HomeMy WebLinkAbout11-442 I _��_ CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
4'x". BUILDING PERMIT APPLICATION FIRMLY
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0 I HEREBV AFFIRM LINDER PENALTY OF PERJl1RV THAT 1 AM E%EMPT FPOM THE CONTRACTORS L4 G0f8 6/C0
W CENSE UW f-0R THE FOLLOWINO REASON(SEC.7031.6 BUSINESSANO PROFESSIONS CODE M1V CITV OR (n 9 �rt
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STATEAIENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHA➢TER V(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOI/Sp8
� FESSIONS CODE�OR 7HAT HE OR SHE IS EXEMPT 7HEREFROM AND THE BASIS FOR THE ALIEGED E%EMP- (�
TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof
� A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(f500�.):
Z ❑4.u^OWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COlfIfTIBfC18I
WILL DO THE WORK,M1D THE STRUCTURE IS NOT INTENDED OR OFFEflED FOR SALE(SEC.70d{,BUSI- J
� NESS M!D PROFESSIONS COOE THE CONTMCTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO BU0.D5 OR IMPROVES THEREON,AND NMO OOES SUCN WORK HIMSELF OR HERSELF OR
CC THROU(1H HIS OR HER OWN EMCLOVEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR m
0 OFFEREDWRS�LEIF,HOWEVEi�7HEBUILDINGORIMPROVEMENTI550lDWITHINONEYEAROFCOMPLE- •
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� W PROVE FOR THE PUqPOSE OF SALE).
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[t TO CONSTRUCT THE PROJECT(SEC.7oal,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU9110n ADJ.AREA
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Y 70RS LICENSE LAWJ.
� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON
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2 I HEHEBV AFFIRAI UNDER PENALTV OF PERJURY THAT 1 AM IICENSED UNDER PROVISIONS OF CHAPTER
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� _I NAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSUflE FOR WORKERS' ¢
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OF THE WORN FOA WHICH THIS PERAl1T IS ISSUED. W
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� _IHAVE/W�WILLMAINTAINWORKERS'CAMPENSATIONINSURANCE,ASREWIqEDBVSECTION
Q 370o OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MY (ER'COMPEN ATION WSUqANCE CARRIER AND FO�L+IC/V�NUMBERAAE: CONSTRUCTION
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Z I CEFTIFV THAT IN THE PERFORMANCE OF THE WOR)(FOF NM1iICH THIS PERMIT IS ISSUED.I MECHANICAL
CS SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
(n WORKERS'COMPENSATqNLAWSOFCALIFORNIA,ANDAOREETHATIFISHOULDBECOME INSPECTIONFEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOq � �
O CODE,I SHALL FORTHWITN COMPLY WIiH THOSE PROVISIONS. ISSUANCE '
p DATE: APPLICANT: SMIP
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J WARNINO:FAILURE TO SECURE WORNERS'CAMPENSATpN COVERAOE IS UNLAWFUL.AND SHALL BE ENERGY P/C �
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� SU&IECTANEMPLOVERTOCFIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPEFMIT
DOILARS(f 100.000),IN/�DDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIOED FOR IN
J SECTION37080FTHELABORCODE,MTEREST,ANDATTORNEV'SFEES. '
w RETENTION FEE: ..��
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV
� FOF THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oY7,CIV.C.).
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� LENDEfYS NAME
� LENDER'SAD�RESS
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�� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORAIATqNISCARRECT. TOTAL FEES � Q� ��
I AQqEE TO CAMPLY WITH ALL CRV AND CWNTV ORDINANCES AND STATE LAWS PEUTWO TO BUILDINO �� as' � �70 ����;��
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPoN THE �( G,
Z ABOVE-MENTqNED PROFERTY FOR INSPECTION PURPOSES. COMMENTS ' ` �� ' �
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� RECPT.NO. PAID BY WWDATION
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GREEN—Applicanfs Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLO�R DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPIACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 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 E�ECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING 1NSULATION OFF SITE IMPS.
DRYWALL NAiLiNG DEDICAT(ONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITlL.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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