HomeMy WebLinkAbout14826 � � CITY OF DIAMOND BAR ��PIRED
DEPARTMENT OF.COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 J U N 17 2002 PRESS
� ��A�. BUILDING PERMIT APPLICATION � FIRMLY
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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u� NRE,PRIOR TO ITS ISSUANCE,/�L50 RE�UIRES THE APPLICANi FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT ME OH SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE COHTfUCTORS LI-
� CENSE UW(CHAPTER 9(COMMENCINO N'ITH SECTION 1000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' PooVSpa
FESSIDNS OODE)OR THAT HE OR SHE IS El(EMPT TMEREfROM AND 7HE BASIS FOH THE ALLEDED EXEMP-
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� A CML VENALTY OF NOT MORE THM!FNE NUNDRED DOILARS(t500).):
� ❑LASOWNEROFTHEPROPERTY,ORMVEMPLAYEESWI7HWAGESlSTHEIRSOIECOMPENSA710N, � COf71rt1BfC181 �
MALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OH OFFERED FOR S/�LE(SEC.7W�.BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF
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Q THROUGH NIS OR HER ONM EAIPLOYEES,GHOVIDED 7HAT SUC}1 IMPROVEMENTS ARE NOT INTENDED OR m
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Z �TqN,THE OWNERBUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR .
� W PROVE FOR THE PURPOSE OF SALE�
W ❑I,ASONMEROFTHEPROPEHT`/,AME%CLUSIVELVCOHTMCTINOWRHLICENSEDCONTMCTORS
� TO CONSTRUCT THE PRQIECT(SEC.7oH.BUSINESS AND PROFESSIONS CODE:THE CONiMC10R5 U- V81UflllOfl ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OWNER OF A PROPERTV NRiO BU!LDS OR IMPROVES THEREON,AND
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� ❑I AM EXEMPf UNDER SEC. B.8 P.C.FOR THIS REASON Q
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F IICENSED CONTRACTORS DECLARATION W
� 1 MEREBV AFFIRM UNDER PENALTY OF PERIURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� Y(COAIYENCYICi WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z �
MY IICENSE IS IN fULL F CE EFF CT. � m
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBY AFFIRM UNDER PENALTY OF PERIUM ONE OFTHE FOLLAWING DECURATIONS: U
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0 I HAVE AND WILL MAINTAIH ACERfIFICATE OF CONSENT 70 SELF-INSURE FOR WORKERS' _
� COMPENSATqN,AS PROVIDED BV SEC710N 970o OF 7HE LABOR CODE,FOR hIE PERFORMANCE �U
OF THE WORK FOR NMlp1 THIS PEHMIT IS ISSUED. �
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W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION
Q 3700 OFTHE UBOR COOE,FOH THE PERFORMAN F THE WORK FOR NRiICH THIS PERMIT IS
� ISSUED.MY WORKERS' NSA�N INSUR CE CARRIER�ID POLICY NUMBER ARE: CONSTRUCTION �
� CARRIER � r ~// PLAN REVIEW
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Z I CERTIFY 7NAT IN THE PERWRMANCE OF 7HE WORK FOR WHICH THIS E IT IS ISSUED,I
(,�J SMALL NOT EMPLOY MIY PERSON IN ANY MANNER SO AS TO BECAME U ECT TO THE
� WORKERS'COMPENSATION UWS OF ClLIFORNIA AND AGREE THAT I I OULD BECOME INSPECTION FEE (�(�
S SU&IECTTOTHEWORKERS'COMPENSA710NPROVISIONSOFSECTI 7ooOFTHELABOR �SSUANCE �f1I7 'I � �I111
CADE,I SHALL FORTHWIn�CAMPLY SE PROVISIONS.
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'J WMNINO:FAILUdE TO SaCURE WOiiKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE v- ��'��
� SUBIECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT L1TTiT TITN�i���
DOLURS(i10o,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN
J SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. � RETENTION FEE:
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a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
`�� � 1 HEREBY AFFIHM UNDER PENALTY OF PERIURY THQ THERE IS ACANSTRUCTION LENOING AGENCY, �
n- FOR THE oERFORMANCE OF THE WORK FOR NTIIGi 7HIS PERMIT IS ISSUED(SEC.9087,CIV.C.J.
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� LENDER'S NAME
F- LENDERSADDRESS
W I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FEES ! 5� l D
� I AOREE TO COMPLV WITH ALL CITY AND COUNTV OfiDINANCES AND STATE LAWS RELATINO TO BUILDING
CONSTRUCTION,AND HEREBV AUTFIORIZE REPRESEN7A71VE5 OF THIS COUNTY TO EMER UPON THE .
ZABOVE-MEHTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS �
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WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assesaor Capy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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GROUND PLUMBING UNDER FLOOR CU�IDUIT . • '
SLAB GRADE FIREPLACE FaUNDATION �
TEMP POWER FIREPLACE BOND BEAM ' '
•WATER SERV.IC�, MID HT. BOND BEAM � ` � � � - �
ROOF SHEATHING - -1"� • 8 FT. BOND BEAM �� �
FRAMINGNENTILIATION � �FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH E�ECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADWG �
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION • � POOL FINAL .
CEILING IN5ULATION OFF SITE IMPS. �
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK . LANDSCAPE/IRRIG.
SEEP PIT/L.L. -� ON SITE IMPS. � '.
GAS AIR TEST FINAL ZONING '
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
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