL NAILING DEdICATIONS
SEWER FINAI ENG.
SEP7'IC TANK � . LANDSCAPE/IRR1G. �
SEEP PfT/L.L. � � ON SITE IMPS.
GAS AIR TEST FINAL Z�NING
FINAL CONST. � F4RE DEPT. FINA�
FIR1,4L HEATING ��-7- HEALTH DEPT. FItdAL
FINAL ELECTRIC DEV. FEES f'AID
FINAL PLUMBING � ENERGY
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