HomeMy WebLinkAbout17315 (25) ^ _�� _ CTI'Y OF DIAMOND BAR
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
� 21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 EXPIREp PRESS
��»�� BUILDING PERMIT APPLICATION FIRMLY
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� APPLICAT ON PERMIT /
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I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM E%EAIPT FROM THE CANTRACTORS LI- G8f8Q8/CBfPOf(
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIpNED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
CENSE UW(CHMTER Y(COMMENCIN�WITH SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND Pq0- � POOUSpB
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� A CIVIL PENPLTV OF NOT MORE 7HAN FNE HUNDRED DOLLARS(5500).):
� ❑I.ASOWNEROFh1EPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIR50LECAMPENSATION, 0 CORIrt1BfCl81
Z WILL DO THE WOHI(,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.70�a,BU51- J J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NR10 BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HEFSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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- � � LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTV OF PERNRY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
� B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
�� MY LICENSE IS IN FULL FORCE AND EFFECT. m (
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� WOFKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLAMTIONS: Z
�Z _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢
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COMPENSATION,AS PROVIOED BV SEC710N 3700 OF THE 1A80R CODE,f-0R THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTqN
Q 37o00F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE CONSTRUCTION / �
jcnARiER PLAN REVIEW •
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � ��
CJ SHALL NOT EMPLOY ANV PERSON IN M!Y MANNEFi SO AS TO BECOME SU&IECT TO THE
� WORKERS'CAMPENSATION UWS OF CALIFORNIq AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECTTO THE WORNEFS'CAMPENSATION PFOVISIONS OF SECTION 77000F THE LABOR
S CA�E,I SHALL FORTHWIhi COMPLY WITH THOSE PROVI510N5. ISSUANCE
p DATE: APPLICANT: SMIP ��-1" ---".-r-"'-'" . .`�
J WARNINO:FAILURE TO SECURE WOAKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SNALLBE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMRJALPENALTIESANDCIVILFINESUPTOONEHUNDREDTFKKISAND ENERGYPERMIT
OOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATKKJ,DAMAGES AS PROVIDED FOR IN
� SECTqN3708OFTHELABORCO�E.INTEFEST,ANDATTOFiNE1"SFEES. ' RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDEF7 PENALTV OF PERJURV THAT THERE IS ACANSTRUCTION LENDING AOENCY
FOR THE PERFORMANCE OF THE WORN FOR WHICH TNIS PERMIT IS ISSUED(SEC.308],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.
� I AOREE TO CqMPLV WITH ALL CITY AND CWNTY ORDINANCES AND STATE LAWS RELATINO TO BUIL�INO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES^. COMMENTS
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~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicent's Copy �
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FTGS/FORMS/STEEL � FHA RECIMTS
ELECTRIC GRC7UND UNDER FLOOR DJCT
GROUND PLUMBING � ^ � UNDER FLOOR CU�IDUIT � �
SLAB GRADE FIREPLACE FOUNQATION
TEMP POWER FlREPLACE BOND BEAM
WATER SERVECE �• P/lID HT. BOND BEAM
ROOF SHEATHING �. j�/�Y ,�l /�� �.� 8 FC. BQND BEAM �_
FRAMINGNENTILIAT►ON � � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING i
R(�UGH ELECTRIC ROUGH GRADING
FiOUGH PLUPv161NG FINISH GRADING
SH�WER/TUB TEST POOL ELECTR(C
EXT. LATH/SIDING POOL FENCIt�dG
WALL IMSULATIOPJ POOL FINAL
CEIUNG INSUTATIQN OFF SITE lMPS.
DRYWALL h1AILlfVG DED�CATIONS
SEWER FINAL ENG.
SEPTIC TANK IANDSCAPE/IRRIG.
SEEP PIT/L.L ON SITE IMPS. '
GAS AIR TEST FINA�ZONlt�G
FIN/�L CONST. GIRE JEPT. FINAL
FINHL HEAT;NG HEALTH DEPT. FINAL
FiNAI ELECTRIC DEV. FEES PAID
FINAL PLUMBING I ENERGY
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COMi1�ENTS
SEPTIC T,4NK SIZE
SEEP PIT/U SIZE
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