HomeMy WebLinkAbout17934 (17) CTI'Y OF DIAMOND BAR
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��'%�M�� BUILDING PERNIIT APPLICATION FIRMLY
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p I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8I89B/CBfpOII
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w TURE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Deck
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� CENSE LAW(CHAPTER o(COMMENCINO WITH SECTION 7oD0)OF DIVISION 7 OF THE BUSINE55 AND PqO� � PooUSpe
Q FESSIONS COO�OR THAT HE OR SHE IS E%EMPT 7HEREFROM AND THE BASIS FOR THE ALLEOED E%EMP- C7
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i N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEHTY MR10 BUfLDS OR IMPROVES THEREON,AND YA-10 DOES SUCH WORK HIMSEIF OR HERSELF OR
� iHROUGH HIS OR HER OWN EMPLOVEES,PROVIDEO 7HAT SUCH IMPqOVEMENTS ARE NOT IMENDED OR m
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� 1 HEREBY AFFIRM UNDER PENALTV OF PEiLIURY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCWG WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION