HomeMy WebLinkAbout16961 _�,� _ CTI'Y OF DIAMOND BAR
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES .
21825 E.Copley Drive
� (909)860-3195 Fax(909)861-3117 EXPIRED PRESS
���� BUILDING PERMIT APPLICATION FIRMLY
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p I HEREBV AFFlRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FAOM THE CONiRACTORS LI- G8f8 0/C8 OfI
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w NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W '
g STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll-
� CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 7 OF THE BUSINE55 AND PRO� � POOUSPO
� FESSIONS CODE)OR THA7 HE OR SHE IS EXEMP7 THEREFROM AND 7HE BASIS FOR 7HE ALLEOED E%EMP- "
V TION.ANYVIOLATIONOFSECTION7W7.6BYANVAPPLICANTF-0RAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof � � �
� A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(5500).):
� OI,ASONRJEROF7HEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATqN, COrtIrtI0fC18I
Z WILL 00 THE WORK�ND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70��,BU51- � `
� NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WFq BUILDS OR IM7ROVE5 THERE-0N,AND WHO DOES SUCH WORK HIA/SEIF OR HERSELF OR
� THROUGH HIS OR HER OWN EIAPLOVEES,PROVI�ED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE�ID NOT BUIID OR
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Q TO CONSTRUCT THE PRQIECT(SEC.7oN,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U- VBIUe�I0f1 ADJ.AREA
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISqNS OF CHAPTER �
� B(COMMENCWOWfTHSECTION7o00�OFDIVI510N30FTHE0USINE55ANDPROFE55KKJ5CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION a �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOW W0 DECLARATIONS: Z
O _I HAVE AND WILL MAWTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' _
� COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FORhIE PERFORMANCE U
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w _IHAVEANDWILLMAIMAINWORICERS'COMPENSATqNINSUR/WCE,ASREOUIREDBVSECTqN M
Q 37000F THE LABOR CODE.FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HIS PERMIT IS I` `� ��
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Z �I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C} SHALL NOT EMPLOV ANY PERSON W ANV MANNER 50 AS TO BECOME SU&IECT TO THE
N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETMATIFISHOULDBECAME INSPECTIONFEE
= SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTKKJ 37000F THE IABOR - — � '
COD I SH FORTHWITH COMPLV WITH T E PRO ISIONS. ISSUANCE ��
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� WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATqN COVERAGE IS UNUWFUL.AND SHALL BE
� SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED THOUSAND � � �� �
DOLLARS(f100.000�.IN ADDITION TO THE COST OF COMPENSATKKJ,DAMAGE6 AS PROVIDED FOR IN ENERGY PERMIT /'� I `-�
� SECTqN 3�Oe OF iHE LABOR CODE,WTEREST,AtJD ATTORNEY'S FEES. RETENTION FEE: / � /� I �,v
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ,��_`__—._=I
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THEFE IS A CANSTqUCTION LENDING AGENCV �
FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
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� LENDERS NAME
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� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT.
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINMICES AND STATE UWS RELATING TO BUILDINO
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� CONSTRUCTION,MIDHEREBVAUTHORIZEREPRESENTATIVES'OFTHISCWNTVTOENTERUPONTHE
Z ABOVE�MENTIONED PFOPERTY FOR INSPECTION PURPOSES. COMMENTS
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� - RECPT.NO. � PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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ELECTRIC GRC�UND '� UNDER FLOOR DUCT
GROUND PLUMBING ! UNDER FLOOR CU�IDUIT
SLAB GRAQE FIREPLACE FOUNDATlON
TEMP POUVER FIREPLACE BOND BEAM
W,4TER SERVICE MI�HT. BOND BEAM
ROOF SI-lEATHING ' 8 FT. BOND BEAM
FRAMINGNENTILIATION FINAL BON� BEAM �
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROU^uH ELECTRIC ROUGH GRADING
ROUGH PLUMBING � FINISH GRADING
SHOWER/TUB TEST POOL ELECTR(C
EXT. LATH/SIDING POOL FENCING
WALL IPdSULATfON POOL FINAL
CEiLING INSULATION �FF SITE IMPS.
DRYWALL NAlUNG DEDICATIONS ^
SEWER FINAL ENG.
SEPTIC TANK � LAPVDSCAPE/IRRIG.
SEEP PIT/L.L. ' ' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FIPVAL HEATING HEALTH DEPT. FINAL
FINA�ELECTRIC DEV. FEES PAID
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