HomeMy WebLinkAbout13376 �� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117 �RESS
���������W BUILDING PERMIT APPLICATION � FIRMLY
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Z TURE,PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- W
�. CENSE UW(CHAPTER D(COMMENCINO 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 ALLEOED EXEMP-
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� ACML PENALiY OF fqT MORE TWW FNE HUNORED DOLLARS(l5a0).j:
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� MALL DO THE WORK AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70l1,BUSI- J
NE55 AND 7ROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NO7 APPLY TO AN OWNER OF
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Z �`TION,THE OWNER$URDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR
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❑I,AS OWNER OF iHE PROPEHfY,AM E%CLUSIVELV CONTRACTING WITH LICENSED CONTMCTORS
� TO CONSTRUCT THE PRQIECT(SEC.7oM,BUSINESS AND PROFESSIOHS CODE:THE CONTRACTORS LI- V81U8f1Of1 ADJ.AREA
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� I HEREBYAFFIRM UNDER PENQTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � x 1.��,;,� .
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� IHAVEANDWILLMAINTAINACEfiTIFICATEOFCONSENT705ELF-INSUREFORWORKERS' 2
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OF THE WORK FOR NMIGi THIS PERMIT IS ISSUED. �
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W I HAVE AND WILL MAIMAIN WORI(EHS'COMPENSATION INSUfUNCE,AS REQUIHED BY SECTION ' � I
Q J7oo OF THE LABOR CODE,FOR THE PERFDRMMICE OF THE WORK f-0H WHICH 7HI5 PERMIT IS , c 1 O
�SSUED.MY M10RKER5'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� POLICYNUMBER ELECTRIC
� (fH6SECTIONNE�NOT8E0p.�LEfIDOF71#PEPMfSFORONEF0.X�DREDDOLLMS1Si0o)ORLESS) PLUMBING .
Z 1 CERTIFY THAT IN THE PERFORMANCE OF iHE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL ��
(,�} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECAME SU&IECT 707HE
N WORKERS'COMPENSATION UWS OF CALIFOFiNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SU&IECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF 7HE LABOR �5�.�n
COOE.1 SHALL FORTHWITi COMPLV Wlhl THOSE PROVISIONS. ISSUANCE t�' /y
p DATE: APPLICANT: SMIP I ��1 lJ
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J WARNINO:FAILURE 70 SECURE WORKERS'COMPENSATION CAVEHAGE IS UNLAWFUL,AND SHALL BE
� SU&IECT AN EMPLOVER TO CRIMINAI.PENAL7�ES AN�CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5700.000).IN ADDITION TO THE COST Of COMPENSATION,DAMAGES AS PROVIDED FOR IN �.
J SECTION 37oe OF hIE UBOR CODE,INTEREST,AND ATfORNEY'S FEES. RETENTION FEE: �� CG O
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a CONSTRUCTION LENDING AGENCY PFJ��ALT FEE:n
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� I HEREBV AFFIRM UNDER PENAL7V OF PERIURV THAT THEHE IS ACONSTRUCTION LENDING AGENCY -Y � � .Y
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME � n� / L
F– LENDER'SADDRESS
� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES
W I AGREE 70 COMPLV WITH ALL CRY M1D COUN7V ORDINANCES AND STA7E UWS REUTING 70 BUILDING
� COHSTRUC71qJ,AND HEREBV AU7FIORIZE REPRESEN7A71VE5 OF THIS COUN7V TO EMER UPON 7HE �
Z /�BOVE-MEMIONED VROPERTV FOR INSPECTION PURPOSES. COMMENTS �
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� RECPT.NO. � PAID BY VALIDATION
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TEMP POWER FIRE�LAC�BC3�fI�B�AM`"' ':'�,` `Y'. � - . . ,, .._
WATER SERVICE. MID HT. BOND BEAM
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FRAMINGNENTILIATION � � � FINAL BOND-B�,M .. ...,,- � . ,: , ,,:y , -•••
ROOF COVER � , � PRE-GRAC�f{JG,.�;i`�..�..r��+�_,,�� �i...,�_y!',_� 4�' .
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ROUGH PLUIVIBING FINISH GRADING
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EXT. LATH/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. � `1 t�" a ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. p FIRE DEPT. FINAL
FINAL HEATWG HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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