HomeMy WebLinkAbout13378 CITY OF DIAMOND BAR �F
---��'�— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 �RESS
� ��A^' BUII,DING PERMIT APPLICATION FIRMLY
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ISSUE S� 3 ,. L�'Q ONST. GROUP
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W CENSEUWFORTHEFOILONJINOREASON�SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOH (n
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�L TUqE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w�
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO hIE PROVISIONS OF 7HE COMMCTORS LI� ,
� CENSE UW(CHAPTER Y(COMMENCINO Wlhi SECTION 7000)OF DIVISION]OF TME BUS�NESS AND PRO- � PooVSpa I
FESSIONS CODE)OR THAT HE OR SHE IS El(EMPT THEREFROM AND THE BASIS FOR THE ALLE6ED EXEMP•
TION.ANYVIOLATIOHOFSECTION70.71.58YANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICNfTTO Z Re-Roof
� A CML PENALiY OF NOT MORE THAN FNE HUNDRED DOLURS(t500).):
� ❑I,ASOMMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial -
NALL DO THE WORK AND THE STRUCNRE IS NOT INiENUEO OR OFFERED FOR SALE(SEC.70�4,BUSI- J
NESS AND PiqFESSIONS CODE:THE CONTMC70R5 LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PROPEHfYWNOBURDSORIMPROVE5TIEHEON,ANDNM1IODOE55UCHWORKHIMSELFORHERSELFOR �
Q iHROUGH HIS Oq HER ONTI EMPLOVEES,PfiOVIDED THAT SUCH IMPROVEMENTSAHE NOT INTENDED OH m
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Z �TqN,THE OWNER-0UILDER WILL HAVE THE BURDEN OF PROVINU THAT HE OR SHE DID NOT BUILD OR �I
= IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS ONMER OF THE PROPEfRV,AM EXCLUSIVELY CONTMCTING WfTH LICENSED CONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.10u,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8l1Of1 ADJ.AREA �
W �CENSE LAW DOES NOTMPLYTO AN ON?lER OF A PROPER7V WHO BUILDS OR IMPROVES THEHEON,AND �
� WNOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUAHTTOTHECOHTRAG QUANTITY DESCRIPTION FEE .
� 70RSL10ENSEUW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON U
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�Q LICENSED CONTRACTORS DECLARATION W - ' -".':�
[L I HEREBY AFFIRM UNUER PENALTY OF PERIURY THAT I AM LICENSED UNDEH PROVISIONS OF CHAPTER � .
a, 0(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
"� MY LICENSE IS IN NLL FORCE AND EFFECT. m
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� WORKERS'COMPENSATION DECLARATION � °�TiT]�:`�iTCi r'11��-`' �.�rL ,a
� I HEREBY AFFIRM UNDER PEN/�17V OF PER1UfiY ONE OF TiE FOLLAWING DECLARA710N5:
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� _I HAVE AND WILL MAINTAIN A CEHfIFlCATE OF CONSENT TO SELF-INSURE FOR WORKERS' S
COMPENSATION,AS PROVIDED BY SECTION 37000F 7HE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR NMICH iH�S PERMIT IS ISSUED. �
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W I HAVE AND VALL MAIMAIN WORKERS'COMPENSATION INSURANCE.AS REOUIHED BY SECTION
Q 9700 OF THE LABOR CODE,FOH THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS /
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jc�RpiEp PLAN REVIEW �
� POLICY NUMBER ELECTRIC
0 (fF055E(,'IIONNE�NOTBE00M'IETmOF71fPERAffiSFORONEFIR�DREDDOLLARS(L100)ORLESS� PLUMBING
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Z I CERTIFV THAT IN THE PEHFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
(J SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECAME SU&lEC7 TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNII�AND AGREE THAT IF I SHWLD BECOME INSPECTION FEE
S SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHEL�BOR /��
CODE,I SHALL FOftfHW17H COMPLV W17H THOSE PROVISIONS. ISSUANCE �L�✓"'
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p DATE: APPLICANT. . .
� ENERGY P/C
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL.AND SHALL BE
LL SUBJECTMI EMPLOVER TO CHIMINAL PENALTIES AND CIVIL FINES UP 700NE HUNDRED THOUSAND ENERGY PERMIT
DOIURS(f100,OW),IN ADD�TION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
¢ SECTqN 37oB OF THE UBOR CODE,INTEREST.AND ATTORNEY'S FEES. � RETENTION FEE: ���
a CONSTRUCTION IENDING AGENCY PHE- FEE:
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� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT TIERE IS A CANSTRUCTION LENDING AGENCV
n- FOR THE PERFORMANCE OF THE WORK FOR NMICH 7HIS PEFMIT IS ISSUED(SEC.3087,CIV.CJ. � '�,
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LENDER'S NAME �
F- LENDER'SADDRESS
W I CERTIF/THAT 1 HAVE READ THIS MPLICA710N AND STATE THA77HE ABOVE INFORMATION IS CORRECT. TOTAL FE ES
� I AGREE TO COMPIY WITH ALL CT'M1D COUNTY OfiDINANCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBV AU7FIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE .
Z ABOVE-MEMIONED PROPERT'FOR INSPECT RPOSES. COMMENTS
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� SIONATURE OF PE DATE '
� RECPT.NO. O PAID BY ' VALIDATIO
WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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FTGS/FORMS/STEEL 4•,� .,• , FHA REQMTS` �
ELECTRIC GROUND ` UNDER FLOOR DUCT �, : ._�, � ,-, :_ ._,,: .. •„�'t .
GROUND PLUMBING UNDER FLOOR C�R�IbUI•'lJ r����=F�-r;�, 'r':�� .:`
SLAB GRADE FIREPLACE FOUNDATION - .�• ��.. ^ ,. � ' y '-'`�`'��`�-`�� �
TEMP POWER FIREPLACE BOND BEAM " � � �'� � M
WATER SERVICE MID HT. BOND BEAM
ROCOF SI�EATN{j�tC3;` .'�,. . 1.�, ; ` ._ -,•! 8 FT. BOND BEAM
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FRAMINGNENTILIATION. � � � FINAL BOND„�EAM.., ,�._ ...., �,,, , , , ,,,,,, , �
ROOFCOVER �� PRE-GR�D{NG` � :.:i � -, �-,'�,.,:, � � ��� �
ROUGH HEATING - BEN HG�IU'•��=;.��. ;; � ,:��t; � �� -•,i .�,'��,.��_H.•.
ROUGH ELEGTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER�fUB TEST POOL ELECTRIC
EXI: 11�TH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. '
SEPTIC TANK _ ,., , LANDSCAPE/IRRIG.
SEEP PIT/L..L. �� '•' �� � ON SITE IMPS.
GAS AIR TEST - FINAL ZONING
FINAL CONST. p _�aa FIRE DEPT. FINAL
FINAL HEATIMG HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY.
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