HomeMy WebLinkAbout18154 CITY OF DIAMOND BAR
----��`-- DEPARTIv�NT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�%9�^�� BUILDING PERMIT APPLICATION RMLY
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p I HEREBV AFFlH/A UNDER PENALTV OF PERJUFV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f8QB/CBfPOff
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w TURE,PRIOR TO ITS ISSUANCE.AL50 RE�UIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patio/Deck
� STATEMENT hIAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TNE CONTRACTORS LI-
� CENSE LAW(CHAPTER B(COMMENCMG WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PRO� � POOI/SP8
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMMIDTHEBASISFORTHEALLEGEDE%EMP- (�
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A GVIL PENALTY OF NOT MOAE THAN FNE HUNDRED DOLLAqS(5500).):
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. Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFEFED GOR SALE(SEC.7Wa,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PflOPEHTV WHO BUILDS OR IMPqOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVER711EBUILDINOORIMPFOVEMINTISSOLDWITHINONEVEAROFCOMPLE�
Z TION,THE OWNER�BUIIDER WILL HAVE THE 9URDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILD OR
� UAPROVE FOR THE PURPOSE OF SAL�.
w ❑I,AS OWNER OF THE PROPERTV,AM EXCWSNELY CANTRACTINQ WITH LICENSED CONTRACTORS
� TO CONSTRUCT 7HE PR0.IECT(SEC,70U,BUSINESS M!D PROFESSIONS CODE:THE CONTRACTORS LI- VeIl10�lOf1 0 ADJ.AREA
W CENSELAWDOESNOTAFVLVTOMIONMEROFAPROPEflTVWHOBUILDSORIMPROVESiHEREON,AND
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Y TORS UCENSE LAW.).
� O I AM EXEMPT UNDER SEC. B.6 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 PERIUFV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �
� 9(COMMENCINO WITH SECTION 7oa0)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE.AND Z
LLI �LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION Q �
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. � I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWIN6 DECURATIONS: Z
� _IHAVEANDVJILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a
� COMPENSATqN,AS PROVIDED BV SECTION 3l0oOF THE LABOR CODE.FOR THE PERFORMMICE U
Q OF THE WOH)(FOR WHICH THIS PERMIT IS ISSUED. �
Qw _I HAVE/WD WILL MAINTAIN WORKERS'COMPENSATqN INSURANCE,AS REOUIRED BY SECTION �
370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ' �� � ��
ISSUED.MV WORKERS'COA/PENSATqN INSURANCE CARRIER AND POIICV NUMBER AAE: CONSTRUCTION �1 r�i_
jCMRIER PLAN REVIEW � /,
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 MECHANICAL
C} SNALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE '
(n WOfiKERS'COMPENSATIONUWSOFCALIFORNI/�ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE
= SU&IECT TO THE WORKERS'CAMPENSATbN PROVISIONS OF SECTION 37000F THE LABOR ^�
CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISKKJS. ISSUANCE
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p DA7E: APPLICANT: SMIP
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J WARNING:FAILUHE TO SECURE WORNERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SFIALLBE ENERGY P/C
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�y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOU5AN0 ENERGYPERMIT
DOLURS(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
� SECTION31080FTHEUBORCODE,INTEREST,ANDATTORNEI"SFEES. RETENTIONFEE: �_
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70D7,CIV.C.�. .
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� LENDER'S NM1E �
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w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES � � O ,-'`�J' f.-'-.!_'�:.�J�'� �''
� I AGREE TO CAMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS REIATINQ TO BUILDINQ `, -� lJ
� CONSTRUCTION, D HEREBV AUTFqRRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE /� ��) J�T+ -(/,�y���j s� � �_ � ,r, _, ._.
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RECPT.NO. PAID BY VALIDATION
WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SLAB GRADE FIREPLAGE FOUNDATION
TEMP POWER FIREPLAGE BOND BEAM
WATER SERVICE MIQ HT. BOND BEAM '
ROOF SNEATHiNG S FT. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING ~
ROUGH HEA7ING BEf�CHING
RUUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING '
SHOWER/TUB TEST POQL ELECTRIC '
EXT. L4TH/S(DING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION QFF SITE IMPS.
DRYWALL NAILING DEDICATlONS
SEWER FINAL ENG.
SEPTIC TANK LAf�lDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IN9PS. �
GAS AIR TEST FlNAL ZONING
FINAL CONST. FlRE DEPT. FINA�
FINAL HEA71MCa HEALTH DEPT. FINAL
FlNAL ELEC7RIC ' DEV. FEES PAID
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