HomeMy WebLinkAbout17967 CITY OF DIAMOND BAR ��
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
'�'�»��� BUILDING PERMIT APPLICATION FIRMLY
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I HEREBV AFFIRM UNDER PENALTV OF PEPJURV THA7 I AM E%EMP7 FROM THE CONTRACTORS LI� G8f290/C8fF10A
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� �
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINE55 AND PRO- POOVSpB
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7HEBASISFORTHEALLEGEDE%EMP- (�
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� A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
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WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J
N NESS AND PROFESSIONS CADE:7HE CON7RAC70RS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
GROPERTV WHO BUILDS OR IM7ROVES THEREON,AND WHO DOES SUCH WOFK HIMSELF OR HERSELF OR
� THROUGHHISORHEROWNEMPLOYEES,PROVIDED7HATSUCHIMPROVEMENTSARENOTIN7ENDEDOR m
� OFFEREDFORSALE.IF,HOWEVER,hIEBUILDiNGORIMPROVEMENTIS50lDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE 7HE eURDEN OF PROVING 7HA7 HE OR SHE DID NOT BUILD OR
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w ❑I,AS OWNEROFTHE PROPEPTY,AM EXCLUSNELV CON7RAC71NG WI7H UCENSED CANTRAC70R5
� TO CANSTtiUCT THE PR0.1EC7(SEC.70��,BUSINE55 AND PROFESSIONS CODE:THE CON7RACTORS LI� VelU2�lOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN OMMER OFA PROPERTV WHO BUILDS OH IMPROVES 7HEREON,AND
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� ❑I AM EXEMPT UNDEfi SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLAAATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�X MY LICENSE IS IN FULL FORCE AND EFFEC7. m
� IICENSE CLASS C�� LIC.NO. ��C F M� Y �
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� WORKERS'COMPENSATION DECLARATION ¢
NI HEREBY AFFIRM UNDER PENALTV OF PE0.IURV ONE OF THE FOLLOWING DECLARATIONS: Z ,,
�Z _INAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' a
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CAMPENSATION,AS PROVIDED BV SECTION 370o Of THE 1A80R CODE,FOR THE PERFORMANCE w
Q � OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � ",
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I HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE.AS RE�UIRED BV SECTION
Q 370o OF 7HE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 I �Il J t�
ISSUED.MY WOR-K/ERS'COMPENSATION INSURAN CARNIEF AND PO!LIC`Y NUMBER ARE: CONSTRUCTION ��
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� (iHISSECTIONNE�NOTBECOMPLEfEDOfhIEPEWMISFORCNEHUI�DREDDOlLNLS(f100)ORLESS). PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�J SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ii
� SUBJECTTOTHEWORNERS'COMPENSATIONPROVISIONSOFSECTION37000FTHEUBOR '�'�T �
, � CODE ALL ORTHWITHCOMPLVWITHTHOSEPROVISIONS. - ISSUANCE �( 1J
p DATE: S � V APPLICANT: SMIP . �i�
J WARNING FAILURE TO SECURE WORKERS'CAMPENSATI VERAGE IS FUL,ANO SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESlW�CIVILFINESUPT NE NDREDTHOUSAND ENERGYPERMIT
DOILARS(floo.oao�.INADDITIONTOTHECOSTOFCOMPENSATION, MA ASPROVIDEDFORIN
� SECTION37080FTHELABORCODE,INTEREST,ANDATfORNEY'SFE RETENTIONFEE:
d CONSTiiUCTION LENDING AGENCV PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENDINCa AGENCY
FOR THE PERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
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� LENDER'S NAME
F— LENDER'SADDFESS
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES `
w I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINAIJCES AND STATE UWS RELATING TO BUILDING (
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPER7Y FOR INSPECTION PURPOSES.
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SLAB GRADE , �_- ---.- __�_� FIREPLAGE_FOUNpATlON
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TEMP POWER � ___'t `_�IREPLACE BOND BEAM '
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WATER SERVICE ' . � MIQ HT. BOND BEAM •
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ROOF SHEATHING �/��_ ' ' . BOND BEAM — --------_� -'.-----
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ROOF COVER ,�_�,� 1 PRE-GRADING ! _ _
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ROUGH ELECTRIC __ ROUGH GRADING ____ ___
ROUGH PLU(VIBING ': FINISH GRADING
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SHOWER/TUB TEST � POOL ELECTRIC
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EXT. LATH/SIDING ; ; POOL FENC{NG �.
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CEILING IN�ULATION � ' QFF SITE IMPS.
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DRYWAL�NAILIiVG ( __ j DEDICATIONS �` _ _
SEWER �INAL ENG. �
SEPTIC TANK LA�lDSCAPE/IRRIG. ;
SEEP PITlL.L. ' ON SITE IMPS.
GAS AIR TEST ! FINAL ZOiVING '
FINAL CONST. ; �!RE DEPT. FIIVA!_
FINAL HEATING : HEALTH DEPT. FINAL
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FINAL ELECTRIC ; j DEV. FEES PAID _�
FINAL PLUMQIfVG ' ` � �����Y i
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