HomeMy WebLinkAbout09-194 �� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection HoHine(909)839-7027 PRESS
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� . OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDEH 7ENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f8gB/C9fpOR
W CENSEIAWFORTHEFOLLOWINOREASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANYCITVOR (n
U COUPJTYWN�qIREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.OEMOLISH,ORREPAIRAIJYSTRUC- w
w TURE,PRIOR TO RS ISSUANCE,AL50 REOUIRES iHE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Patio/Deck
g STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 70oa)OF OIVISION 3 OF THE BUSINESS AND PRO- u' POOUSPB
FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOq iHE ALLE�ED E%EMP- (�
TION.ANV VIOLATqN OF SECTION 7031.5 BY ANV APPIICANT FOR A PERMIT 5U&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOlURS(i500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECAMPENSATbN, � CORIfI1BfC10I
Z WILL DO THE WORI(,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/a,BUSI- J �
N NESS AND PROFESSIONS CODE:THE CANTRACTOHS LICENSE UW DOES NOT A7PLV TO AN OWNER OF �
PqOPERTY WHO BUILDS OR IMPROVES THEREON,AND WMO DOES SUCH WOqK HIA/SELF OR HERSELF Oq
Q THROU(3M HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORS�LEIF,FqWEVER7T1E8UItAINOORIMPROVEMENTI550lDWITHINONEYEAROFCOMPLE-
Z TION.THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR
� fMPROVE f-0R THE PURPOSE OF S�LE).
W ❑I,AS OWNER OF THE PROPERTY,AM E%ClUSNELV CANTRACTINO WITH LICENSED COMRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC,7W1,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTORS LI- V01U8f1Of1 9���n P � qDJ.AREA
W CENSE U.W DOES NOTAPPLY TO AN OWNER OF A PHOPERTV WHO BUILDS OR IMPqOVES THEREON,AND
� WViOCAMMCT5FOR5UCHPR0.1ECT5WITHACONTRACTOP(S�LICENSEDPURSUANTTOiHECONTRAG QUANTITY DESCRIPTION
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0 ❑I AM E%EMGT UNDER SEC. 8.8 P.C.FOR THIS REASON �
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� DA7E OWNEF �
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¢� UCENSED CONTRACTORS DECLARATION w
2 I HEREBY AFFIRN UNDER PEN�LTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� e(COMMENCIMO WITH SECTION 7oao)OF DIVISION J OF 7HE BUSINESS AND PROFESSKKJS CADE,AND Z
��� W LICENSE IS IN FULL FORCE AND EFFECT, I� � m
� LICENSE CLASS Cr�f•i LIC.NO. !J�J�/ �
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� WORKERS'COMPENSATION DECLARATION Q
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N 1 HEREBY AFFIRM UNDEF PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z �
Z� I HAVE AND WILL A/AINTAIN A CERTIFlCATE OF CONSENT TO SELF-INSURE FOR WORNERS' ¢
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COMPENSATION,AS PROVIDED BV SECTION 370o OF T/E LABOR fADE,FOR TME 7ERFORMANCE U
� OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. W
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_I HAVE AND WILL MAINTAIN WORKERS'COMVENSATION INSURANCE,AS RE�UIRED BV SECTION }�,�
Q 3700 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS �C �G J
ISSIJED.MY WORKERS'�COM-P�ENSATION IN7SU►R�ANCE CA RIER AND POLICV NUMBER AAE: CONSTRUCTION J ��
jCARRIEF_ � /ct�� /%{.0�'�L� REA
� 70lICV NUMBER � � �/'�
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Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C.�} SHALLNOT EMPLOYANV PERSON IN ANV MANNER 50AS TO BECAME SU&IECT TOTHE �
(,/) WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AaREE THAT IF I SHOULD BECOME CTION FEE
= SU9JECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3]OOOF THE UBOR ��.
CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. // ISSUANC
� ALfI�IlU .�R4�7�//.�/J SMIP 5 Q
p DATE: I '� APPLICANT.
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� WARNINO:FAILURE TO SECURE WOflKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � �
� SU&IECTANEMPLOVERTOCfiIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHWSAND E�pER T
OOLURS(5100.000�.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOF IN
11 SECTION 37oe OF iNE LABOR CODE.INTEREST,AND ATTORNEV5 FEES. �
oC -.AETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: JJ
� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THEFE IS A CONSTRUCTION LENDWO AQENCV �-�,�� , �
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). �-
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� LENDER'S NM/E
H LENDER'SADDRE55
W I CERTIFV THAT I HAVE fiEAD THIS AP7LICATION AND STATE THAT 7HE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES �� •, �7( ��
I AGREE TO CAMPLY WITH A�L CITY AND COUNTV ORDINANCES ANO STATE LAWS REUTING TO BUILDINO � w
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTEF UPON THE w.t� � �`� ' \�
ABOVE-MENTIONE�VROPERTV FOR INSPECTION PURPOSES. CJ
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Uj SIGNATUREOF fTTE DA7E �
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW�inar�ce Copy,PINK—Asseseor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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INSPECTIOV� RECORD
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SET BACK � FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLO�R 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 BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCIlJG
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 HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMEIVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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