HomeMy WebLinkAbout13370 CITY OF DIAMOND BAbt �"
---�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suitc 190
(909)860-3195 Fax(909)861-3117 PRESS
� ���� BUILDING PERMIT APPLICATION FORMLY
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
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� I HEHEBY AFFlRM UNDER PENAL7V OF PERNRY THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8�89B/CHfPOft
W CENSEUWPoRTHEFOLLOWINOREASON(SEC.7031.68USINESSMIOPROFESSIONSCODE:ANYCITVOR � (n
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�Z TURE,PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH�PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO TNE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHAFTER Y(COMMENCINO WIiN SECTION 7000)OF DIVISION 9 OF THE BUSINESS AND PRO- u" PooUSpa
FESSION9 COOE7 OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE 8A515 FOR hiE IILLEGED EXEMP-
TION.ANV VIOLATION OF SECTION 70J1.6 BY ANV APPUCANT FOR A PERAIIT SUBJECTS THE APPLICANT T0 Z Re-Roof
� A CML CENALT/OF NOT MOFE THAN FNE HUNOqED DOIURS(i500).):
� ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASiHEIRSOLECOMPENSATION, � Commercial . -
NALL DO THE MIOFiK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BU51� J
N NESS AND VROFESSIONS COOE:THE COHTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF �
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Q 7HROUGHHISORHEROWNFJdPLOVEES,VROVIDEDTHATSUCHIMVROVEMEHTSARENOTINfENDEDOR �
w OFFERmFORSALEIF,lION�EVEi�T1EBU�LDINOORIMPROVEMINTI550LDWfTHINONEYEAROFCOMPLE-
Z �TqN,THE OWNER�BUILDER WILL HAVE THE BUROEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THS PURPOSE OF SALE�.
❑1,AS OVMER OF 1HE PROPERTV,AM EXCIUSIVELY COHTRACTINO NrtTH LICENSED COHTRACTORS
¢ TO CONSTRUCT THE PROJECT(SEC.70N,BUSINESS AN�PROFESSIONS CODE:THE OONTRACTORS LI� V81U91i011 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFA7ROPERTVNM1iOBU1LDSORIMVROVESTHEREON,AND
� MTIOCOMMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE �
� 70fi..LICENSE LAW.).
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Q ❑I AM EI(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� DATE ONMER V .
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� LICENSED CONTRACTORS DECLARATION �j �-�;. �
� 1 MEREBV AFFlRM UNDER PENALTV OF PEiUURV THAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTEH � .
� G(COMMENCINO WITil SECTION 7000)OF OMSION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
?C MY LICEHSE IS IN FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION Q '� " "�'iD�VII 1�IV�J J;f;��Y�i��
� I HEREBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THE WLLOWINO DECURATIONS: � �
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0 _I HAVE AND WILL MAINTAIN A CERfIFICATE OF CONSENT TO SELF-INSURE FOR WOHKERS' 2
� COMPENSATpN,AS PROVIDED BV SECTION 3700 OF THE UBOR CODE,FOR THE PEHWRMANCE W
OF 7HE WORN FOR NM1iICH THIS PERMIT IS ISSUED. �
�
_1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
� Q 37000F TME LABOR CODE,FOR 7HE PERPDRMANCE OF THE WORK FOR WHICH hIIS PERMIT IS �
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLiCY NUMB£R ARE: CONSTRUCTION , �' �
j �pqiEp PU1N REVIEW O
Z POLICY NUMBER ELECTRIC
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p �Ss�crqN�rqrgEoo�rIDOFn�pEqMrsFoqor�ra�mpouaas�siro)aa�ss� PLUMBING
. Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
� (, SMALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECAME SUBJECT TO THE
y WORKERS'COMPENSATION UWS Oi CALIFORNIA,AND AGREE 7MAT IF I SHOULD BECOME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE tABOR ��Q
CODE,I SHALL FOHTHWihI COMPLV WITI THOSE PROVISIONS. ISSUANCE L,
p DATE: � APPLICANT: - �SMIP � � 7 �
� ENERGY P/C
WARNINO:FAILURE TO SECURE WORKEHS'COMPENSA710N COVERAGE IS UNLAWFUL,AND SHALL BE
� SUBJECT AN EMPLOVER TO CRIMINAL PEN/�L71ES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT �
DOLUFS(i1o0,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 37oe OF THE UBOR CODE,INTEREST,AND ATTORNEV'S FEES. ' RETENTION FEE: �� n�
a CONSTRUCTION LENDING AGENCY PRF�(�T///FEE: �
� 1 HEREBV AFFIRM UNDER VENALTY OF PERIURY THAT THERE IS ACONSTRUCTION LENDING AGENCV n'��
d FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3067,CIV.C.�. -
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� LENDER'S NAME � ([)�r1 C
H LENDER'SADDRESS
w ICERTIFYTHATIHAVEREADTHISAPPLICATIONAtJDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES �
� I AGREE TO COMPLV N7TH ALL CRV M1D COUNTV ORDINANCES AND STATE UWS HEUTING TO BUILDINO
CONSTRUC710N.AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV 70 EMER UPON THE .
ZABOVE-MEHfIONED PROPERTV FOR 1 SPECTION P SES. COMMENTS �
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� RECPT.NO. PAID BY � VALIDATION
� WHITE—DepeRment Copy,YELLOW—Finence Copy,PINK—Assessor Capy,G LDENROD--File Copy,GREEN—Applicant's Copy
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ELECTRIC.GROUND UNDER FLOOR DUCT .. , _ : � .. ,,,,�� �,
GROUND PLUMBING • UNDER FLOOR CUMDUIT'�-' --`���t ; •y�-i 'i=""'•'t `'
SLAB GRADE � FIREP�AC� F UN ATION�'� �� ' '�' �'�
TEMP POWER � FIREP��ACE BOND�gEAM ��� � �� "
WATER SERVICE •• MID HT. BOND BEAM •
RO(?F'SH�ATHIf�G ''.:' ` -�� ."' � 8 FT. BOND BEAM ,
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FRAMINGNENTIUATION FINAL BOND BEAM, ;
ROOF COVER PRE-GRA�If�iG _ .`•=i .�.:.,, . .•, ' ���:...;�,�..:.;
ROUGH HEATING - BENC,�'JG�'�i.;'•, ;�; , ,y!��.,'��'+,'"�`� .
ROUGH ELECTRIC ROUGH GRADING I
ROUGH PLUNIBING FINISH GRADING
SHOWERITUB TEST POOL ELECTRlC
EXT. LATH/SIDING � POOL FENCING
WALL INSULATION . POOL FINAL '
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING , QEDICATIONS �
SEWER FINAL ENG.
SEPTIC TANK __ .. ,_,t LANDSCAPE/IARIG. '
SEEP PIT/L.L. • � ' ':' � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. d .� �t,.( FIRE QEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINA�PLUMBING ENERGY � '
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