HomeMy WebLinkAbout13362 �� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suitc 190
(909)860-3195 Fax(909)861-3117 PRESS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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0 I HEREBY AFFlHM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE CONTMCTORS LI- G8f89B/CBIpOfI -
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� NRE,PRIOR TO RS ISSUANCE,ALSO REW IflES THE APPLICANf FOR SUCH PERMIT TO FILE A SIGNED W
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHAPTER 0(COMMENCINO N'ITH SECfIOH 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- V" POOUSp9
FES9IONS CODE)OR TFUT HE OR SHE IS EXEMPT TMEREFROM AND THE BASIS FOR THE ALLEGED E%EMP-
TqN.ANYVI0LAT10f10FSECTION7W1.5BYANYMPLICANTFORAPERMITSU&IECTS7HEAPPLICANTTO Z Re-Roof
� A CML PENALT'OF NOT MORE THAN FNE HUNDRED DOLURS(5500).):
� ❑I,ASOWNEROFTHEPROPERT',ORMVEM7LOYEESWITHWAGESASTHEIqSOLECOMPEN5A710N, � COrtIrtIBfClei �
MALL DO THE WORK AND 7HE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC.70��,BU51- J
NESS AND VROFESSIONS CODE:THE COHTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PROPEAT'/WIIOBUILDSORIAIFROVESTHEREON,ANDNRiODOE55UpiWORKHIMSELFORHERSELFOR � �
� 1HROUGHHISORHEROWNELIPLOVEES,VROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
Q ,OFFERWFORSKEIF,ifOWEVEF�THEBUIIDINGORIMPROVFMEMIS" �WfTHINONEYEAROFCOMPLE-
Z 'Tlpi,THE OWNEH-BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVEFOR7H=PURPOSEOFSALE).
W ❑I,A40WNEROF THE PROPEHTV,AM EXCLUSNELYCONTMCTINU WRH LICENSED COHTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.70/4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V91UflSlOf1 ADJ.AREA
W CENSEUWDOESNOTMPLYTOAHOWNEROFAPROPERiYWHOBUILDSORIMPROVESTiEREON,AND
� NRIOCOHTMCTSWRSUCHPRO,IECTSWITHACOHTRACTOR(5)LICENSEDPURSUANTTO7HECONTRAG QUANTITY DESCRIPTION FEE
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� ❑I AM EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON Q
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DATE ONMER V
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� LICENSED CONTRACTORS DECLARATION W ,1�� `)
� I MEREBY AFfIRM UNDER PENALTV OF PERIUqY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 0(COMYENCWO WRH SECTION 7oDo)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS COOE,AND
�� MY LICENSE IS IN FULL FORCE AND EFFECL m {`�n�i✓ � n
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� LICENSE CUSS LIC.NO. � �� �
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� WORKERS'COMPENSATION DECLARATION a "✓'�LlJ�S��m R
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� I HEREBY AFFIRM UNDER PENALTV OF PE0.1UM ONE OFTHE FOLLOWING DECLARATIONS: Z i 1
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� _IHAVEANDWILLMAINTAINACEfifIFIG1TEOFCONSENTTOSELF-INSUREFORWORKERS' _
COMPENSATION,AS PROVIDED BV SECTION 370o OF THE l/�BOR CODE,FOR THE PERWRMANCE U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _IHAVEANDWILLMAIMAINWORKERS'COMPENSATIONINSURANCE,ASREOUIHEDBYSECTION ^
Q �7000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS V
ISSUED.MY WORKERS'CONPENSATION INSURANCE CARRIER AND POLICY NUMBER ME: CONSTRUCTION
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� POLICV NUMBER ELECTRIC
0 �niss[t,�rqHr�r�orgEoo�p�r�poFnfpew.rrswqoriErurnpEooatnfs(s�m�oa�ss� PLUMBING
Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOq WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
(,'} SHALL NOT EMPLOY MIY PERSON IN ANY MMlNER SO AS TO BECOME SUBJECT TO THE
N WORKERS'CAMPENSATION LAWS OF CALIFORN10.AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE,I SHALL FORTIWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � � �
� SMIP I-
p DATE: � APRICANT. .
� ENERGY P/C
J WARNINO:FAILURE TO SECUHE WORKERS'CAMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
� SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE MUNDRED THOUSAND ENERGY PERMIT �
DOlURS(i1o0,000),IN ADDI710H TO THE COST OF COMPENSATpN,DAMAGES AS PROVIDED FOR IN
J SECTION370BOFTHELABORCOOE.INTEREST,ANDA7TORNEV'SFEES. RETENTIONFEE:
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a CONSTRUCTION LENDING AGENCY pRE-A E(E:'
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT THERE IS A CANSTRUCTION LENDING AGENCV v
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30W,CIV.C.).
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� LENDER'SNAME
F- LENDER'SADDRESS .
� ICERTIFY7HATIHAVEREADTHISAPPLICATIONANDSTATE71iATT1EABOVEINFORMATIONISCORRECT. TOTAL FEES
w I AOREE TO COMPLV N7TH ALl CT'AND ODUNTY ORDINANCES AND STATE LAWS REU71N4 TO BUILDING
� CONSTRUCTION,AND HEREBV AU7HORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE �
ZABOVE-MENTIONED VROPERTY f-0R INSPECTION PURPOSES. COMMENTS �
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� sa�N D E � RECPT.NO. PAID BY O� VALIDATI
� WHITE—DepeRment Copy,YELLOW�inance Copy,PINK—Asaessor Copy,GOLDENROD—File Copy,GREE�ApplicanYs Copy
Cl�Y OF DIAMOND �AR . ,
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FTGS/FORMS/STEEL , , , � FHA REQMTS
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GROUND PLUMBING UNDER FLOOR CUt�IDUIT'. � �`;���':f -� - '� •``'
SLAB GRADE FIREP , Ex.FOUND,ATION •-�-:�'� � `��� "``
TEMP POWER FIREPLPc`C �BONDBEAM -� It • L.
WATER SERVIGE MID HT. BOND BEAM �
ROUFS�i�ATMI�J�';�,:`''. ' , � '�' ' "�:, .� 8'FT. BONDBEAM �
FRAMINGNENTIUATION FINAL BOND BEAM . ,':. , , �
ROOF C�VER _ �.� 'PRE-GRAQING '� ,�:� �`•;��'j��.,;:`. ; . ;-
ROUGH HEATING BENC�{��t'•�.t=''.: ���� � `�,.:,`Mh:���i.>��1=..:
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ROUGH ELECTRIC ROUGH GRADiNG
ROUGH PLUNIBING FINISH GRADING
SHOWERITUB TEST POOL ELECTRlC
EXT. LATH/SIDING POOL FENCING '
WALL INSULATION POOL FINAL
CEI�ING INSULATION OFF 51TE IMPS.
DRYWALL NAILING DEDICATIONS .
SEWER FINAL ENG.
SEPTIC TAfVK _ _, t, LANDSCAPE/IRRIG.
SEEP PIT/L.L. `-.� - �' . ON SITE IMPS. � ,
GAS AIR TEST FINAL ZC?NING '
FINAL CONST. � .� FIRE DEPT. FINAL �
FINAL HEATING ' HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID
FIMAL PLUMBING ENERGY
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