HomeMy WebLinkAbout12-441� -
CITY OF DIAMOND BAR �
I ""-�'�'— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
� 21810 Copley Drive,Diamond Bar,CA 91765, i
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
��''"', BUII.DING PERMIT APPLICATION FIRMLY
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OWNER-BUILDER DECLARATION
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, p I HEREBV AFFIRM UNDEf1�PENA�7y pF pERR1RY THAT 1 AA1 E%EMPT FROA1 THE CONTMCTORS U- Garage/Carport
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NRE,PRIOR TO RS ISSUANCE ALSO REOUIRES THE APPLICAN�FOp SUGi PERAIIT TO FlLE A SIONED �W
� STATEYENT THA7 HE OR SNE IS LICENSED PURSUANT TO THE PHOVISIONS�OF THE CONTRACTOR9 LF .
CENSE UW(CHAPTER Y(COMMEHCWO WI7H SECTION 7000)OF DIVISION 3 OF hIE BUSMESS NJD PRO- � POOUSpB
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� A CML PENALTV OF NOT MORE 7NAN FIVE HUNDRED OOl1ARS(f5�o).):
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Z N7LL DO THE WOHIC,AND THE STRUCTURE IS NOT IMENDED pq OFFERED FOR 9ALE(SEC.7oN,BU54 J '
� NESS AND PROFESSIONS COOE:THE CONTMCTORS UCENSE LAW DOES NOT MPLY TO AN OWNER OF � �
PqOPEHfV WHO BUILDS Oq IMPROVES THEREON,AND WHO DOES SUCH NORN HWSELF OR HER50.F Oq
� iHROUGH HIS OR HER OWN EMPLOVEES.PROVfDED THAT SUCH WPROVEAIQiiS ARE NOT UffENDED OR m ,
Q OFFEREDFORSALEIF,/10WEVERTMEBUILDINOORIM7ROVEAfENTISSOLpWfTH�NONEYEAROFCOh/PlE-
z TK1N.THE ONRJER�BUILDER WILL HAVE THE BURDEN.OF PROVNIG THAT HE OR SHE DID NOT BU0.D OR .
� IMPROVE FOR THE PURP0.SE OF SALE7. . . �
w OI,A40WNEROF7HEPROPERTV,AME7(CLUSNELYCONTRACTINOWITHtJCENSEDCO�ITRACTORS
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� CENSEUWDOESNOTAPPLVTOANOWNEROFAVROPERTVWFiOBUILD90RIMPROVE67HEREON,AND � �
MMOCONTMCTSFORSUp1PRp1ECf5WIT1A00f7TRACTOR�SjLICFNSEDPUASUAMTOTHECONTRAG pUq�,�7�7y DESCRIPTION �E .
TOR9l10EN5E LAW.�.
3 ❑I AM E%EMPT UNDER SEC. 8.8 P.C.FOq THIg REASON � `m
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. � UCENSED CONTRACTORS DECLARATION w Q ._r0 Q
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I HEREBY AFFlRN UNDEP PENALTV OF PERJURV THAT IAM UCEt15ED UNDER PqOVISION9 OF CHAPTER � � � 1' � r -
d D(OOA/MENCINO WI7}�SECTION 700D)OF OMSION�OF THE BUSINESS N1D PROFESSIONS QDDE,AND Z �
� M'LICENSE IS RJ FUl FORCE AN/D EFFECT. L/ m �
� LICENSE CLASS V UC.NO. /�����' �- .
