HomeMy WebLinkAbout17658 (46) _��_ CITY OF DIAMOND BAR
DEPARTIv�NT OF COrRvIUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive'
(909)860-3.195 Fa�c(909)861-3117 PRE$$
��'z9«^� BUILDING PERMIT APPLICATION FIRMLY
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Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEREBV AFFIRM UNDER PENALTY OF PERNRV THAT 1 AM E7(EAIPT FROM THE CONTRACTORS LI� G9ffl 6/C8 R
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCfTYOR (n 9 �
V CWNTVWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIPANVSTilUG w
w TURE.PRqR TO ITS ISSUANCE,AL50 REWIRES hIE APPLICANT FOR SUCH PERMR TO fILE A SIGNED w P8Ii0/DBCI(
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TME CONTRACTORS LF
� CENSE LAW(CHAPTER e(COMMENCIN�WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSPB
� FESSIONSCqDE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEdEDEXEMP- (�
TpN.ANV VIOLATqN OF SECTION 7031.5 BV ANV APPLICANT FOR A PEfiMIT SUBJECTS THE APPUCANT TO Z Re-Roof
A CML PENALTV OF NOT MORE TW�N FNE HUNDRED DOLLAfiS(f600)J:
� ❑4��M�NEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, � COfflrtlBfClel
Z WILL DO THE WORK,AND TNE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7W�,BU51- J J
� NESS AND PROFESSIONS CODE:7HE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � .
FFOPERTV WHO BUILDS OR IMFROVES THEF7EON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR �
Q TMROUGH HIS OR HER OWN EMPLOYEES,7ROVIDED h1AT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
0 OFFEREDFORSALEIF,HOWEVERn1EBUILDINGORIMPROVEMENTI550lDWITHINONEYEAqOFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURUEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PUFPOSE OF SALE).
W ❑I.ASOWNEROFTHEPROPEFTn',AMEXCLUSNELYCONTRACTINOW(THLICENSEDCONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.70N,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V81U811 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANONRJEROFAPROPERTVWFIOBUILDSORIM7ROVESTHEFEON,AND
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� ❑I AM EXEMPT UNDER SEC. 8.8 P.C.FOR THIS qEASON Q
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� DATE OWNER ¢
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�Q LICENSED CONTRACTORS DECLARATION w
CC 1 HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER �
� o(COMMENCINO WITH SECTION 7000)OF DIVISqN 7 0F THE BUSINESS AND PROF SSIONS CqDE,AND Z
XLI MY LICENSE IS W FULL FORCE/J! EFFECL m
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� UCENSE CLASS � LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION Q
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� I HEREBV AFFIRM UNDER PENALTY OF VERIURY ONE OF THE FOLLOW WO DECLAHATIONS: Z
� _IHAVEANDWILLMAINTAWACERTIFICATEOFCONSENTTOSELF-INSUREFORMIORKERS' _
'� COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
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_I HAVE AND WILL MAIN7AIN WORKERS'COMPENSATION INSURANCE,AS REOUIfiED BY SECTION �
Q 37ooOFTHELABOFCADE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS
J ISSUED.MV WOFK PENSATION I UHANCE CARRIER AND POLICV NUMBEF ARE: CONSTRUCTION _ ��� �
j cu�RiER � � � �/ PLAN REVIEW
� POLICY NUMBER_� _O_�1-/ l�1 �'D�/� ELECTRIC
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p (n�ssEcnor+r��noTeEao'.siErIDOFn,EVEwTrsFoaa+E��oo�uas(sioo�oa�ss} PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF iHE WORK FOR WHICH THIS PEFiM1T IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE
N WORNERS'COMPENSATION LAWS OF CAIIFORNI0.�ND AGREE THAT IF I SFKKILD BECOME INSPECTION FEE
SUBJECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTbN 37000F THE LABOR
S CODE.I SHALL FOHTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE _ /
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p DATE: APPLICANT. SMIP
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J WARNING FAILURE TO SECURE MlORKERS'CAMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
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LL SUBJECTMIEMPLOVERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTFqUSAND ENERGYPERMIT
DOLURS(5100,000),IN hDDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
� SECTION 37080FTHE LABOR CODE,INTEREST,ANDATTORNEV'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO AOENCV
n- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ.
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� LENDERS NAME
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w ICERTIFYTHATIHAVEREADTHISAPPIICATIONANDSTATETHATTHEABOVEINFORMATqNISCARRECT. TOTAL FEES t� t��
p_ I AGflEE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATINO TO BUILDING
� CONSTRUCTlON,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z ABOVE-MENTIONEO PROPER/TV FORAJNSPECTION PURPOSES. COMMENTS
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m PERMITTEE NAME(PRINT ,�
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= RECPT.NO. � PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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FTGS/FORP/IS/STEEL ' FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT •
SLAB GRADE � FIREPLACE FOUNDATiON �
TEMP POWER �IREPLACE BOND BEAM
WATER SERVICE � Mlb HT. BCJND BEAM
ROOF SHEATHING ��i'C'_- _ 8 FT. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER �ZZ�QL ,��� PRE-GRADING
ROUGH HEATlNG BENCHlNG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUfVIBI�IG FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC '
EXT. LATH/SIDING POOt FENCING
WALL INSULATION ' POQL FINAL
CEiLING INSULATION _ �OFF SITE IMPS. _ _ _
DRYWALL NAILING DEQICATIONS
SEWER FINAL ENG. �
SEPTIC TAIVK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SlTE IMPS.
GAS AIR TEST FINAL ZONIi�G
FINAL C09�IST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINA�ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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