HomeMy WebLinkAbout17178 (25) CITY OF DIAMOND BAR
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ADDRESS • DATE I ' �� v NUMBER 1�I� #
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APN LOT TRACT DATE CONST. GROUP
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� GefeJO/C3fPOR
W CENSE LAW FOH THE FOLLOWING fiEA50N(SEC.7o31.5 BUSINE55 AND PROFESSIONS CADE:ANY CITYOR (n
U COUNT'NMICHREOUIflESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG
w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PEFMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CANTRACTORS LI-
� CENSE LAW(CHAPTER B(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSIONSCODE)OfiTHATHEORSHEISE%EMPTTHEPEFROMANDTHEBASISFORTHEALLEGEDEXEMP-. (�
� TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(SSao).):
ZOI,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, � Commercial -
WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a41,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPER7V NM1iO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDFORSALE.IFHOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPIE-
Z TION,THE OWNER�BUILDEFi WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR .
� IMPROVE FOR THE PURPOSE OF SALE). .
w ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVEIY CON7RACTING WI7H LICENSED CONTRACTORS �
� TO CANSTRUCT THE PR0.IECT(SEC.7011,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS ll- V8Il18llOf1 ADJ.AREA
W CENSE UW DOES NOT APPLY TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� WHOCONTRACTSFOPSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.�.
� ❑I AM ExEMP7 UNDER SEC. B.6 P.C.FOR THIS REASON Q
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DATE OWNEFl �
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� LICENSED CONTRACTORS DECLARATION W
� I HEHEBY AFFIRM UNDER PENALTY OF PERJURV THA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
. d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY UCENSE IS IN FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIFM UNDER PENAL7V OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
0 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' _
¢ CAMPENSATION,AS PROVIDED BY SEC710N 370o OF 7HE IABOR CODE,FOR THE PERFORMANCE `U
_/OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED. �
w � 1 HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION �,l
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PEHMI7IS �, J'�J
ISSUED.MY WOR/K�ERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION �/
� CAHRIER L�'iJ�Q.��1�'( ' (�v��'� n pLAN REVIEW
ZPOLICYNUMBER �A'LC'I ��O 2- -l�� ELECTRIC
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(iHISSEC1qNNEmNOTBEC�OMPLEfEDOFTHEPERMlrISFORONEFNI�DREDDOLLMS(f100)ORLESS} PLUMBING /� - ' � �
Z I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715ISSUE�.I MECHANICAL I��j//-\� � I I �„�
(.�} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE I
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUL�BECOME INSPECT�ON FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR l
� C DE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE I i I � �=�.l
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DATE: �— I—�U�PPLICANT: SMIP
w ENERGY P/C Ir,�r. �� I
WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ���)� ,
� SU&IECTANEMPLOVERTOCRIMINALPENAL7IESANDCIVILFINESUPTOONEHUNDRED7HOU5AND ��� �--`��'-'-
DOLURS(5100,000),IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN ENERGY PERMIT
J SEC710N37o80FTHELABORCODE,INTERE57,ANDATTORNEV'SFEES. RETENTIONFEE:
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a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEHEBV AFFIflM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERF-0RMANCE OF 7HE WORK FOR WHICH 7HI5 PERMI715 ISSUED(SEC.3097,CIV.C.). -
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� LENDER'S NAME
F= LENDER'SADORESS I I �� �
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COFiRECT. TOTAL FE ES
w I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEN7A71VE5 OF THIS COUNTY TO ENTER UPON 7HE
ZABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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Vj SIGNA7UREOFPER TTE DA7E �
= RECPT.NO. PAID BY VALIDATION
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GRCJUND PLUMBING __ V ___._ � UhlDER FLOOR CU�IDl�9T ____l,
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SLABGRADE � FIREPLACEFOUNDATION_ _
TEMP POWER � FIREPLACE BOND BE,4M __ _^ ____
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WATER SERVIGE __ I ____ ___._.i _MIQ HT. BOND BEAM �
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ROOF SHEATHING � _ 8 h7. BOND BEAM __ ___
FRAMINGNENTILIATION FINA�BOND BEAM �
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ROOF COVER � PRE-GRADING �
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ROUGH HEATING BENCHING
ROUGH ELECTRIC RQUGH GRADING
ROUGH PLUMBING � � FINiSH uRADING
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SHOWER/TUB TEST � i POC�L ELECT�IC
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CEILING IN�ULATION I ' OFF SITE IMPS. -�-- �� -�---
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DRYWALL PVAILIIVG � DEDICATIONS
SEWER FINAL ENG.
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FINAL E�ECTRIC i DEV. FEES PAID -
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