HomeMy WebLinkAbout17664 CITY OF DIAMOND BAR ,/�
-��`— DEPARTMENT OF COrRvIiJM'TY�.DEVELOPMENT SERVICES �-_�
21825 E.Copley Drive PRESS
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°%.9,;�'�w BUILDING PERMIT APPLICATION FIRMLY
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APN LOT TRACT DATE CONST. GROUP
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� OWNER-BUILDER DECLARATION SFR(AOD/REM
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wTURE.PRIOF TO ITS ISSUANCE.ALSO REQUIqES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT 7NAT HE OR SHE IS LICENSED PURSUANT TO T}1E PROVISIONS OF THE CONTiUCTORS LI- � PQOUS
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTqN 70a0)OF DIVISION 3 OF THE BUSINE55 AND PRO- Pe
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Z WILL DO THE WORK.AND TF1E STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BU51- J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
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Z IMPROVE FOR THE PURP0.SE OF SALE).
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� TO CONSTRUCT 7HE PROJECT(SEC.7oaa,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V9IUBfIOf1 ADJ.AREA
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� LICENSED CONTRACTORS DECLARATION W
CL t HEREBY AFFIRM UNDER PENALTV OF PER�URY THAT I MA LICENSED UNDER PROVISIONS OF CHAPTER Ur
d D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
MY LICENSE�S IN FULL FORCE AND EFFECT. m
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� I HEFEBV AFFIRM UNDEF PENALTV OF PER1Uf1V ONE OF THE FOLLOWING DECLARATIONS: Z
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF�INSUREFORWORKERS' 2
Q COMPENSATION.AS PROVIDED BV SECT70N 37oa OF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR VMICN THIS VERMIT IS lSSUED. �
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w I HAVE AN�WILL MAINTAIN WORKERS'CAMPENSATION INSURNJCE,AS FEOUIRED BY SECTION n��
' Q J700 0F THE LABOR CADE.FOR THE PEFFORMANCE OF 7HE WORK FOR WHICM THIS PERMIT IS V �
� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
jCARRIER PLAN REVIEW _
ZPOIICV NUMBEH ELECTRIC
¢ PLUMBING � :���'��'�
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL
(} SHALLNOT EMPLOV ANV PERSON W ANV MANNEP SOAS T09ECOME SU&IECTTOTHE INSPECTION FEE I �F R 1 Q �n n�
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SFKKILD BECAME . � p.�
S SU&IECTTO THE WOFKERS'CAMPENSATION PROVISKKJS OF SECTION 37000F THE LABOR ISSUANCE I
CADE,I SHALL FOF7THW�TH COMPLV WITH 7HOSE PROVISIONS.
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J ENERGY P/C �"' .___ _ _
J WARNIN�:FAILURE TO SECURE WORKERS'COMPENSATION CAVEFAGE IS UNUWFUL.AND SHALL BE
�—y SU&IECTANEMPLOVERTOCRIMINPLPENALTIESANDGIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT
DOLLARS(5100.000I.IN AODITION TO THE C0.ST OF COMPENSATqN,DAMAQES AS PROVIDED FOR IN
J SECTION77080FTNELABORCOOE,WTEREST,NIDARORNEYSFEES. RETENTIONFEE: �'"
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w CONSTRUCTION LENDING AGENCY PRE-AL7 FEE:
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� LENDER'S NAME
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� I CERTIFY THAT I HAVE REA�THIS APPLICATION AND STATE TMAT THE ABOVE INFORMATKKJ IS CORRECT. TOTAL FE ES (/�, �O
w I AGREE TO COMPLV WITH ALL CITY AND CAUNTv ORDINANCES PND STATE LAWS FEL4TINO TO BUILDING ' •
� CANSTRUCTION,AND HEREBV AUT}pRIZE RE�RESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PROPERTV FOR INSPECTION PUFPOSES. COMMENTS
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� WHITE—Department Copy,YEILOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SLAB GRADE ' FIREPLAC� FO TION
TEMP POWER � FIREPLACE BOND BEAM
WATER SERVICE --���y. MID HT. BO�1�Q BEAM _
ROOF SHEATHING ,Z�2//�� �. /T`-`"-`' 8 FT. BOND B�AM
FRAMINGNENTILIATION • FiNAL BOND BEAM
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ROUGH ELECTRIC ROUGH GRADING
RUUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOI.ELECTRIC
EXT. LATH/SIDING I POOL FcNCING
WALL INSULATION � POOL FINAL
CEILING INBULATIOIU QFF SITE IMPS:
DRYWALL NAILING DEDICATIONS
SEWER FtNAL ENG.
SEPTIC TANK , � LANDSCAPE/IRRfG.
SEEP PIT/LL. � ' ON SITE IMPS.
GAS AIR TEST FINAL ZOiVING
FlNAL CONST. ; �lRE DEPT. FINA!
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC J DEV. FEES PAID
FINAL PLUMBING ENERGY ^
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SEPTIC TANK SIZE
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