HomeMy WebLinkAbout16701 (32) �x�i��D
CITY OF DIAMOND BAR
�- --��` --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�, � JUN 19 2001
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�`'%��^�� B�JIILDIIVG PEI2I1�4IT APPLICATION FVRMLY
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ADDRESS �,� C �'� �� DATE
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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I HEREBY AFFIRM UNDER PENALT/OF PERJURV THA7 I AM ExEMPT FFOM THE CONTRACTORS LI- G8f890/C2fPOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7a31.5BU51NE55ANDPNOFE5510N5CODE:ANVCITYOR (n
U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OHREPAIRANYS7RUC-
w TURE,PRIOFi TO ITS ISSUANCE,AL50 REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck �
STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� V' PooUSpa
FESSIONSCODE)ORTHATHEOqSHEISEXEMPTTHEREFROMANDTHEBA515FORTHEALLEGEDEXEMP- (�
� TION.ANVVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5o0).):
Q ❑I,ASOWNEROFTHEPROPERTY,OFMVEMPLOYEESWITH�WAGESASTHEIRSOLECOMPENSATION, 0 COR1RIBfCi31 �
Z WILL DO THE WORK,AND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7044,BUSI- J
� NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNEP OF �
PROPEFiTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHA7SUCHIMPROVEMENTSARENOTINTENDEDOR m
w OFFEREDf-0RSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMEN71550LDWITHINONEYEAFOFCOMPLE-
0 TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
Z IMPROVE fOR THE PURPOSE OF SALE).
� OI,ASOWNEfiOFTHEPROPERTY,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRAC70RS
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� 70 CONS7RUCT THE PRQIEC7(SEC.70/4,BUSINESS AND PROFESSIONS COOE:7HE CONTRACTORS LI- V81U8�1Of1 ADJ.AREA
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� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
� ❑I AM E%EMPT UNDER SF_C. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIqM UNDER PENALTY OF PEFJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Z � C�A"G�
d 9(COMMENCINGWITHSECTION700o)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND s/J'��
X MV LICENSE IS IN FULL FORCE AND EFFECT. �1
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' _
Q CAMPENSATION,ASPROVIDEDBVSECTION370aOFTHEUBORCODE,FORTHEPERFORMANCE W
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAIN7AIN WOFiKERS'CAMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 370o OF 7HE LABOH CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENS TION INSUR�E CARR AND POLI NUMBER ARE: CONSTRUCTION
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� (iHISSECf10NNEmNOTBE00MREfEDOFTHEPERMffISFORONEHU1�Df7ED00LLARS(E10D)ORLESS). PLUMBING
Z I CEFITIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INS?ECTIONFEE
� SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR v DO
CADE,I SHALLFORTHWITHCOMPLV WITH THOSE PROVISIONS. ISSUANCE
� SMIP
p DATE: APPLICANT:
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENEAGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPEFiMIT
DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37080FTHELABORCODE,M7EREST,ANDATTORNEY'SFEES. RETENTIONFEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDEfl PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
� FOR THE PERF-0RMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
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� LENDEH'S NAME
H LENDER'SADDRESS
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES ,� ,S
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES ANO STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROP TV FOR INSPECTION PURPOSES.
Z COMMENTS
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~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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GROUND PLUMBING � UiVDER FLOOR CU�IDUIT_� ________
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SLAB GRADE FIREPLACE FOUNDATION ____
TEMP POWER FIREPLACE BOND BEAM � __„___
WATER SERVICE MID H7.\BOND BEAM _,_ _.
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ROOF$HEATHING `---� - 8 FT. BOND BEAM_ _� _____�___ �
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FRAMlNGNENTILIATION I FINAL BOND BEAM
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ROUGH HEATING BENGHING __ __
ROUGH ELECTRIC ROUGH GRADING __
ROUGH PLUfVIBING FINISH GRADING • ___
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATIOIV OFF SITE IMPS. .
DRYWALL NAILING DEDIGATIO(VS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRlG. �
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZC7NING '
FINAL COiVST. .� FIRE DEPT. FINAL
FItVAL HEATING i HEALTH DEPT. FI�lAL
FINAL ELEGTRIC � I DEV. FEES PAID
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