HomeMy WebLinkAbout16827 (25) CTI'Y OF DIAMOND BAR
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21825 E.Copley Drive
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''%���' BUILDING PERMIT APPLICATION FIRMLY
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W TURE.PRIOR TO ITS ISSUANCE,AL50 REQUIHES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO 7HE PROVISIONS OF THE CONTRAC70R5 LI�
� CENSE LAW(CHAP7ER e(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSp2
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V TION.ANVVIOLATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roaf .
A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(5500).):
❑I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W I7H WAGES AS 7HEIR SOLE CAMPENSA710N,
Z WILL DO THE WORK,AND THE STRUCTURE IS NO71N7ENDED OR OFFERED FOR SALE(SEC.701�,BUSI� � COrt1rtIBfCi81 -
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO 3UILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELFOR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPFOVEMEN7S ARE NOT INTENDED OR m
w OFFEREDFORSALE.IF,HOWEVER,TiEBUILDINGORIMPROVEMEN7ISSOLDWITHINONEYEAROFCOMPLE-
0 TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OH SHE DID NOT BUILD OR
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� TO CANSTHUC77HE PRQIECT(SEC.70�a,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- VelllB�iOf1 ADJ.AREA
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON J
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2 I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED 11NDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS AND PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIfiM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT 70 SELF�INSURE FOR WORKERS' a
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Q COMPENSATION,ASPROVIDEDBVSECTION37000FTHELABORCO�E,FORTHEPERFORMANCE w
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
Q 3700 0F THE LAeOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7IS
ISSUED.MV WO S'COM�S ON'�CE CARFIER AND POLICV NUMBER ARE: CONSTRUCTION /
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL
(,'} SHAIL NOT EMPIOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THA71F I SHOULD BECOME �NSPECTION FEE
SU&IECTTOTHEWORKERS'CAMPENSATION ROVISION OFSECTION37000FTHELABOR
� CA�E I SH`ALL RTHWITH COMPLY WITH T SE PROVI�ONS. ISSUANCE 1
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p DATE:� Y/ APPLICANT: ,
J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJEC7ANEMPLOYERTOCRIMINA�PENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �
DOLURS(5100.000),IN ADDITION TO 7HE COS7 OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SEC710N 3708 OF THE LABOR CADE,INTEREST,AND ATTOFiNEY'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBVAFFIRM UNDER PENALTV OF PERJURY THAT7HERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERF-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ. .
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� LENDER'S NAME
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� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w 1 AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOV�NTIONED P PERTV FOR INSPECTION PURPOSES.
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� SIGNATUREOFPERMITTEE DATE
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GROUND PLUMBWG � UNDER FLOOR CUf�IQUIT i ___
SLABGRADE _ FIREPLACEFOUNDATION :____
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TEMP POWER � FIREPLACE BOND BEAhA ---- � ---- --
WATER SERVICE i MID HT. BOND BEAM _ _ _
ROOF SHEATHIfVG 8 FT B�ND BEAM
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FRAMIRlGNENTILIATION FINAL BQND �EAM ___ ___ _ � _ ______
ROOF COVER PRE-GRADING ;
ROUGH HEATING BENGHIfVG I _____
ROUGH ELECTRIC __ ROUGH GRADING _�_ ___
R�UGH PLUMBING _ � FINISH GRADING _ _ ___ _
SHOWER/TUB TEST � � POO� ELEGTRIC
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EXT. LATHJSIDING , POOL FENCING
WALL IiVSULATION POOL FINAL
CE{LING IN�ULATION i OFF SITE IMPS.
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DRYWALL NAILI�IG DEDICATIONS
SEWER FINAL ENG. I
SEPTIC TANK LANDSCAPElIRRIG. i
SEEP PITlL.I. ON SITE IMPS.
GAS AIR TEST FINAL ZOh11NG
FINAL COiVST. �IRE DEPT. FINA`
F�NAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
FIPVAL PLUMBING ENERGY
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CONiNiENTS
SEPTIC T/�1i�K SIZE
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