HomeMy WebLinkAbout17721 (42) CTI'1'OF DIAMOND BAR
^----��-- DEPARTMENT OF COIvIIvIUNITY&DEVELOPMENT SERVICES I
21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
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w TURE.PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FI�E A SIONED w Patlo/�eck
� STATEMENT hiAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI�
�, CENSE UW(CHAPTER B(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa
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TION.ANV VIOLATqN OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CML PENALTV OF NOT AqRE THMI FNE HUNDRED DOLLARS(f500).):
� ❑I.ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COffIrtlBfCldl �
Z WILL DO 7HE WORK,AND THE STRUCTUFE IS NOT INTENDED OH OFFERED FOR SAIE(SEC.7041,BU51� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPEfin'WFp BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOFK HIMSELF OF HERSELF OR
CC THROUGH HIS OR HER ONTJ EM7LOVEES,PROVIDED THAT SUCH IMPFOVEMENTS ARE NOT INTENDED OR m ,
Q OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSqDWI7HINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BUR�EN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IAIPROVE FOR THE PURPOSE OF SAIE).
w ❑I,ASOWNEROFTHEPROPERTV,AAIE%CWSIVELVCANTRACTINaWfTHLICENSEDCONTMCTORS
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W CENSE UW DOES NOT MPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
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Y TORS LICENSE LAW.).
0 O I AA1 EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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LL DATE OWNER ¢
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIHAI UNOER PENALTV OF PE0.IURY hIAT I AM LICENSED UNDER PROVISIONS OF CHAFTER �
� Y(COMMENCINO WITH SECTION 700o)OF DNISION 3 OF THE BUSINE55 AND PROFESSIONS CqDE,AND Z
��� MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. �' � � .
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� ORKEFS'COMPENSATION DECLARATION � Q
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� I HEREBV AFFIRM UNDER PENPLTV OF PERJURV ONE OF THE FOLLOWINO OE0.ARATIONS. Z
� �I HAVE/V!D WILL A/AINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOF WORKERS' _
Q ��COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR COOE,FOR THE PERFORMANCE U
OFTME WORK FOR WHICH THIS PERMIT IS ISSUED. w
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION �� ' �
Q 37000FTHE LABOR CADE.FORTHE PERFORMANCE OFhIE WORK FOR WHICH 7HI5 PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION '
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� CARRIER ��T��C.�I lJ{7 PLAN REVIEW
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Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE MlORK FOR WHICM THIS PERMIT IS ISSUEO,I MECHANICAL
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAOREETHATIFISHWLDBECAME INSPECTIONFEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTqN 3700 0F THE LABOR _
C006.�SHALL FORTHWIhI COMPLV WI7H THyOSE PROVISIONS. ISSUANCE
W v' \ �' ` �
DATE:�_i��l'1�APPLICANT. /�L� SMIP
� � � ENERGY P/C
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� SU&IECT EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES U7 TOONE HUNDRED THOUSAND ENERGY PERMIT
DOILAAS(f 700,000).IN ADDITION TO THE COST OF COMPENSATKKJ,DAMAGES AS PROVIDED FOR IN
J SECTION 3�OB OF THE IABOF CODE,IN7ERE5T,AND ATTORNEI"S FEES.
w RETENTION FEE: �
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AOENCV
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.JOB7,CIV.C.�.
Z
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� LENDER'S NAME
� LENDER'SADDRESS (
w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATET1iATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ��j '/ /_ O� {
� I AQREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING �a�r [.r�r� 1 � � �
� CANSTRUCTION,AND HEREBV AUTFIORRE REPflESENTATIVES OF THIS COUNTV TO ENTER UPON THE �� � ��
Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
� -T,A-Y �('i►,�;�
m PERMIITE NAME
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_ � RECPT.NO. _ PAID BY ..i vai inaTinti
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD--File Co GREEN—A licent's Co
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TEh/IP POWER FIREPLACE BOND BEAM
WATER SERVICE MIQ HT. BOND BEAM �
ROOF SHEATHING ��`d1� ` 8 F7 BOND BEA_M, , '
FRAMINGNEfVTILIATION � FINAL BOfVD BEAM
ROOF COVER ����� ,3� �PRE-GRADING
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ROUGH ELECTRiC R�UGH GRA�ING
ROUGH PLUMBING FINISH GRADING
SNOWER/TUB TEST POOL ELECTRIC
EXT. LATHJSIDlNG POOL FENCING
WALL INSULATIOfJ POOL FINAL
CEILING IN�ULATION OFF SITE IMPS.
pRYWALL NAILING DEDlCATIONS
SEWER FINAL ENG.
SEPTIC TANK ' LANDSCAPE/IRRIG.
SEEP PIT/L.L. �" ' ON SITE IMPS.
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FINAL ELECTRIC DEV. FEES PAID
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