HomeMy WebLinkAbout17408 CITY OF DIAMOND BAR �JZ� •
`��--��--- D E P A R T M E N T OF C OMMUNTI'1'&DEVELOPMENT SERVICES
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21825 E.Copley Drive
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM E%EMPT FqOM THE CONTRACTORS LI� G2f8JB/CflfpOfl
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U COUNTVWHICHREOUIRESAPERMIT7000NSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC� �
w TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONT(iACTORS LI�
� CENSE UW(CHAPTER B(CAMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooUSpa
FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFHOMANDTHEBASISFORTHEALLEGEDEXEMP- (� /�,�
� TION.ANVVIOUTIONOFSECTION7031.58VANVAPPUCANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof (JLJ
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ZASON7JEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � COrt1fTIBfCIeI �
WILL THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704t,BUSI- J
� NESS AND PROFESSIONS CADE:THE CON7qAC70RS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTY WHO BUILOS OR IMP{lOVES THEREON,AND WHO DOES SUCH WORK HIMSELFOR HERSELF OR
Q THROUGH HIS OR HER ONM EMPLOYEES,PROVIDEO THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
w OFFEREDFORSPLE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
� TION,THE OWNER-BUILDEF WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
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� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECON7RAC- QUANTITY DESCRIPTION FEE
Y TOFS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE � �( 1�1 _ OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� 1 HEHEBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVI510 CHAPTER �
� B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
`X MY LICENSE IS M FULL FORCE AND EFFECT. _ m
� LICENSE CLASS LIC.NO. j
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V DATE CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTY OF PERIURY ONE OFTHE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOqKERS' _
'7d- COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOH THE PERFORMANCE W
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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W I HAVE AND WILL MAINTAIN WOflKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION b
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �I/.�n
ISSUED.MV WOfiKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION !F'� U
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� CARRIER PLAN REVIEW
Z POLICV NUMBER ELECTRIC
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� (iHISSECfqNNE�NOTBE00MR.ETEDOFTHEPERMITISFORCNEF0.11�DREDDOUARS(E700)OFiLESS} PLUMBING
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Z I CERTIFV THAT IN THE PERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INSPECTION FEE
= SU&IECTTO THE WOFKERS'CAMPENSATION PROVISIONS OF SECTION 37ooOF THE IABOR �
COOE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �
� SMIP �
p DATE: APPLICANT.
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN '`
� SECTION 37oe OF THE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. RETENTION FEE: .��+
a CONSTpUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBYAFFIqM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY ����- �� �� ) )
FOR THE PERf-0RMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). ' �. �_ J ���-�
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? LENDER'S NAME l 4 A ��
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� LENDER'SADDRE55 . ('�
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� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEWFORMATIONISCORRECT. TOTAL FEES � v
w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AN�STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTYTO ENTER UPON THE ��� �F+��'��-'
� ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. -� `��
� �C e r�L�1 l.� �at�� COMMENTS "
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m PERMITTEE N (PRINT) ^ _ �
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�J SIGNA7UREOFPERMI7TEE DATE
= RECPT.N0. PAID BY b VALIDATION
~ WHIT — paAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
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FTGSlFORMS/STEEL ; � FHA REQMTS
ELECTRIC GROUND ^ UNDER FLOOR DUCT _ .�. _
GR�UND PLUMBING _ ; UNQER FLOOR CUt��DUIT —� ' _____
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S�AB GRADE _ __-_-- FIR�PLACE FOUNDATIQN---_._.�__.______
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TEMP POWER � FiR�PLACE EiOND B�A�11
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W,4TER SERVICE � MIQ HT. BOND BEAM _____ _ _
ROOF'SHEATHING 8 FT. BOND BEAM �
FRAiV11NG/VENTILIATION � FINA�BOND BEAM ______ ; ____
ROOF COVER � PRE-GRADING '
ROUGH HEATING BERiCNING �
ROUGH�ELECTRIC � ROU�H GRADING _._______�
— — — __..---- -__� ___..---
ROUGH PLUiV131NG � ; FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
.._ EXT. LATH/SIQING POOL FENCING _ ___
WALL INSULATIOiV POOL FINAL
CEILING INSULATION � OFF SiTE IMPS. �___ _._.:`,
-- — ----- ---...__ —_._ —_._.-------._..�__ �__
DRYWALL NAILING DEDICATIONS
SEWER FfNAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITlL.L. ON SITE IMPS.
�'-�a5"�'(R TEST F!N��ZONING
FINAL CONST. �iRE DEPT. FINA� � v___._.__
---- --_..__..- --..__—_ ��____._.
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUP/IBING ENERGY
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