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� WORKERS'COMPENSATION DECLARATION Q � - �
� 1 HEAEBV AFFIHI.1 UNDER PENALTY OF PERJURY ONE OF 7HE FOLLOW W6 DECLAHATIONS; U � -
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� _I HAVEANO Wf1L MAMTAW A CEftTIFlCATE OF CON5EN770 SELF-INSURE FOR WORI(FAS T � �
� COIdPENSATION,ilS GROVIDED BV SECTON 37o00F 7V/E UBOR OODE,FOR THE PERWRMANCE �U
OFTHE WORK FOR WHICH THIS pERMIT IS ISSUED. �
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W _IHAVEANDVALLMAWTAW.WORKERS'�COMPENSATIONINSUH/WCE;A9qEWfREDBVSECTiON
� 37oD OF�THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WH1CH iH15 PERMIT IS
f55UED.MVN�DPo(ERS;COMP NSA I SU CECARRIERANDPO�ICYNUMBERARE: CONSTRUCTION� '
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w (n+ss[cncHr+FIDrareeoor�rmoFn+Ea�,trsroAa+EM+n�noaluislsiao)oa�ssl PLUMBING �'���
Z 1 CERTIFY THAT W h1E PERFORMANCE OF THE.WORK FOR WHIp1 THIS PERMIT IS ISSUED,1 MECHANIC/U: �.+�
CJ SHALL NOT EMPLOY M7V PERSON W ANY lIANNER SOAS TO BECOME�SUBJECT T07HE' � ���
(/� WORNERS'CAMPENSATIONLAWSOFCILLIFORNIA,ANDA6REETHAT�FI5HWl08ECOME INSPECTIONFEE
SUBJECT TO THE WDRKERS'COMPENSATIDN PROVISION3 OF SECTION 3700 OF THE IABOR � ��
O CODE,I SHALL FORTHWITH CqApLY WITH hfOSE PRONSIONS. ISSUfWCE '�
.•.p DATE: nv�icnHr: �SMIP
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. � WARNIN(i:�FA1LURETOSECUREWORKERS'COMPENSATIONCAVEMGEISUNUWFUL,ANDSHALLBE ENERGYP/C
� SU&IECrANEMPLOYERTOCRININAL7ENALTIESANDCMLFWESUPi00NEHUNDREDT}IOUSAND ENERGY�PERMIT
DOLLARS(f10o,o00),IN ApDITON TO THE COST OF COMPENSATION,DAMAOES AS PROVfDED FOR IN
J SECTION 37oe OF hIE LA80R CODE,fN7EREST,AND AT70fiNEYg FEES.
� �� � RETENTION FEE: �QD
O , CONSTRUCTION LENDING AGENCY � PRE-ALT FEE:
� 1 HER�V AFFlRM UNDER PENALTV OF PERIURY THAT THERE IS ACONSTRUCTION LENDWO AOENCY
FOR hIE PERFORMANCE OF 7HE WORK FOR WHICH TI{IS 7ERMIT IS ISSUFD(SEC:�3047,qV.C.).
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� LENDERS NAME , . .. . ..
� LENDER'S ADDHESS �
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W I CERTIFY TIiAT 1 HAVE READ THIS APPLICATION AND STATE hIAT hiE ABOVE INFORAIATION 19 CORRECT. TOTAL FE ES `
� 1 A6PEE TO COMPLY Wlhi hLl,CfTV AND COUNTY ORDINANCES AND STATE UWS RELATINO 70 BURDINO '
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTV 70 ENiER UPON THE � �
Z A80VE-MENTqNED7ROPER7Y.FORiNSPECiIONPURP0.5ES.
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N swNANRE OF PERMRTEE DA7E �
� RECPT.NO. � PAID 8Y VALIDATION
WHITE-0epartmen[Copy,YELLOW—Ftne�e Copy,PINK—Assessor Copy,GOLDENROo---Flle Copy,GREEN—i4pplkaM'y Copy -
, CIT'Y tJF DIAMOND BAR
IIVSPECTIOP� RECORD
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SE7BACK _ FLOORJOIST �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND lJNDER FlOOR DUCT
GR�UI4D PLUMBING UNDER FLOOR CONDUlT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WP,TER SERVICE MID HT.BOND BEP,M
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRApING
ROUGH HEATING BENCHItdG
ROUGH ELECTRIC ROUGH GRADI(�G
ROUGN PLUMBING FINISH GRADING
SHOWERlTlJB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATfONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAI ZONfNG
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATtNG HEALTN DEPT.FINAL
fINAL ELECTRIC DEV.FEES PAID
FINAL PLUM8ING E(VERGY
FINAL PLANING
FINAL ENGIIdEERING _ � . �_ . � �
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