HomeMy WebLinkAbout16785 (26) � EXPIREI]
CITY OF DIAMOND BAR�
�--� --�f� --- DEPARTIvIENT OF COMIvfUNITY&DEVELOPIvIENT SERVICES
� JUN 17 2002 1,,.-;;.
21825 E.Copley Drive
�" PRESS
(909)860-3195 Fax(909)861-3117
�'�»��� BUILDING PERMIT APPLICATION FIRMLY
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I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM 7HE CON7RAC70RS LI� G8f89B/CBfpOff
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Z 7URE,PRIOR TO ITS ISSUANCE,PLSO qEOUIRES THE APPLICANT FOR SUCH PERMI7 70 FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� w
I � CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooVSpa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
� TION.ANYVIOUTIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roaf �
A CIVIL PENALT/OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).):
Z ❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfilrtlBfClel -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEHTV NMO BUILDS OR IMPROVES THEFEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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w OFFEREDf-0RSALE.IF,HOWEVER�IEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAFiOFCAMPLE-
� TION,THE OWNEF-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
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� 70 CANS7RUCT 7HE PRQIECT(SEC.70��,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V81U2l1Of1 �f!/�O ADJ.AREA
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70RS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q " '� � �-
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� LICENSED CONTRACTORS DECLARATION W ,
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � � ` /Z
a e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PROFESSIONS CODE,AND Z � ` l/
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� � I r WO S' PENSATION DECLARATION �
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� I HEREB FFIRM UNDER PENALTV OF PERJURV ONE OF 7HE FOILOWING DECLARATIONS: Z
O �AVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' a
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CAMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE.FOR THE PERFORMANCE U
¢ 9RFHE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w _��HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
QQ 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS .
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION ��
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Z �CERTIFV THAT M THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICA�
(,�} S AlL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE
Uj OR ERS'COMPENSATION LAWS OF CALIFOFNIA,AND AGREE THA71F I SHOULD BECAME INSPECTION FEE T'u+�..�
� �1 5 THE WORKERS'COMPENSATION PROVISION OF SEC710N 370o OF 7H BOR � 1 } s
� HALLFORTHWITHCOMPLVWITHTHOS I � ISSUANCE " " ��""�
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0 DATE: O` APPLICANT: 4 SMIP ' I V
� ENERGY P/C I
J WARNING FAILUFE TO SECURE WORKERS'COMP SATION CAVERAGE IS UNLAWFUL,AND SHALL BE �
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTMOUSAND ENERGYPERMIT
OOLURS(floo,000),IN ADDITION TO7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37080FTHELABORCODE,MTEREST,ANDATTORNEV'SFEES. • j_-- _ f
RETENTION FEE: t
� CONSTRUCTION LENDING AGENCY � ' � '�
PRE-ALT FEE:
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� 1 HEREBV AFFI{iM UNDER PENALTY OF PERJURY THAT THE(iE IS A CONSTRUCTION LENDING AGENCY
� FOR 7HE PERFORMANCE OF 7HE WORK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.3097,CIV.CJ.
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� LENDER'S NAME
� LENDER'SADDRE55
� I CERTIFV THAT I HAVE FiEAD THIS APPLICATION AND STATE THAT THE ABOVE WFORMATION IS CORRECT. TOTAL F E ES '` 1
w I AGREE TO COMPLV WITH ALl GTV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEFEBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES.
Z COMMENTS
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m PERMITTEE NAME(PRIN7)
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� SIGNA7UREOFPERMITTEE DA7E I
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLOENRO File Copy,GREEN—ApplicanYs Copy
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GRf]UND PLUMBIN� � � UNDER �LC�QR C�i�3C�U11" ,
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SLAB GRAQE _ ; ___ ___ _ FIREPLACE FC)U�l�ATION �
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TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE � � MID HT. BONQ BEAM
ROOF SHEATHING "��3-d� �-- 8 FT. BONa BEAM _ � �
FRAiVIINGNENTILIATION � FINAI.BOND BEAM I
ROOF COVER i PRE-GRADING
ROUGH HEATING BENCHING I
--- -- --
ROUGH ELECTRIC ROUGH GRADING
-- --- __--------�- __ _-___..._.. _..____.._—
ROUGH PLUMBING � ; � ___�_ _FINISH GRADING
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SHOWERlTUB TEST ; POOL ELECTRIC
EXT. LATH/SIDING i � POOL FENCING , �
WALL INSULATIO�I • POOL FINAI
CEILIfVG IN�ULATION � � �FF SITE IMPS. _
DRYWALL i�AILIIVG � DEDIC,4TIOiVS �
SEWER FINAL ENG.
SEPTIC TAfVK LAhIDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS. �
GAS AIR TEST FINAL ZONING
_ ___.____�._ _ ------
FIiVAL COIVST. ' � I F1RE DEPT. FlNA;�
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FINAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC ' DEV. FEES PAID �
FIf�AL PLUMBING . ENERGY
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