HomeMy WebLinkAbout16599 (22) ----��._-- CIT'Y OF DIAMOND BAR �X�IRED
,, DEPARTIv�NT OF COrRv1UMTY&DEVELOPMENT SERVICES
� 21825 E.Copley Drive
, (909)860-3195 Fax(909)861-3117 JUN 18 2002 pRESS
�"%���� BUILDING PERMIT APPLICATION FIRMLY
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I HEREBY AFFIRM UNDER PENAL7Y OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f89B/COryOft
W CENSE LAW FORTHE FOLLOWING REASON(SEC.7o31.5 BUSINESSAN�PROFESSIONS CODE:ANV CI7V OR (n
U COUNTYWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOH TO ITS ISSUANCE,AL50 REQUIRES 7HE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMC70RS LI-
� CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB
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V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z Re-Roof
A CIVIL PENAL7V OF NOT MORE 7HAN FIVE HUNDRED DOLURS(SSaO).):
Z ❑I,ASOVMEROFTHEPROPERiY,ORMYEMPLOYEESWITHWAGESASTNEIRSOLECOMPENSA710N, 0 COmfflOfCldl �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.70I4,BUSI- J
� NESS AND PfiOFESSIONS CODE:7HE CAN7RAC70R5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPER7Y NM1iO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,PFOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Z TION,THE OWNEH-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OH SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASONMEROFTHEPROPERTY,AMEXCLUSIVELYCON7RAC71NGWITHLICENSEDCONTRACTORS
� TO CANSTRUCT THE PRQIECT(SEC.701<,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS U- V8IU8flOf1 ADJ.AREA
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F WHOCONTMCTSfORSUCHPRQIECTSWITHACANiRAC70R(5)LICENSEDPURSUAN7TOTHECONTRAC- QUANTITY DESCRIPTION FEE
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� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w i
� I HEREBY AFFIqM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � .
d e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSANO PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFEC7. /+ ,^ �/
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� WORKERS'COMPENSATION DECLARATION Q ���� i1�.„� �\ \
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� I HEREBV AFFIRM UNDER PENALTY OF PEPJUHV ONE OFTHE FOLLOWING DECUHATIONS: Z �� � /,��(� ,�{�,/� _
C.) // "V
Z _I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2 I
¢ CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOH CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. �
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
� CAHRIER �-GL ��2^ �'�'�� PLAN REVIEW
� POLICY NUMBER C �����--0� ELECTRIC
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� (iHISSECIIONNEmNOTBE00MREfEDOFTHEPERMfTISFORONEHU R D�).`- PLUMBING `
Z I CERTIFV 7HA71N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL ��V�
(.'} SHAIL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CAL ORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&IECTTO THE WORKERS'COMPENSAT O PROVISIONS OF SECTI�N 37 F E LABOR . (,
CODE,I SHALL FORTHWITH COMPLV WI H SE PROVISIONS. ISSUANCE v�
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p DATE: �7J OI APPLICANT. SMIP , ..,._ .... ....
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENEFGY P/C ��
LL SU&IECTANEMPLOYERTOCRIMINALPENAL7IESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000).IN ADDI710N 70 THE COS70F COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37oeOFTHELABORCODE.IN7EREST,ANDATTORNEV'SFEES. RETENTIONFEE:
ow., CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HAT THERE IS A CONSTRUCTION LENDING AGENCV
� FORTHE PERFOFMANCE OF 7HE WORK FOR WHICH 7HIS PEHMIT IS ISSUED(SEC.3o97,CIV.C.). � .
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� LENDER'S NAME
F- LENDER'SADDFESS
� TOTAL FEES �� � D
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLY WITH ALL CITY AND CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE fiEPRESENTATIVES OF 7HI5 COUN7V 70 EN7ER UPON THE
� ABOVE-MEN710NED PROPERTY FOR INSPECTION PURPOSES.
Z COMMENTS
� //2 E�v� SH�r,�o N�
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= RECPT.NO. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A licant Co
P PY, PY. PY, PY, PP PY .
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FTGS/FORMS/STEEL ! FHA REQMTS '
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ELECTRIC GROUND � ; UNDER FL�OR DUCT
--- --- - -- -- - _---
----
GFIOUND PLUMBING ___ __ � UNDER F�OOR�CUI�IDUIT _ �____��
_....__ � ....... __
S�AB GRADE �______ ,_ I j �IREPLACE FOUNDATION
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TEMP POWER � I _�IREPLACE BOND BEAM _ ; __ _ __
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WATER SERVICE ; MID HT. B(�ND BEAPdI
ROOF SHEATHING � 8 FT. BO.ND BEAM _ ______�
FRAMING/VENTILIATION i FlNAL BOND BEAM ____.
ROOF COVER • PRE-GRADING ;
ROUGH HEATING BENCHING
ROUGH ELECTFiIC __ ROUGH GRADING ___ _____
ROUGH PLUMBING � i_ FWISH GRADING
- -- --- --- ---_------- --
_ _ __
SHOWER/TUB TEST ; PC�OL ELECTRIC
------ -----
EXT, LATH/SIDING � � POOL FENCING j � ___ __�
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WALL INSULATION ; POOL F1NAL _ __� ;
_. _._.... - --------
CEILIfVG INBULATION , __ ; OFF SITE IMPS. _
DRYWALL N,4ILING DEDICATIC)NS �
SENIER FINAL ENG. �
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. I �!RE DEPT. FINAL
FINAL HEATING j HEALTH DEPT. FINAL
FIPJA�ELECTRIC i DEV. FEES PAID ___ _
FINAL PLUMBIMG ; ENERGY
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C�G]U OO(� a � o I
COMNiENTS � �
SEF'TIC TA�K SIZE
SEEP PIT/U SIZE
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