HomeMy WebLinkAbout17049 CTI'Y OF DIAMOND BAR
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I HEREBY AFFIRM UNDER PENALTY OF PERJURV THA7 I AM E%EMPT FROM THE CANTRACTORS LI- GefeJB/CefpOR
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w TURE.PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICAN7 FOR SUCH PEqMIT TO FILE A SIGNED w Patio/Deck
S7A7EMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CAN7RAC70RS LI-
I � CENSE LAW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa
O FESSIONS CADE)OR THAT HE OR SHE IS EXEMPT THEREFfiOM AND THE BASIS FOR THE ALLEGED EXEMP- (�
V TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPUCANT T0 Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSao).):
0 ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ Commercial -
Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70I4,BUSI- J
. N NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF �
PROPERTY WHO BUIL�S OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
�. � THROUGH HIS OR HER OWN EMGLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Z 710N,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE�ID NO7 BUILD OR �
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❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVELV CONTRACTING WITH LICENSEO CAN7RAC70RS
� TO CANSTNUCT THE Pq0.1EC7(SEC.7oal,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8�i �d b' ADJ.AREA
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� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� � I HEREBY AFFIRM UNDER PENA�TV OF PERIURV 7MA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d 8(COMMENCING WITH SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE.AND Z
' �X MY UCENSE IS IN FULL FORCE AND EFFECT, m
� LICENSE C SS �� LIC.NO. � � j
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSEN7 70 SELF�INSURE FOR WOHNERS' _
¢ CAMPENSATION,AS PROVIDED BV SECTION 370oOF THE LABOR CODE.FOR THE PERFORMANCE IU
OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED. �
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� �I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE.AS REOUIRED BY SEC710N �
Q 370o OF 7HE LABOR COOE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MY WOR ERS'}CA�MPENSA710N INSURANCE CARRIER AND POUCV NUMBER ARE: CONSTRUCTION _
j CARFIER S�M�/C' LOI'N.p s�, ��'N�-,� PLAN REVIEW .�O.�
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1ED,1 MECHANICAL �� .
(� SHALL NOT EMPLOV ANV PERSON IN ANV MANNEFi 50 AS TO BECOME SUBJECT TO THE .
(n WOFKERS'COMPENSATION LAWS Of CALIF ,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ��, C���r�_ ' I
� SUBJECTTOTHEWORKERS'COMPENSATI P VISIONSOFSE TIO 7o00FTHEUBOR I'�7'C
� CA ,I 5 LL FORTHWITH COMPLV WIT HO PR=VISION ISSUANCE \J��
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p DATE: S APPLICANT:
� ENERGY P/C i•-'�• I
J WAHNIN :FAILURE TO SECURE WOflKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE --__���_____�.--___.�
LL SUBJECTANEMPLOYERTOCRIMINALPENAL7IESANDCIVILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT
DOLLARS(f700.o00�,IN ADDITION TO THE COS7 OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CADE.INTEREST,AND ATTORNEY'S FEES. RETENTION FEE:
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HE(7EBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY .
� FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
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� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES � � �+
w I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING -
� CONSTRUCTION,AND HEREBY AUTHOFIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PROPERTV FOR INSPECTION P RPOSES.
Z COMMENTS
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m PERMITTEE N E(P MT)
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Uj SIGNATUREO PEFMITTEE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROo--File Copy,GREEN—Applicant's Copy
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FTGS/F�RMSISTEEL I, ' FHA RECIMTS
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ELECTRIC GROUND ' UNDEf� FLOQR DUCT , ,__.__�____ _�v ; -
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GROUND PLUMBING ( �� UNDER FLOOR CUt�!dUIT
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SLAB GRADE +_ FIREPLACE FOUNDATION � , �
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TEMP POWER __._ I ___._ i FIREP�RCE EiOfi�D BEAM .
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WATER SERVICE ; I, MID HT. BOND BEAM ' �
ROO�SHEATHING ' � ' 8 Ff. BOND BEAM � '
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FRAMINGNENTILIATION � FINAL BOND BEAM ,
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ROOF COVER PRE-GRADING �
ROUGH HEATING BENCHING
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RdUGH ELECTRIC ; ROUGH fa'RADIN.��
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ROUGH PLUMBING � FINISH uRADING
SHOWERITUB TEST ; POOL.ELECTRIC
EXT. LATH/SIDING � ; PUOL FENCING .
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WALL INSULATION j POOL FINAL
CElLING Ih18ULATIOiV � OFF SITE IMPS. ____ � _
DRYWALL NAIUNG DEDIGATIONS j
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SEWER FINAL ENG. �
SEPTIC TANK LAPIDSGAPE/IRRIG.
SEEP PIT/L.L. ON SITE lMPS.
GAS AIR TEST � FINAL ZONING
FINAL CONST. ; . �IRE DEPT. FINA�
FINAL HEATING : HEALTH DEPT. FlNAL
FINAL ELECTRIC ' DEV. FEES PAID �� ^
FIfVAL PLUMBING � ENERGY !
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CUiViMENTS �__�
SEPTIC TANK SIZE
SEE� PIT/U SIZE --� "---
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