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�� � CITY OF DIAMOND BAR E^PIRF�D
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� 21660 E.Copley Drive Suite 190 �U N 1 J ZOOZ PRESS
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���^� BUII.DING PERMIT APPLICATION FIRMLY
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Z NHE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APVLICANT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMEHf THAT HE OR SHE IS IJCENSED PURSUAHT TO THE PROVISIONS OF THE CONTRACTORS Lb w '
� CENSE UW(qUPTER 0(COMMEHCINO WI7H SECTIOH 70Do)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa �
FESSqNS ODD�OR THAT HE OR SHE IS EXEMPT 7HEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANVVIOLATIONOFSECfION7031.6BYANVAPPLICANTFORAPERMITSUaIECTSTHEAPPLICANTTO Z Re-Roof
� ACML PENALT/OF NOT MOHE TT1AN FNE HUNDRED DOLURS(5500).):
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WILL DO THE MIORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70//,BUSI� J
NESS AND PROFESSIONS CODE:THE COHTMCTORS LICENSE UW DOES NOT APPLY 70 AN OWNER OF
N PfiDPEHfYNR10&11LDSORIMVROVESTIEREON,ANDMMODOESSUCHWORKHIMSELFORHERSELFOR � �
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Z `TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILD OR
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❑I,ASOMMEROFTHEPROPEHfY,AME7(CLUSIVELYCONTRACTINOWfTHLICENSEDCOHTMCTORS �
� TO CON5TRUCT THE PRO,IECT(SEC.7oH,BUSINESS AND 7ROFESSIONS CODE:THE CONTMCTORS LI• VelU8�1011 ADJ.AREA
W CENSE UW DOES NOTMPLV TOAN ONMER OF A PROPERTY NM1iO BUILDS OR IMPROVES 7HEREON,AND
� N?1000HTMCTSFORSUq1PR0.1ECTSMATHACONiMCTOR(S)LICENSEDPURSUAN7707HECON7RAG QUANTITY DESCRIPTION FEE �
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q C�+-
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LICENSED CONTRACTORS DECLARATION �
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I HEREBYAfFIRM UNDER PENALTY OF PEFUUM THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
d Y(CpAMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CADE,AND Z ^� /
iLi MY LICEHSE IS IN FULL FORCE AND EFFECT. m �
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� WORKERS'COMPENSATION DE LARATION j�� Q
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N I HEREBY AFFIRM UNDER PENALTY OF PE0.JURV ONE OFTHE FOLLOWING DECURATIONS:
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0 _I HAVE AND WILL AUINTAIN A CERTIFIGTE OF CONSENT 70 SELF•INSURE FOR WORKERS' 2
� COMPENSATION,AS PROVIOED BY SECTON 37ao OF THE LABOR CODE;FOR 7HE PERFORMANCE W
OF THE WORK FOR NMICH THIS PERMR IS ISSUED. �
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W _1 HAVE AND WILL MAINTNN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION /-� n
Q 37000F THE LABOR CODE,FOR hIE PERPDRMANCE OF THE WORK FOR WHICH THIS PERMIT IS �'/�7 v �
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
� CMRIER - � C 4�� PLAN REVIEW
� POLICY NUMBER Q"'V li � t� '� ELECTRIC
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Z I CERTIFV THA71N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFOHN10.�1D AGREE THA71F I SHOUID BECOME INSPECTION FEE
S SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION�700 F THE LABOR
CODE.ISH FORTMWIiHCOMPLVWITHT105EPROVI510NS. ` ISSUANCE
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WARNINO:FAILURE 70 SECUHE WORKERS'COMPENS ION COVERAGE IS UNLAWFUL,ANO SHALL BE . �
' � SU&IECTAN EMPLOYER TO CHIMINAL PENALTIES AN CIVIL FINES UP 700NE HUNDRED THOUSAND ENERGY PERMIT � �'
� DOLLARS(i10o,000),IN ADDITION TO THE COST OF C MPENSATION,DAMAGES AS PROVIDED FOR IN (�r7.�,/� - (� /y�
SECTqN 37oB OF THE LABOR CODE,IN7EREST,ANDATTORNEY'S FEES. - RETENTION FEE: `�`! r 1 1F T�I I A A����g�n � " 1��4�
d CONSTRUCTION LENDING AGENCY P -ALT�C�yE1^ BI TTT ��T�a�j��o,�Lm..
� I HEREBVAFFIRM UNDER PENALTY OF PERIUF#Y iHAT THERE IS A CONSTfiUCTION LENDING AGENCV �J V �
FOR hIE VERFORMANCE OF THE WORK FOR NM1iICH THIS PERMIT IS ISSUED(SEC.ao87,CIV.C.).
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� ICERTIFYTHATIHAVEREADTHISMPUCATIONANDSTATETHAThiEABOVEINFORMATIONISCORRECL TOTAL FEES �I�� �G" � v�/�+ � � •
w 1 AGREE TO COMPLV WITM ALL CT'AND COUNTV OR�INANCES AND S7A7E UWS REUTING TO BUILDING �^ Q� ,' �. � _/
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HI5 COUN7Y 70 ENTER UPON THE � 2�v' P'. � '
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GROUND PLUMBING UNDER FLOOR GU�IDUIT � �
SLAB GRADE FIREQLACE FOUNDATION
TEMP POWER FIREP,L'ACE B'OND BEAM
WATER SERVICE � � MID HT. BOND BEAM
ROOF SHEATHING • �•� ' ' 8 FT. BOND BEAM
FRAMIIVGNENTILIATION �0 Z6 � FINAL.BOND BEAM
R�OF COVER PRE-GRADING ' '
ROUGH HEATING d ' BENCHING• . �;- �- - - - •� •
ROUGH ELECTRIC ROUGH GRADING �
ROUGH RLUMBING b-�6- ,�:: FINISH GRADING
SHOWER/TUB TEST POOL ELE.CTRIC
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WAL�INSULATION POOL FINAL
CEIUPVG INSULATION OFF SITE IMPS.
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SEWER FINAL ENG. •
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FINAL CONST. � �. � �" � FIRE DEPT. FINAL
FINAL HEATING ' HEALTH DEPT. FINAL
FIIVAL ELECTRIC � ' � DEV. FEES PAID
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