HomeMy WebLinkAbout11-1390 ��_ CITY OF DIAMOND BAR �-. �
- DEPARTMENT OF COMMUNITY&,DEVELOPMENT SERVICES /
�, 21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS
�'°�'�.w BUILDING PERMIT APPLICATION FIRMLY
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p� OWNER-BUILDER DECLARATION �
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w NqE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W P8f10/DBCK
� STATEA/ENT THAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO• � POOUSPB
I , � FESSIONS CODE)OR 7HA7 HE OR SHE IS EXEMPT TIIEREFRON AND 7HE BA515 FOR 7HE ALLEGED E%EMP- (3
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A CIVIL PENALTV OF NOT AqRE THAN FNE HUNDRED DOLLAqS(f500).):
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Z WIIL DO 7HE WORI(ANO THE STRUCTURE IS NOT INTENDED OR OFFERED f-0R SALE(SEC.7M�,BUSI� J
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VROPERTY WHO BUILDS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
w THROUGH HIS OR HER OMM EMPLOVEES,PROVIDED THAT SUClI IMPROVEMEMS ARE NOT WTENDED OR m
Q OFFEREDFORS/�LEIF,FqWEVER7NE8UIlAIN00RIMPROVEMENTIS50LDWITHINONEVEAAOFCOMVLE-
Z TION,THE OWNEREUILDER WILL HAVE T}IE BURDEN OF PROVINa THAT HE OR SHE DID NOT OUILD OR
� IMPROVE FOR THE PURPOSE OF SALE). '
w �I.AS ONRJER OF THE PROPERTV,AM EJ(CLUSNELY CANTMCTINO WfTH LICENSED CONTMCTORS
� TO CONSTqUCT THE PqOJECT(SEC.)044,BUSINESS ANO PROFESSIONS CADE THE COMRACTORS LI- V81U81i0 ADJ.AREA '
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� ❑I AM E%EMPT UNDEH SEC. B.8 P.C.FOR THIS REASON Q
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� DATE OWNER ¢
�¢ LICENSED CONTRACTORS DECLARATION w
2 I HEREBY AFFIRN UNDER PEN�LTV OF PERJURV TNAT I AM UCENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCINO WITH SECTION 7000)OF DIVISqN 3 Of THE BUSINESS AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS IN FULL FORCE AND EFFECT. m
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� WORKERS'COMPENSATION D LARATION �
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOILOWING DECIAAATIONS: �
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� _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' Q
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Q COMPENSATION,ASPROVIDEDBYSECTION37o00FTHElABORCODE,FORTHEPERFORMANCE U
OF 7HE WORN FOR WHICH THIS PERMIT IS ISSUED. W
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w 1 HAVE AND WILL MAINTAIN WOH7(ERS'CAMPENSATION INSURANCE,AS REWIqED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS /�� ��
ISSUED.MV WORKER'COM NSATION INS E CARR�IE/f]AND POLICV NUMBER ARE: CONSTRUCTION _��
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Z I CERTIFY THAT M THE PERFORMANCE OF THE WORH FOH WHICH THIS PERMIT IS ISSUED.1 MECHANICAL
C} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER AS TO BECOME SU&IECT TO THE
(/� WORI(ERS'COMPENSATqN UWS Of CALIFORNI AND A�REE THAT IF I SHOULD BECAME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION P VISION SECTION 3700 OF THE LABO
O CODF/j,1 SHN/}FORTHWITM COMPLY WITH TH PROV 5. ISSUANCE �. � �
p DATE:/,�Q��y-�— APPIICANT: SMIP �
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� WARNINO:FAILURE TO SECURE WORKERS'CqM SATION CAVERAdE IS UNLAWFUL,AND SHALL BE ENERGY P/C v
�y SU&IECTANEMPLOVERTOCRIMINALPENALTIES �CIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLAfiS(5700,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PqOVIDED FOR IN
J SECTION 3708 OF THE LPBOR CODE.INTEREST,ANO ATTORNEVS FEES.
w � FETENTION FEE: O�
� - CONSTRUCTION LENDING AGENCY P ALT FEE:
� 1 NEREBV AFFIRM UNDEF 7ENALTV OF PERJURV THAT THERE IS A CANSTRUCTION LENDING AOENCV �� O �/
� FOR TME PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3007,CIV.C.�. �
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� LENDER'S NMIE
� 'LENDER'SADDRE55
� TOTAL FEES � , �.
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TMAT THE ABOVE INFORMATqN IS CARAECT.
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES ANO STATE UWS RELATING TO BUILDIN6
� CONSTqUCTION,AND HEREBV AUTHORRE REPqESENTATIVES OF THIS CWNTV TO ENTER UPON THE '
� ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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o COMMENTS
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m PERMI77EE NAME(PFUNn � �
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� RECPT.NO. PAID BV VAUDATION
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SET BACK FLOOR JOIST '
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOQR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE �"`�� MID HT. BOND BEAM
ROOF SHEATHING � ' /MY�•�' ;�� 8 FT. BOND BEAM
FRAMlNGNENTILATION - FINAL 80ND 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 FENCING
WALL INSULATION � POOL FINAL
CEILING INSULATIQN aFF SITE IMPS.
DRYWALL NAiLING DEDICAT�ONS
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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SEEP PIT/U SIZE
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