HomeMy WebLinkAbout13383 _!� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
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�Z NRE,PRIOR TO ITS ISSUANCE,ALSO REW IflES THE APPLICAHf FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE COMRACTORS LI-
� CENSE UW(CHA7TER G(COMMENCINO WIT?1 SECTION 7000)OF DIVISqN 3 OF THE BUSINE55 AND PHO- � PooUSpa
FESSpNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEOED E%EMP•
TION.ANYVIOLATIONOFSECTION7091.6BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
,� A CML PENALTY OF NOT MORE THAN FNE HUNORED DOLLARS(i500).):
� ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � CORIRIBfCIeI � '
NALL DO THE WORK AND THE STRUCNRE IS NOT INTENDED OR OFFEfiED FOR SALE(SEC.70t�,BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PROPEHTYM'1108UttDSORIMPROVESTHERC-0N,ANDNMODOESSUCHWORKHIMSEIFORHERSELFOR m
Q THROUGH HIS OR MER ONM EMVLOYEES,GRONDED 7HAT SUCH IMPROVEMENTS AHE NOT IMENDED OR
W pFFEqmPppSALE1F,HOWEYERTMEBUILDINGORIYPROVEMENTISSOLDWfTHINONEVEAROFCOMPLE-
� Z �TION,THE OWNER-0UILDER WILL HAVE THE BURDEN OF PROVINO hIAT HE OR SHE DID NOT BUILD OR
� IMPROVEFORTH=PURPOSEOFSALE).
❑1,AS ONMER OF THE PROPEHTV,AM EXCLUSIVELY COMRACTINO WfTH LICENSED COHfRACTORS
Q TO CONSTAUCT THE PRQIECT(SEC.7oH,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI� V81U8f1Of1 ' ADJ.AREA
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F LICENSED CONTRACTORS DECLARATION W ,��� .l�
� I MEREBYAFFIRM UNDER PENALTY OF PEiUURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� 0(COMMENCVq WfTH SECTION 7000)OF DMSION 3 OF THE BUSINESS AND PROFESSIONS CADE.AND Z
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� I HEREBY AFFIfUI UNDER PENALTY OF PERNRY ONE OF THE FOLtAWING DECLARATIONS:
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0 1 HAVE AND WILL MAINTAIN A CERfIFICATE OF CONSENT 70 SELF-INSURE FOR WORNERS' _
� COMPENSATION,ASPROVIDEDBYSEC710N370oOFTHEUBORCOOE,FORTHE7ERWRMANCE W
OF 7HE WORK FOR WHICH THIS PE(iM1T IS ISSUED. �
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_1 HAVE AND WILL MAIHfA1N WORKERS'COMPENSATION INSUfUNCE,AS REQUIRED BY SECTION
Q 970o OF THE LABOR CODE,FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMI715 �/.�.�
ISSUED.MY WORKERS'COMPENSATION INSURMICE CARRIER M1D POLICV NUMBER ME: CONSTRUCTION ((/
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Z I CERTIFY THAT IN THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL '
LJ SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SOAS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 97000F THE LABOR �
CODE,I SHALL FORTHWIhI COMPLY WITITHOSE PROVISIONS. ISSUANCE /�''�
p DATE: � APPLICANT. SMIP ,- v
w ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKEHS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE
LL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED hi0U5AND ENERGY PERMIT
DOLURS(iloo.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION37080FTHELABORCODE,IN7EREST,ANDATfORNE1^SFEES. ' RETENTIONFEE: � •
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� CONSTRUCTION LENDING AGENCY PRE- F/EE�:
� 1 HEREBYAFFIRM UNDER PENALTV OF PERIURY THAT 7HERE IS A CONSTRUCTION LENDING AGENCV �/ i
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.9087,CIV.C.).
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� LENDER'S NAME
F– LENDER'SADDRE55
� I CERTIFY TMAT I HAVE READ hIIS APPIICATION AND STATE THAT 7HE ABOVE INFORMATKKI IS CARRECT. TOTAL FE ES �
W I AGREE TO COAIPLV WITH/�Ll CfTV AND COUNTV ORDINANCES AND STATE UWS REU71N0 TO BUILDING . I
� CONSTRUCTION.AND HEREBV AUTFIORIZE REPRESENTATIVES OF 7HIS COUNTY 70 EHfER UPON THE
ZABOVE-MEHTIONED PROPERTY FOR INSPECT auaaoses. COMMENTS �
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� RECPT.NO. / � PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy;;GREEN—Applicant's Copy
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GFiOUND PLUMBING UNDER FLOOR CU�IDUIT�•� �_.: ;��: - - _
SLAB GRADE FIREPLqC� FOUNpqTION =4 � � -, , . .. • • ` `"
TEAAP POWER FIREP�!A'C��C3ND��AM ' ::`�, : -'� :.'. , � .
WATER SERVICE MID HT. BOND BEAM
ROOF'SH�ATNING�- ';:`'-.., ..'.i:':.� =�. _ � ' -- 8 FT. B(JND BEAM t
FRAMINGNENTILIATION � u � y� � � FINAL BOND BEAM. .,, . , r
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ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUfVIBING FINISH GRADING
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EXT. LATH/SIDING POO� FENCING
WALL INSULATION POOL FINAL ' '
CEIUNG INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK �� , �ANDSCAPElIRRIG.
SEEP PIT/L.L. - �- �;�� �N SITE IMPS.
GAS AIR TEST FINAL ZONING
FINA�CONST, o �� FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL:ELECTRIC DEV. FEES PAID
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