HomeMy WebLinkAbout16652 CITY OF DIAMOND BAR
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21825 E.Copley Drive
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�%N^�� BUILDING PERMIT APPLICATION RMLY
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p I HEREBV AFFlRM UNDER PENAL7Y OF PERJUHV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f8 0/Cfl ft
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w NRE.PRIOR TO ITS ISSUANCE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w P8f10/DBCI(
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
� CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF hiE BUSINESS AND PRO- � PooUSpa
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
TION.M1V VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CIVIL 7ENALTY OF NOT MOqE THAN FIVE HUNDRED DOLLAAS(5500).�:
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Z WILL DO THE WORK,AND THE STRUCTURE 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 �
PROPEHTI'WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK MIMSELF OR HERSELF OR
w THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m .
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� I HEREBY AFFIRM UNDER PEIULTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCINO WITM SECTION 7000)OF DIVISION 3 0F 7HE BUSINESS AND PROFESSIONS CADE.AND Z
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� I HEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF THE f-0LLOWING DECLARATIONS: Z
Z� _I HAVE AND WILL A/AINTAIN A CERTIFICATE OF CONSENT 70 SELF�INSURE F-0R WORKERS' a
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COAIPENSATqN,AS PROVIDED BV SECTION 37ao OF THE UBOR CODE,FOR THE PERFORMM7CE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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w �HAVE AND WILL MAINTAIN WORKERS'CAMPENSATqN INSURANCE,AS RE�UIRED BV SECTION ypp�►►''' /�
Q 3700 OF THE UBOR CADE,FOR THE PERFORMANCE OF E WORK FOR WHICH 7HIS PERMIT IS ' 1�� �, `
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH hIIS PEqMIT IS ISSUED,I MECHANICAL
C.�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(,/J N'ORl(ERS'COMPENSATIONLAWSOFCALIFORNIA, DAGREETHATIFISHOULD ECOME INSPECTIONFEE
SU&IECT TO THE WORNERS'COMPENSATqN PR ISIONS OF SECTION 3700 O E LAB .`
O sZ R MWI7HCOMPLV WITHhp, PROVISIO ISSUANCE , J
p DATE:� J � APPLICANT: SMIP / � � � e
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J WAANINO:FAIWRE TO SECURE WORKERS'CAMPENSATION CAVERAOE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANOCNILFMESUPTOONEHUNDREDTHOUSAND ENERGVPERMI � �
DOIURS(5100,000),IN ADDITION TO THE COST OF COMPENSATqN,DAMAQES AS PROVIDED FOR IN
� SECTION 3loe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE (
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: B�• ��1
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT THERE IS A CONSTRUCTION LENDINO AOENCY �
FOR THE PERF-0RMANCE OFTHE��WHICH THIS PERMIT IS ISSUED(SEC.3097.CIV.C.�.
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� LENDER'S NNdE
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� LENDER'SADDRESS
w I CERTIFV THAT I HAVE READ THIS APPLICA710N AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �� �
� I AGREE TO CAMPLV N7TH ALL CfTY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z A80VE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicent's Copy
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SET BACK • FLOOR�GiST_ •
FTGS/FORMS/STEEL FNA REQMTS
ELECTRIC GROUND UNQER FLaOR DUCT ..�
GROUND PLUMBING l3NDER FLOOR CU�IDUIT• �
SLAB GRADE � FIRERLRCE FOUNDATION
TEMP POWER � FIREPLAC� BOND BEAM
WATER SERVICE MID HT. BONQ BEAM ' -
ROOF SHEATHING �2�-f,�,. — 8 FT. BOND BEAM
FRAMING/VENTILIATiON FINAL BOND BEAM
ROOF COVER � ��j _ � PRE-GRADING
ROUGH HE,4TING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC �
EXT. LATHISIDING POOL FENCING
WALL IiVSULATION POOL FINAL �
CEILiNG INBULATION � OF�SITE IMPS.
DRYWALL NAILING � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK ', LANDSCAPE/tRRIG. `
SEEP PIT/L.L `^ ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FINAL
FIN,4L HEATIRIG - HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING • ENERGY
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COM�IENTS
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