HomeMy WebLinkAbout17776 (35) �
CTTY OF DIAMOND BAR �
�----��`— DEPARTMENT OF COMMiJNTI'Y&.DEVELOPMENT SERVICES
21825 E.Copley Drive '`�'` �
�" (909)860-3195 Fax(909)861-3117 PRE$$
`',9�'w � BUILDING PERNIIT APPLICATION FIRMLY
� JOBSITE � �yAPPLICATION PERMIT { ,'�'�]' PJC
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DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/FiEM
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� I HEREB�AFFlHAI UNDER PENALTV OF PE0.IURY THAT I MI E%EMPT FROM THE CONTRACTORS LI- GefB(JB/COfPOR
LL{ CENSEUWFORTHEFOIIOWINOREASON(SEC.70.11.59USINE55MlOPROFESSIONSCODE:ANYCITYOR (�
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W TURE,PRqR TO ITS ISSUMICE.ALSO REQUIRES THE APPLICANT FOR SUCH PEN�11T TO FILE A SIONED W
� STATEMEN7 THAT HE OR SHE IS 110ENSED WRSUANT TO THE PROVISIONS OF THE CONTRNCTORS lf� � pool/Spa
� CENSE UW(CHAPTER B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO-
FESSIONS CODE)OR THAT HE OH SHE IS E7(EMPT TNEREFROM AND THE BASIS FOR THE�LLEOED EXEMP�
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Z WILL 00 THE WORK�D THE S7RUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70aa,BU51- J .
� NESS AND PROFESSIONS CODE:THE COMRACTORS LICENSE LAW DOES NOT A7PLV TO�7J OWNER OF �
VROPERTV Yh10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSEIF OF HERSELF OR m
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IMENDED OR
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Z TION,THE OWNER�BUILDER WILL HAVE 7HE EURDEN OF PROVWO THAT HE OR SHE DiD NOT BUILA OR
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� TO CONSTRUCT TNE PRQIECT(SEC.70M,�USINESS AND PROFESSIONS CODE:TF1E CONTRACTORS LI- V8IU8(IOfI ADJ.AREA
� CENSE LAW OOES NOT MPLV TO AN OWNER OFA PHOPERTY WHO BUILDS OR IM7ROVES THEREON.AND
WHOCONTRACTSFORSUCHPROJECTSWITHACONTFACTOR�S)LICENSEDPURSUANTTOTHECONTRAF QUANTITV DESCRIPTION FEE
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� LICENSED CONTRACTORS DECLARATION J
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I NEREBV AGFIRM UNDER PENALTY OF PERIUpY THAT I AM LICENSED UNDER PR0�i510NS OF CHAPTER �
d e(COAUIENCIN(i WfTH SECTqN 7000)OF DIVISION 3 OF THE BUSINE55 ANO PROFESSKKJS CADE,AND Z
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� WORKERS'COMPENSATION DECLARATION � -
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� I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWINO DECIARATIONS: Z
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� _I HAVE AND WILL MAlN7AIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2
Q COMPENSATION,AS PROVIDED BV SECTION 37a00FTHE LABOR CODE,FOR THE VERFORMANCE w
OF THE WORK FOR WMICH TH7S PERMIT IS 7SSUED. �
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w _I HAVE ANO WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION (��`�
Q 37000F THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS �
� ISSUED.MV WORNERS'COMPENSATION INSUFANCE C�RRIER AND POLICY NUMBERARE: CONSTRUCTION �
� CARRIER PLAN REVIEW
Z POIIC�NUMBER ELECTRIC
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� R1115SECTIONNE�NO78ENWPLETmOFTFEPERA4TISFORONEF�RX�OFEDDIXlARS(itOalORIESS?
w I CERTIFV THAT IN THE PERFORMANCE OF THE NlORN fOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
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C} SHpLL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO TME
� WORKERS'COMPENSATqNUW50FCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE ,�
S SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTqN]�OOOFTHELABOH ISSUANCE •
CODE.I SHALL FOR7HWITH COMPLV WITH THOSE PROVISIONS.
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p DATE: APPLICANT: � .
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J WARNIN�:FNLURE TO SECURE M/ORKERS'COMPENSATION COVERAGE IS UNLAWFUL,ANO SHALL BE
�y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINE5l1PTOONEHUNDREDTHOUSAND ENERGYPERMIT
OOLURS(f 100.OW).IN ADDI710N TO 7HE COST OF COMPENSATION,DAMAGES A$PROVIDED FOR W ��
J SECTqN 37oe OF THE UBOR CADE,WTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
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w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PEN/LLTV OF PERJURV THAT THERE IS A CONSTRUCTION LENOINO AGENCV
d FOR h1E PERFORMANCE OF 7NE WORK FOR WHICH hVIS PERM�T IS�SSUED(SEC.�09�.CIV.C.). �
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� LENDER'S NAME
F- LENDER'SADORESS p\�'�'
� ICERTIFYTHATIHAVEREA�THISAPPLICATIONANDSTATETHATTHE�BOVEINFORIAATIONISCORFECT. TOTAL FEES I+ J
w I AOREE TO CAMPLV WITN ALL CITV AND COUNTY ORDINANCES AND STATE UWS RELATINO TO BUILDINQ
� CONSTRUCTION,AND HEREBV AUTHORIZE FEPRESENTATIVES OF THIS CWNTV TO EMER UPON THE
Z ABOVE��EMIONEDPROPERTYFORINSPECTIONPURPOSES.
COMMENTS
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� Gt�ANR OF PERMI7TEE DATE qECPT.NO. PAID BY VALIDATION
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GROUND PLUMBING _ UNDFR FLOOR CUNDUIT � _
SLAB GRADE FIREPLACE FOUNDATION
TEP/IP POWER FIREPLACE BOND BEAM
WATER SERVICE � MIC�HT. BOND BEAM
ROOF SHEATHIPVG �g/vZ �Q�.� 8 F7: BOND BEAM `
FRAMING/VENTILIATiON �-_-�_ _ FINAL BOND BERM
ROOF COVER j/���� PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWEFITfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POt7L FENCING
WALL 1(dSULATION POOL FINAL •
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL iVAILING DEdICATIONS
SE4YER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/LL. ON SITE tMPS.
GAS AIR TEST FINAL ZOh11NG
FINAL COPJST. FIRE DEPT. FINA!
FINAL HEATING HEALTH DEPT. FiNAt
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBIMG ENERGY i
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