HomeMy WebLinkAbout17907 (25) CITY OF DIAMOND BAR
`---��` --- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
� 21825 E.Copley Drive
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(909)860-3195 Fax(909)861-3117 PRESS
��"%��� BUILDING PERMIT APPLICATION FIRMLY
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ADDRESS �C1C) ����«' DATE � � PERMIT P/C
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APN LOT TRACT DATE CONST. GROUP
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w TURE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
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A CIVIL PENAL7V OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).):
❑I,AS OWNER OF THE PROPERT',OR MY EMPLOVEES WI7H�WAGES AS THEIR SOLE CAMPENSATION,
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFfEFED FOR SALE(SEC.70�L BUSI- � Commercial -
� NESS AIJD PROFESSIONS CODE:THE CANTRAC70R5 LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPER7Y VhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPFOVEMENTS ARE NOT INTENDED OR m
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Z TION,THE OWNER-BUILDER WILL HAVE THE BUiiDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
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� TO CANSTRUCT THE PROJECT(SEC.7o1I,BUSI D PROFESSIONS CODE:7HE CAN7FlACTORS LI� VelUet1011 ADJ.AREA
W CENSE LAW DOES NOTAPPLY TO AN ONTJER B OPER7V�' O BUILDS OR IMP ES THEREON,AND
� WHOCONTRACTSFORSUCHPFOJECTS A 6NTRACTOR�6)LICENSEDPU 770THECONTRAC- �UANTITY DESCRIPTION FEE �
TORS LICENSE UWJ.
� �I AM EXEMPT UNDER SEC. � B.8 P.C.FOR 7HI5 REASON Q I � �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
a e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
X MV LICENSE IS IN FULL FORCE AND EFFECT, m
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBY AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECURA710N5: Z
Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' _
¢ COMPENSATION,AS PROVIDED BV SECTION 7700 OF THE LABOR CADE,FOR THE PERFORMANCE w
OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED. �
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W I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION 1
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS U
ISSUED.MV WORKERS'COMPENSATION INSUHANCE CARRIER AND POLICY NUMBER AFE: CONSTRUCTION ��P�
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� CARHIER PLAN REVIEW •
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WONK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I
C7 SHALL NO7 EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGFEE THAT IF I SHOULD BECOME INSPECTION FEE �.
= SU&IECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE.I SHALL FORTHWITH COMPLV WI7H THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: SMIP �� �
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&lEC7ANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f 7 oo.oao).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37080FTHELABORCODE,MTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS ACONSTHUCTION LENDING AGENCV
FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
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� LENDER'S NAME
H LENDER'SADDRE55 /�
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES I `/ I ,�
� I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE UWS PELATINC,TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PROPERTV FOR INSPECTIO ES.
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= RECPT.NO. PAID BY VALIDATION
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SET BACK FLOOR JOIST ;
FTGS/FORMS/STEEL ; � FHA REQMTS
ELECTRIC GROUNQ ` UNDER FLOOR QUCT �
GROUND PLUMBWG _ � UNDER FLOOR CUf�IDUIT�
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SLAB GRADE FIREPLACE FOUNDATION _____
TEMP POWER ; FIREPLACE BOND BEAM
WATER SERVICE ' MID HT. BOND BEAM _
ROOF SHEATHING ,3'G`d � 8 Ff. BOND BEAM __, _____
FRAMING/VENTILIATION _; �, FINAL BOND BEAM
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ROOF COVER ��'���-- �; PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC RQUGH GRADING
ROUGH PLUfVIBING FlNISH GRADING
---,. _._ __ ----- --...._____..__.
SHOWER(TUB TEST I POOL ELECTRIC
EXT. LATN/SIDIIVG POOL FENCING
WALL INSULATION POOL FINAL
CEILING IIV�ULATION OFF SITE IMPS.
DRYWALL NAILING dEDICATIONS
SEWER FINAL ENG. �
SEPTIC TANK - LANDSCAPE/IRRIG.
SEEP PIT/L.L. C1N SITE IMPS.
GAS AIR TEST FINAL ZONING
FIiJAL CONST. FIRE DEPT. FINAL ^
FIPVAL HEATIfVG HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID
FIiVAL PLUMBIfVG ENERGY
- - C�L�OG� � - -- --- __ ---- -
CO�liNiENTS
SEPTIC TAfVK SIZE
SEEP PIT/U SIZE ---
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