HomeMy WebLinkAbout17649 (33) CITY OF DIAMOND BAR
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�`'-»����' BUILDINGPERMITAPPLICATION JUN 18 FURMLY
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ADDRESS 3�R17 'rBy�/@� e 889 ZONING SETBACKS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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I HEREBV AFFIRM UNDER PENAL7V OF PERJURV THAT I AM EXEMPT FROM THE CANTRAC70RS LI� G8f89B/COfpOfi
W CENSELAWFORTHEFOLLOWINGfiEASON(SEC.7o31.5BUSINESSAN�PROFES510N5CODE:ANYCITYOR (n
U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC�
w TURE.PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7HE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PqO� � POOVSpB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFOR7HEALLEGEDE%EMP- (�
� TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL 7ENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESAS7HEIRSOIECAMPENSA710N, � COfflrtlBfClal -
Wlll 00 THE WORK,AND THE S7RUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.704�,BU51- J
� NESS M1D PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF �
PROFERN NMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� 7HROUGH HIS OR HER OWN EMP�OVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NO7 INTENDED OR m
QOFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE-
Z TION,THE OWNER�BUILDEH WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,AS ONRJER OF THE PROPER7Y,AM EXClU51VELV CONTRACTING WITH LICENSED CANTRAC70R5 .
Q TO CANSTRUCT THE PR0.IECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V0I113�1Of1 ADJ.AREA
W CENSEUWOOESNOTAPPLV70ANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
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� ❑I AM EXEMPT UNDEfi SEC. B.d P.C.FOR THIS REASON Q
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DATE OWNER � �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PE(UURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT. '
� LICENSE CLASS C��d LIC.N0. �/�� / j
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBY AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURA710N5: z
0 ✓ IHAVEANDWILLMAINTAINACERTIFICA7EOFCONSENTTOSELF-INSUREFORWORKERS' _
Q COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I NAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
Q 37oa OF 7HE LABOR CODE,FOR THE PEAFORMANCE OF THE WORK FOR WHICH THIS PERMI715
ISSUED.MY WORKERS'CAMPEN/S�A�TION INSURANC`E CARRIEf1 AND POLICY NUMBERARE: CONSTRUCTION
� CAHRIEF� �/i�Mlr//�� � PLAN REVIEW
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� (fHISSECTK)NNE�NOTBE07MREfEDOFhiEPERMfTISFORONEFNI�DREDDOLLlAS(5100)ORLESS} PLUMBING
Z I CERTIFV THAT INTHE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED,I MECHANICAL I
(} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE �
� WORKERS'COMPENSATION UWS OF CAUFOFNIA,AND AGREE TNAT IF I SHOULD BECOME �NSPECTION FEE 'i
= SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR V O
CADE,I SHALL FORhIWITH COMPLV WI7H THOSE PRO�V/IS/IOyNS. �,/ ISSUANCE . i
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p APPLICANT:
J WARNING:FAILURE TO SECURE WORNEFiS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUN�REDTHOUSAND ENERGYPEFMIT
DOLLARS(5700.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
J SEC710N37a0OFTHELABORCODE,INTERE57,ANDAT70RNEY'SFEES. RETENTIONFEE:
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBVAFFIqM UNDER PENALN OF PEFJURY THAT 7HERE IS ACONSTRUC710N LENDING AGENCY
a- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ.
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-�Z LENDER'S NAME �
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H LENDER'SADDRE55
,� TOTAL FEES �q�, �'jb
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. �
� I AGREE TO COMPLV WI7H ALL CI7V AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUC710N,AND HEREBV AUTHORIZE REPRESENTA71VE5 OF THIS COUNTY TO ENTER UPON THE
Z ABOVE�MENTIONED GROPERTV FOR INSPECTION PURPOSES. COMMENTS
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~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy I
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GROUND PLUMBIN_G �_ _ _ ___ � UNDER FLC>OR CU�!DUIT__� ______
SLAB GRADE i FIREPLACE �OUNDATION �
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TEMP POV�/ER FIREPLACE BOND BEAM ___
WATER SERVICE MID HT. BDND BEAM ____ ___ ___
ROOF SHEATHING � 8 FT. B�ND BEAM � _____
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WALL IiVSULATION POOL FINAL
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'SEWER FINAL�NG. i
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FINAL HEATING � ' HEALTH DEPT. FINAL
FINAL ELECTR�C j DEV. FEES PAID _ __ _
FINAL PLUMBING I ENERGY• �
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