HomeMy WebLinkAbout16936 (25) C1TY OF DIAMOND BAR �1(P���p
�-- --J�� --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive JUN 19 2002
(909)860-3195 Fax(909)861-3117 PRESS
'`%���� BUILDING PERMIT APPLICATION F9RMLY
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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p I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gefe90/CBfPOR
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70R5 LI-
� CENSE UW(CHAPTER 0(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSP2
FESSIONS CADE)OR THAT HE OR SHE IS E%EMPT THEREFROM AN�THE BASIS FOR THE ALLEGED E%EMP- (�
� TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICAN7 FOR A PERMIT SU&IECTS THE APPLICAN7 70 Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(1500)J:
� Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 Commercial � –
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70da,BUSI- J
� NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO 9UIL�5 OR IMPiiOVES THEREON,AND NhiO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOfl m
w OFFEREDFORSALE.IF,HOWEVER,hiEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROfCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE�.
_ ❑I,AS OWNEROFTHE PHOPERTY,AM EXCLUSIVELV CONTRACTING WITH UCENSED CONTRACTORS
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� TO CONSTRUCT THE PRQIECT(SEC.7041,BUSINESS AND PROFESSIONS CO�E:THE CONTRACTORS LI- V8IU3llOf1 ADJ.AREA
� W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7HEREON,AND
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� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PERJUPV THAT I AM LICENSED UNDER PROVISIONS Of CHAPTER �
d 6(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND z '
`X AIV LICENSE IS IN FULL FORCE AND EFFECT. m
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� WORKERS'COMPENSATION DECLARATION �
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. � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLAHATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' _
Z COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE UBOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOfl WHICH THIS PERMIT IS ISSUED. �
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w _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION
Q 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS
ISSUED.MV W��N¢J�TION IN�ANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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� (MISSEG�qNNEmNOTBE00MREfEDOFTHEPERMf�ISFORONEHUI�DREDD011M5(5100)ORlESS). PLUMBING
Z I CEFiTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL_ . .-----�-�-u��'�-
�} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE �7 ` I � �F �
� WORKERS'COMVENSATION LAWS OF CALIFOHNIA, D AGREE THAT IF I SHOULD BECOME INSPECTION FE1E� /��\J- ' "
SU&IECT 70 THE WORKERS'COMPENSATION P ONS OF SEC710N 370o OF THE LABOR ��1\
� ISH I,FORTHWITHCOMPLVWITHT OV I ISSUANCE � `��
� ,`� SMIP AUG 1 �Z�_.
� p DATE: �l APPLICANT:
J WARNING:FAILURE TO SECURE WORKEHS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IEC7 AN EMPLOYER 70 CRIMINAL PENAL71E5 AND CIVIL FINES UP 70 ONE HUNDRED 7HOUSAND ENERGY PERMIT �
DOLURS(f1ao,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN `r'�� �!,".,__- „
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION Et:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIFM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDIN�AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFiMIT IS ISSUED(SEC.30Y7,CIV.C.).
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� LENDER'S NAME
F- LENDER'SADDRESS
� � I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INfORMATION IS CARRECT. TOTAL FE ES ///��.�
� I AGREE TO COMPLV WITH ALL qTV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING �Y
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z ABOVE� NTIONED PROPEFTV FOfl INSPECTION P arosEs. COMMENTS
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aGERMIT7E (PRINT �- 3 0/
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� SIGNAT REO P HMITTEE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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ELECTRIC GROUND � ' i UNDER FLOOR DUCT
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GR�UiVD PLUMBING ______ ; UiVDER FLOOR CUf�IDUIT �_ ;
SLAB GRADE FIREPLACE FC�CJNDATit�N --_._.__...-.---.-.---.
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TEMP POWER FIREPLACE BOND BEA(��I
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WATER SERVICE__ __� ; �_____._ __ __' MID HT. BOND BEAM
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ROOF SHEATHIiVG � 8 FT. BOND BEXM i
FRAMIRlGNENTILIATION 'FINAL BOPJD BEAM i
ROOF COVER � PRE-GF3ADING
ROUGH HE,4TING BENCHiNG ��� ��A� ----___
ROUGH ELECTRIC ROUGH GRADING
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R�UGH PLUMBING ! FINISH GRADlNG
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SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATH/SIDING � � � POOL FENCING
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WALL INSULATION ! POOL�(NAL I
CEI�Ii�G IN�ULATION ; OFF SlTE IMPS.
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DRYWALL NAILING � DEDICATIO�IS
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SEWER FINAL ENG. I
SEPTIC TANK LAPJDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITF_ iMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FINAL
FINAL HEATiNG I � HEAL7N DEPT. FINAL �
FINAL ELECTRIC I � DEV. FEES PAID
FINAL PLUMBING ; ENERGY
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