HomeMy WebLinkAbout17211 (25) ��_ CTI'Y OF DIAMOND BAR EX P I R ED
DEPARTMENT OF COrM�fUMTY 8c DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 F�(909)861-3117 JUN 181002 PRESS
�9�� BUILDING PERMIT APPLICATION FIRMLY
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p OWNER �QCaYIo (->oYnc�2 DATE t��I�I�1 CONST. GROUP
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o ARCH/ENG/
z DESIGNER
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� UNITS STORIES BEDROOMS
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
p SFR/ADD/REM
p I HEREBY AFFIRM UNDER PEN�LTV OF PERJURY THAT I AM E%EMPT fROM THE CONTRACTORS LI� G0f8 B/C8 OfI
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.5BUSINESSANDPROfESSIONSCODE:ANVCITYOR (n 9 �
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w 7URE,PRIOR TO ITS ISSUANCE,AL50 REW IRES iHE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNED w
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI�
�� CENSE LAW(qiAPTER D(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO� � POOUSPe
FESSIONSCODE)Ofl7HATHEORSNEISEXEMPTTHEREFROMANDTHEBA515FOqhiEALLEOEDE7(EMP� C7
V T10N.ANYVqLAT1pNOF5ECTlON7031.SBVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A CNIL PENALTY OF NOT MORE THMI FIVE HUNDRED OOLLARS(S5o0)J:
Z ❑I,ASONTJEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIrtIOfCldl �
N�LL DO THE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a�,BUSI- J
� NESS AND PROFESSIONS COOE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV MR10 BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,FHOVIDED THAT SUCH IMPqOVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVER71'�EBUILDWOORIMPROVEMENiIS50LDWfTH1NONEVEAROFCOMPLE-
Z TION,THE OWNER�UILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR .
� IMPROVE FOR T1E PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSNELVCANTRACTINOWITHLICENSEDCONTRACTORS
� TO CANSTRUCT THE PRQIECT(SEC.704/,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI� VdIU0fI0(1 ADJ.AREA
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE �Q S O I ONMEF aC�.QY/I� �f i�Y�I E7 F—
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� LICENSEO CONTRACTOFS DECLARATION w
� I HEREBY AfFIH1A UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
I � e(COMMENCINO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z '
��x MY LICENSE IS IN FULL FORCE M!D EFFECL m
� LICENSE CLASS LIC.NO. �
V DATE CONTRACTOR �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV ONE OFTHE FOLLOWING DECLARATIONS: Z
� _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' a
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COMPENSATION,AS PROVIDED BV SECTION 3�00 OF THE LABOR CODE.FOR THE PERf-0RMANCE U
OF THE WORK FOR WHlqi THIS PEPMIT IS ISSUED. w
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w _I HAVEAND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE.AS RE�UIRED BY SECTqN
Q 3�00 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jCARRIER PLAN REVIEW
Z POLICV NUMBER ELECTRIC �~ �
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� (iHISSECfpNNEIDNOTBEOJMPLEfIDOFTlfPERAYTISFORONEF�0.1rDREDDOILAfYSK100)ORLESS} PLUMBING
. Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C'} SHALL NOT EMPLOV ANV PERSON IN!WY MANNER SO AS TO BECAME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIqlWD AGREE THAT IF I SHOULD BECAME INSPECTION FEE
SUBJECTTOTHEVJORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHELABOR �r = r J
s CODE,ISHALLFORTHWITHCOMPIVWITHTHOSEPROVI510N5. ISSUANCE U
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p DATE: APPLICANT:
J WARNINO:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,lWDSHALLBE ENERGYP/C
�y SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTFIOUSAND ENERGYPERMIT \
DOLLARS(f100.000).IN ADDI710N TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN
� SECTION37aeOFTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. {��ENTIONFEE: i '� "
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDINO A�ENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED(SEC.708�,CIV.C.). .
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� LENDER'S NM1E �
H LENDER'SADDRESS
w TOTAL FEES ��j ��j � ,
I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TYiAT THE ABOVE INFORMATION IS CARRECT.
� I AOREE TO COMPLV WITH ALL qTY AND COUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CAUNTV TO EMER UPON THE �
Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
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FTGS/FORPViS/STEEL , ,� FHA REQMTS � � ' �
ELECTRIC GROUNO � UNDER FLQOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT i '
SLAB GRADE FIAEPi,ACE FOUNDATIOPd
7EMP POWER � FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHlNG $ F1'. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING ~
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUh/IBING FINISH GRADING
SHOWEF�fUB TEST P�OL ELECTRIC
EXT. LATH/SIDING POOL FENCING �
WALL INSULATIOPV POOL FINAL
CEILING INSUTATI�N � OFF SITE IMPS. � +
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. W—A
SEEP PITl�.L. �N SITE IMPS.
GAS AIR TEST FINA�ZONING
FINAL CONST. - cIRE DEPT. FINA�
FINAL HEATING � HEALTH QEPT..,�INAL
FINAL ELECTRIC DEV. FEES PAID �
FINAL PLUMBING ENERGY �
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