HomeMy WebLinkAbout16900 (25) �` _ CITY OF DIAMOND BAR lOOl L T N f 1 f
DEPARTIv1ENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 ����� PRESS
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p I HEREBY AFFIRM UNDER PENALTV OF PERAIRY THAT I AM E7(EMPT FROM THE CONTMCTORS LI- G8f09B/C8(POft �
W CENSELAWFORTHEFOILOWINGREA50N(SEC.7031.68USINESSANDPPOFESSIONSCODE:AtJVCITYOR (n
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w NRE.PRIOR TO ITS ISSUANCE.ALSO REW IRES 7HE MPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patio/Deck ` \t
� STATEMENT 7HAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS L6
� CENSE LAW(CHMTER D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF hIE BUSINESS AND PRO� � POOVSP3
� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDh7EBASISFORTHEALLEGEDE%EMP- � �
V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPIICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof O O
A CNIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLl.ARS(f500).):
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Z WILL 00 THE WORK,AND THE STRUCNRE IS NOT IMENDED OR OFFEiiED FOR SALE(SEC.70N,BU51� J
� NESS AND 7ROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROVERTV WHO BUILOS OR IMPROVES THEREON,AND Nh10 DOES SUCH WORK HIMSELF OR HERSEIF OR
� THROU�H HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
Q OFFEREDFORS�LEIF,FqWEVEi�7HEBUILDWGORWPROVEMENTI550LDWITHINONEVEAAOFCOMPIE-
Z TION,THE OWNER-BUILDER WILL H�VE THE BURDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILA OR
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Q TO CONSTRUCT THE PR0.IECT(SEC.7oN,BUSINE55 AND PROFESSIONS CODE:THE COMRACTORS LI� V81Uef1011 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONiRACTOFi(S)LICENSEDPURSUANTTOTMECONTRAG QUANTITY DESCAIPTION FEE
Y 70RS LICENSE LAW.).
� O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRM UNDER PEWLLTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
� 9(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z _-`\
�X MY LICENSE IS IN FULL FORCE AND EFFECT. m
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LICENSE CLAS LIC.NO. � � �i
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� WORKERS'COMPENSATION DECLARA 10 � � /�' � Q �
� 1 HEREBV AFFIRM UNDEF PENALTV OF PERIURY ONE OF THE FOILOWING DEqARATIONS: Z
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� i FIAVE AND WILL MAINTAIN A CERTIFICATE OF CqNSEM TO SEIF-INSUPE FOR NqRKERS'
Z COMPENSATION,AS PROVIDED BV SECTION 3�OOOF THE LABOR COOE,FOR THE PERFORMANCE U
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�I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE.AS REWIRED BV SECTION
Q 3700 OF THE UBOR CODE.FOR THE VERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��.�Tr �
ISSUED.MV WJRNERS'COMPENSATION INSURANCE CAARIER AND POLICV NUMBER ARE: CONSTRUCTION / D
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Z aouCY NUMBER ����� (�,Z �� ELECTRIC ' �
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Z I CERTIFV THAT M THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERA/IT IS ISSUED,I MECHANICAL Y� I
CJ SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE i"'-"'
(/� WORKERS'COMPENSATIONLAWSOFCALIFORNIqANDAGREETHATIFISHWLDBECOME INSPECTIONFEE
S SU&IECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F E UBOR , .
COD I SHA FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: SMIP f � C�J .
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J WARNINO:FAILURE TO SECURE M/ORKERS'COMPENSAT VERAOE IS 11NLAWFUL,AND SHAILBE ENERGY P/C
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� SU&IECTMIEMP�OVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTFIOUSANO ENERGYPERMIT �
DOLURS(f100.000),IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
J SECTqN 37080FTHE LABOfl COOE,INTEREST,ANDATTORNEV'S FEES.
OC RETENTION FEE:
' O � CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PEfUURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV
FOq THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3ael,CIV.C.�.
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� LENDER'S NAME
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w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORAIATION IS CORRECT. TOTAL F E ES �1 1,h�D
� I AGREE TO COMPLV WITH ALL CITY AND CAUNTY ORDINANCES AND STATE UWS REUTINO TO BUILDING � v
� CANSTRUCTION,AND HEREBV AUTHOflIZE REPRESEMATNES OF h115 COUNTY TO ENTER UPON THE
Z ABOVE-MEMIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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GROUND PLUMBING UNDER FLOOR CUI�!DUIT
SLAB GRADE FIREPLACE FC3UNDATION
TEN/IP POWER FIREPLAGE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMI(VGNENTI�IATtON FINAL BOND BEAM
R�OF COVER PRE-GRAQING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBIfVG FINISH GRADING
SHOWERITUB TEST POOL ELECTRIC
EXT. LATNISIDING POOL FENCING
WALL INSULATIOfV POOL FINAL '
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK ; LANDSCAPE/IRRIG.
SEEP PiTJL�. ' � ON SITE IMPS.
GAS,41R TEST FlNAL ZONING
FINP,L COIVST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBIMG ENERGY
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