HomeMy WebLinkAbout17445 (25)� CITY OF DIAMOND BAR
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'�"������ BUILDING PERMIT APPLICATION FIRMLY
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p I HEREBV AFFIRM UNDER PENAL7V OF PERIURV THAT I AM E%EMPT FROM THE CONTRAC70p5 LI� G8f8(J6/CBfpOR
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w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w I
� STATEMENT 7HA7 HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS Lb � �,
� CENSE lAW(CHAP7ER Y(CAMMENCING WITH SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSpB ��,
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A CIVIL PENALTY OF NO7 MORE 7HAN FIVE HUNDRED DOLLARS(SSoo).):
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Z WILI DO THE WOFK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ola,BUSI- J
� NE55 AND 7ROFESSIONS CODE:THE CONTRACTORS IICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGHHISORHEHOWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
w OFFEREDFORSALE�F,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE-
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Z IMPROVE FOR TFIE PURPOSE OF SALE).
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OC I HEREBV AFFIRM UNDER PENALN OF PERJURV THAT I AM LICENSED UNDER PROVISIONS Of CHAPTER � dT1,(rjf _
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� �v
w MY LICENSE IS IN FULL FOF7CE AND EFFECT. m �r Q
� LICENSECLASS/���•��+ � LZ� ���.No. 1o`iy�y j �• 7
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBV AFFIRM UNDER PENALTI OF PEfiIURY ONE OF 7HE FOLLOWING DECLARATIONS: Z
Z _I HAVEAND WILLMAINTAIN A CERTIFICATE OF CONSENTTO SELF�INSURE FOR WORNERS' _
¢ CAMPENSA710N,AS PROVIDED BY SECTION 370a OFTHE UBOR CODE,FOR THE PERFORMANCE `U
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 370o OF THE LABOR CADE,FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS FERMIT IS
ISSUED.MV MtlOyR.K_ERS'CAMPENSATION INSUrRANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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Z POLICV NUMBER 9��—Ol �� y S ELECTRIC
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Z I CEFTIFY THAT IN THE PEFiFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
U' SMALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE I ��,'�'1 A 7 n(1'1 I
� WORKERS'COMPENSATION�AWS OF CALIFOFNIA,AND AGREE TMAT IF I SHOULD BECOME INSPECTION FEE __�`T�
= SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR I , T-i7T� I -
CODE,I SHALL FORTHWITH COMPLY WITIi THOSE PROVISIONS. �SSUANCE .
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1p DATE:_�� APPLICANT: � __ 1���� , ,
J � ENERGY P/C b�-�:_'---.____ _
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION CAV AGE IS UNLAWFUL,AND SHALL BE
� SU&IECTAN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP 700NE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
¢ SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � ~�
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THATTHERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERf-0RMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.7087,CIV.C.�.
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� LENDER'S NAME
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W I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA L F E ES � �O
� I AGREE TO COMPLV WITH ALL GTV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTA7IVES OF THIS COUN7V 70 ENTER UPON THE
Z ABOVE-MENTIONED PROPEHTV FOR INSPECTION PURPOSES. COMMENTS
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GROUND PLUMBING ; UNDER FLOOR C:U�!DUIT ; -----------
SLAB GRADE � � ..... ___._.__ FIREPLACE FOUNDATION__ i _
TEMP POWER ( _ �. FIREPLACE BO�1D B�AM __ __ ___
WATER SERVICE _.__ I _._ ____; ��D HT. BC�ND_BEAM
-- ----__..____ _.....
ROOF SHEATHING +8 Ff. BOND BEAM i
FRAMINGNENTILIATION _____ � FINAL BOND BEAM
__ ----;---- -_ __._.- ----.....------- - ................--.
ROOF COVER � ' PRE-GRAUING
ROUGH HEATING _ BENCHIN� ___� _ �___ _
ROUGH ELECTRIC ROUGH GRADING
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ROUGH P�UMBING `; i FINISH GRADING
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SHOWER/TUB TEST ' POOL ELECTRiC
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CEILING IfV�ULATIOIV ; OFF SITE IMPS.
DRYWALL NAIUNG _ ----- D-� ED�CATIONS - - ---------- --
SEWER FIt�AL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. �N SITE IMPS.
GAS AIR TEST FINAL ZONING �
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATIfVG I HEALTH DEPT. FINAL
FINA�ELEGTRIC � � DEV. FEES PAID
FINAL PLUMBIMG � j ; ENERGY _
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