HomeMy WebLinkAbout17621 ---_��� -- CTTY OF DIAMOND BAR ' ��
DEPARTMENT OF COMMUNTI'1'&DEVELOPMENT SERVICES
21825 E.Copley Drive ' �
- (909)860.3195 Fax(909)861-3117 PRE$$
�'�:�� BUILDING PERMIT APPLICATION FIRMLY
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTOflS LI- G8f8JB/CafPOIS
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w TURE.PRIOR TO ITS ISSUANCE,/�150 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIQNED w Patio/Deck
g STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PqOVISIONS OF iHE CONTRACTORS LI� �
g CENSE LAW(CHAPTER D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 MlD Pq0- POOUSPB
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V TKKJ.ANV VIOLATION OF SECTION 7031.5 BV ANV APPUCANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A GVIL PENALT/OF NOT MORE 7HAN FNE HUNDRED DOLLARS(f5o0).):
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Z WILL DO THE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�4,BU51� J �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
FROPERTY WHO BUILDS OR IMPqOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUGNHISORHEHOWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSAAENOTINTENDEDOR m
Q OFFEREDFOqSPLEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION.hIE OWNER�BUILOER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASON7JEROFTHEPROPEHTY,AME%CWSIVELVCANTRACTINOWITHLICENSEDCONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7014,BUSINE55 AND PROFESSIONS CADE:THE CANTRACTORS LI- VBIUefIOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TOMI OWNER OFAPROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� VhIOCONTRACTSFORSUCHPR0.IECTSWI7HACONTRACTOR(5)LICENSEDPUHSUANTTOTHECONiRAG QUANTITY DESCRIPTION
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I HEREBV AFFIRM UNDER PENAITV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER /
� e(COMMENCINO WITH SECTbN 7000)OF DNISION 30F THE BUSINESSAND PROFESSIONS COOE,AND Z C��IhL C�C�SS t D �r �
X`� MV LICENSE IS IN FULL FORCE AND EFFECT. m 2 0�����uT�L LL{�{�
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� WORKERS'COMPENSATION DECLARATION � " 1 ' �'�' �'C
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLARATIONS:
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0Z _IHAVEANDWILLMAWTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' ¢
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COMPENSATION,AS 7ROVIDED BV SECTION 7700 OF THE LABOfl CODE.FOR THE PERFORMANCE U
OF 7HE WORK FOR WHlqi THIS PERMIT IS ISSUED. W
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w _I HAVE AND WILL MAINTAIN WORKERS'COMFENSATION INSURANCE.AS FEWIRED BV SECTION
Q J700 OF iHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHIC}i THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
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CARRIER �-7
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� (IHI.SSECi%7NNE�NDTBECOA�P�E7EDOFThEPEA�.ir15FpRqVEMTDREDD0.WiS(f100)ORLESSy PLUMBING �' „�\7
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2 I CERTIFY 7HAT IN THE PERFORMANCE OF T1E WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � 1 �1
G} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO7HE � o
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I S pULD BECOME INSPECTION FEE
= SUBJECTTOTHEWORKERS'COMPENSATIO OVISIONSOFSECTION . 60FTFIELAB R � ���,
CO�E,I SHALL FORTHWITH COMPLV P 6VI fS. ISSUANCE
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J WARNINO:FAILURE TO SECURE WOHKERS'CO SATION COVEMO NLAWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTM!EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP ONE HUNDRED THOUSANO ENERGY PERMIT
DOLLARS(5100,000),IN ADDI710N TO THE COST OF COMGENSATION,DAMAGES AS PFOVIDED FOR IN ��O
J SECTION 3]OB OF THE LABOR CODE,WTEREST,/�ND ATTORNEI"S FEES.
w � RETENTION FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDINO AGENCY
� FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB],CIV.C.).
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� LENDER'S NAME
� LENDEfYSADDRESS
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT 7HE ABOVE INFORMATION IS CORRECT. TOTAL F E ES J�,� „�
� I AGREE TO COMPLV W(TH ALl CITYlWD COUNTV ORDINANCES AN�STATE UWS REUTING TO BUILDINa �/
� CONSTRUCTION,AND MEREBV AUTHORIZE flEPRESENTATNES OF iHIS COUN7V TO ENTER UPON THE
Z ABOVE�MEMIONED PROPERTV FOq INSPECTION PURPOSES. COMMENTS
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� SIGN PE EE DATE
� RECPT.NO. � PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLAENRO�File Copy,GREEN—ApplicanYs Copy
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GROUND PLUMBING UNDER FtOOR�U�IDUiT
SLAB GR,4DE FIREPL`ACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WA7ER SERVICE MID HT. BOND BEAM
ROOF SNEATHING � 8 FT. B�j�JD�85AIV4�
FRAMINGNENTILtATIOfV FINAL BOND BEAM
ROOF COVER � PRE-GRADING �
ROUGH HEATING BENCHIAIG
ROUGH ELECTRIC � _ ROIJGH GRADING
ROUGH PLUMBING � .��(��� FfNISH GRADING
SHOWER/TUS TEST � POOL ELECTRIC
EXT. tA7H/SIDiNG POOL FENCING
WALL INSUTATIOh! � POOL FII�AL
CEILtMG INSULATiON OFF SITE IMPS.
DRYWAL�NAILING DEDICATIONS
SEWER �FlNAL ENG.
SEPTIC TANK ; " �,4NDSCAPE/IRRIC,.
SEEP PIT/LL. � -� j QN SITE IMPS.
GAS AIR TEST , FINAL ZONING
FINAL CONST. ��-l_pL ��. , FlRE DEPT. FINA!.
FIfVAL HEATING �;� HEALTH DEPT. FINAL
FINA�ELEGTRIC � DEV. FEES PAID
FINAL PLUMBING � a '� ENERGY
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