HomeMy WebLinkAbout10-921 �
_f��_ CITY OF DIAMOND BAR , 1/
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
�, 21825 Copley Drive,Diamond Bar,CA 91765
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``���'� `i BUILDING PERMIT APPLICATION FIRMLY
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W TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patlo/Deck'
� STATEMENT 7HAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 700a)OF DIVISION 3 OF THE BUSINE55 AND PRO- u' POOI/SP8
FESSIONS CODE)OR 7HAT HE OR SHE IS EXEAIPT THEREFROM AND THE BASIS FOR THE ALLEOED E%EMP- (�
� TION.ANV VIOlAT10N OF SECTION 7031.5 BV ANV AGPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(f600�.):
Z~ OI,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWIhIWAOESA5THEIRSOLECAMPENSATION, �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEPED FOR SAlE(SEC.7aa,BU51- J COrtIrtIBfC18I
N NESS AND PROFE55lONS CADE:THE CANTRACTORS UCENSE UW DOES NOT APPLY TO AN OWNER OF �
PROPERTV WHO BUILDS OR IAIPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CL iHROU(3MNISORHERON?lEM7LOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
� OFFEHEDFORSALEIF,HOWEVERTMEBUILDIN60RIMPROVEMENTISSOLDWITHINONEVEAROFfAMPLE�
Z TION,THE OWNERBUILDER WILL HAVE TNE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR
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� TO CONSTRUCT TME PR0.IECT(SEC.704/,BUSINESS AND PROFESSIONS CODE:TME CANTRACTORS LI- V81U0f1Of1 � ADJ.AREA
W CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILAS OR IMPROVES iHEREON.AND
� MM1/OCONTRACTSFORSUCHPROJECTSWITHACONTMCTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
Y TORS LICENSE LAW.). FEE
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� DATE OWNER � �
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� LICENSED CONTRACT DECLARATION . W
� I HEREBY AFFIRAI UNDER PENALTY OF PERIURV THAT I AM IICENSED UNDER PROVISKKJS OF CHAPTER �
� Y(COMMENGNO WRH SECTION 7000)OF DMSION 3 OF THE BUSINESS AND PROFESSKKJS CODE,AND Z � '
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� WORKERS'COMPENSATION DECLARATION a ��
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OFTHE FOLLOWINO DECLARATIONS: Z
0 _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORNERS' a
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Q COMPENSATION,AS 7ROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICN THIS PERMIT IS ISSUED. �
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w _I NAVE AND WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOq WHICH THIS PERMIT IS 7o�
J ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND FOLICV NUMBER AAE: CONST � ' �/
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� POLICV NUMBER ' -
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� (1FM1SSECt10NNE�NOTBE00MRF7IDOFhEPEW.4rISFpRONEFM1II�DREDDOLLARS(5100)ORLESS} PLUMBING '
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(/� WORNERS'COMPENSATION LAWS OF CALIFORNIA NJD AQREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECT TO THE WOH)(ERS'fAMPENSATKKJ PROVISIONS OF SECTION 37000F THE LABOR A
O CODE,I SHALL FOFTHWITH COMPLV WITH THOSE PROVISIONS. ISSUA C SV
p DATE: APPLICANT: ' P � ��
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J WMNIN�:FNLURE TO SECURE WOFl)(ERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SH�LL BE GY P/C �
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� SU&IECTANEMPLOVERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND NERGY ♦7
DOLUR9(floo.oao),IN MDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
� SECTqN 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. E7ENTIO FE �_(��
OCONSTRUCTION LENDING AGENCY ��E� o
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUC710N LENDINO ADENCV
FOR THE PERFORMANCE OF THE WORN FOq WHICH THIS PERMIT IS ISSUED(SEC,3087,CIV.C.).
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� LENDERS NAME �
� LENDEIYSADDRE55
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W I CERTIFV THAT I HAVE READ THIS APPIICATION AND STATE THAT 7HE ABOVE INFORMATqN IS CAfiRECT. TOTAL FE ES � 2 6 e.35 . 3�(�'-�.S'3
� I AOREE TO COMPLV WITH ALL CfTV AND(,`OUNTV ORDINANCES AN�STATE UWS REUTING TO BU0.DING
� CONSTRUCTION,AND HEREBV AUTIqR12E REPRESENTATNES OF 7HIS CWNTV TO ENTER UPON THE ' 1 ��
QABOVE-MENTIONEO PROPER7V FOR INSPECTION PUqPO5E5. COMMENTS 17�5� ` ��C � �1�p��..J\ � �n
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WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROa–File Copy,OREEN—Applicant's Copy
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ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM - "� � � ' ` ' �
FRAMINGNENTILATION � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHIfJG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERrfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK • — _ � LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SiTE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTN DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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