HomeMy WebLinkAbout11-1187 ��_ CITY OF DIAMOND BAR
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, � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'��'f BUILDING PERMIT APPLICATION FIRMLY
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W TURE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE CAN7FiAC70R5 LI- �
CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSPB
, � FESSIONS CADE)OR THAT HE OR SHE IS EXEMPT THEfiEFROM AND THE BASIS FOR THE ALLEGED EXEMP� (�
V TION.ANV VIOUTION OF SECTION 7071.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICAN7 TO Z Re-Rool
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f50o)J:
� Z ❑I,ASOWNEROPTHEPROPER7V,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COrtIrtl8fCi01
WILL DO 7HE WORK,AND THE STRUCTUHE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.7a�1,BUSI- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT AGPLV TO AN OWNER OF �
PROPERTV VhlO BUIlD50fi IMPROVES 7HEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSELF Oq
� THqOUGH HIS OR HER OWN EM7LOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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, L11 CENSE UW DOES NOTAPPLV TO AN OMMER OF A PHOPERTV WHO BUILDS OR IMPHOVES THEREON,AND I
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� ❑I AM EXEMFT UNDER SEC. B.8 P,C.FOR THIS REASON Q
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— DATE OWNER H
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� LICENSED CONTRACTORS DECIARATION W
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
MY LICENSE IS IN FULL FORCE A D EFFECT.
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� WORKERS'COMPENSATION DECLARATION Q
� IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOF7HEFOLLOWINGDECLARATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WONKERS' a
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Q COMPENSATION,ASPROVIDEDBVSECTION37000FTMELABORCODE,FORTHEPEfiWRMANCE U
Q OF 7HE WORK FOF WHICH THIS VERMIT IS ISSUED. �
w .�I HAVE AND WIIL MAINTAIN WORKERS'COMPENSA710N INSURAN AS REOUIRED BY SEC710N
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WO FOR WHICH THIS PERMIT IS �� �. � /�}
ISSUED.MV WORKERS'COM N TION INSURAN RIER AN LICY NUMBERARE: CONSTRUCTION Cl
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� (fHISSECfqNNE�NOTBE00MP1.EfEDOFhIEPERMfTISFORONEFNrDREDDOLLAKS(E100) PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THI P MIT SSUED.I MECHANICAL
(3 SHA�L NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOM SU TO THE
Uj WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHAT I ULDBECOME INSPECTIONFEE
= SU&IECT TO THE WORNERS'CAMPENSATION PROVISIONS OF SECTI N OOOF THE LABOR ��//
COD ,ISHA FORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE
p DATE: � � APPLICANT: SMIP � �V
J WARNING:FAILURE T SECURE WORKERS'COMPENSATION COVERAGE IS WFUL,AND SHALL BE ENERGY P/C
� SU&IECTAN EMPLOYEii TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100.000),IN MDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: •�
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� I HEREBV AFFIFM UNDER PENALTV OF PERJURY THAT THEHE IS A CONSTRUCTION LENDING AGENCY �.
FOR THE PERf-0RMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
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� LENDER'S NAME
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w I CERTIFV THAT I HAVE HEAD THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES f �(/ �� /�f/"��
� 1 AGREE 70 COMPLY WITH ALL CI7Y AND COUNTV ORDINANCES AND STATE Uw5 RELA7ING TO BUILDING
� CANS7RUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF 7HIS COUN7V 70 ENTER UPON THE �
Z ABOVE-MEN710NED FR PERTV FOR INSPECTION 7URPOSES. COMMENTS '
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� SIGNATUREOFPERMITTEE DA7E
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~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOIDENR D--File Copy,GREEN—ApplicanYs Copy
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ROOF,SHEATHING ' 8'FT. BOND BE,4M
FRAMINGNENTILATION-� FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
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. ON SITE IMPS.
GAS AIR TEST _ _ FINAL ZONING _ ____ _
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTN DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
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