HomeMy WebLinkAbout16564 (22) _ �
_f� CITY OF DIAMOND BAx
DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190 '
' (909)860-3195 Fax(909)861-3117 PRESS
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v� DESCRIPTION Q.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION �
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� STATEMENT THAT HE OR 9HE IS LICENSED VURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � . �
CENSE UW(CHA7TER Y(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO� POOUSPB
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N HESS AND CROFESSIONS CODE:THE COHTRACTORS LICENSE UW DOES NOT MPLV TO AN OWNER OF ? ,"� . �
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[t TMROU4HHI90RHEROWNEMPLOYEES,PROVIDEDTHATSUGIIAIVROVEMENTSARENO7INTENDEDOR m ,
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❑I AN D(E4PT UN�ER SEC. B.L P.C.FOR THIS REASON U n.�
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DATE OWNER � , ^
� LICENSED CONTRACTORS DECLARATION � , \A
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1 HEREBY AFFlRM UNDER PENKTV OF PERIUqY THAT I MI LICENSED UNDER PROVISIONS OF C}1APTEH � �
� Y(COIAMENCNO WITH SECTION 7000)OF DMSION 7 OF THE BUSINESS AND PROFESSIONS CODE,AND � '
lll ��ENSE IS IN FULL FORCE A1tD EFFECT. m ...•�- 1
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V DATE CONTFUCTOR a. �
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� WORKERS'COMPENSATION DECLAAATION Q
� I HEREBYAFFlRAI UNDER PEN�LT/OF PERIURY ONE OF THE FOLLOWINO DECLARATIONS: Z '�
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� W�IPEHSA710N,A9 VROVIDED BV SECTION 37000F 7HE L�BOR CODE,FOR THE PERFOqMANCE U \JLJ
O OF THE WORK FOR WHIp1 THIS PERMIT 19 ISSUED. �
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Q _I HAVEAND WILLMAINTNN WORKERS'COMPENSATION INSURANCE,AS REWIRED 9V SECTKKJ
370o OF 7HE L�BOR COOE,f-0R T1E PERFORMAkCE OF THE WORK FOR WHICN THIS PERMIT IS
ISSUm.MY WORKERS'COM7ENSATION INSUiUNCE CARRIER AND PoLICV NUMBER ARE: CONSTRUCTION
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� POLICYNUAABER ELECTRIC O. ��
0 (n�ssEcrnnr�IDr+oreEoons�ETIDaFn�p�r�sFoqaNErara�pqlu�sK�ro)op�ss? PLUMBING �
Z I CERTIFY THAT IN THE PERFORA/ANCE OF THE WORK f-0R WHICH THIS PERMR IS ISSUED,I MECHANICAL
�J SHAI.L NOT EMPLOV ANV PERSON M ANY MMlNER SO AS TO BECOME SU&IECT TO THE �
(/� WORKEHS'COMPENSATION UWS OF C.LLIFORNIA,AND AOREE THA71F I SHOULD BECOME INSPECTION FEE
S SU&IECTTOTHEWORKERS'COMFENSATqNGROVIS10N50F5ECTION37000FTHELABOR '
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p DATE: - APPLICANT. SMIP �
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� WARNIN�:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNUWFUL,AND SHALL BE , . ,O
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DOLUflS(5100.000),W ADDfT10N TO THE COST OF COMPENSATIDN,DAMAOES AS PROVIDE�FOR IN �//�`
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d CONSTFiUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENAITV OF PERIURV THAT TrIERE IS A CONSTRUCTION LENDIN�AOENCV ' '
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70B7,CIV.C.). �
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'� LENDERS NAME
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F- LENDERSADDRESS
w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEWFORMATqNISCORRECT. TOTALFEES ,
� I A(iREE TO COMPLV WITH ALL CfTV M1D COUNTY ORDINANCES AND STATE UWS REU7ING TO BUILDING � � •
CONSTRUCTqN,AND HEREBY AUTHORIZE REPqESENTA7NE5 OF THIS CWNTV TO EMEF UPON THE ' �
Z /�BOVE�AIENTIONED PROPERTY F-0R INSPEC710N PURPOSES. COMMENTS '
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SLABGRADE ` .-dy ,,� FIREPLACE�FOUNDATION � �
TEMP POWER FIREPLACE BONQ BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING �(._ 8 FT. BOND BEAM
FRAMINGNENTtUATION -.�-0 I FINAL BOND BEAM
ROOF COVER PRE-GRADING
R�UGH HEATING -O BENCHING
ROUGH ELECTRIC . .U/' � ROUGH GRADING
: f3�UGH PLUNIBING' ' -FINISH GRADING
SHOV1WERffUB TEST .POOL ELECTRIC
EXT. LATH/SIDING V� ••o POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSUIJ�TIO�1 OFF SITE IMPS.
DRYWAL�NAILING DEDICATtONS
SEWER E2'ZS�o FINAL ENG.
SEPTIC TANK LANQSCAPE/IRRlG. '
SEEP PIT/L.L. - � .. �.� ' ON SITE lMPS.
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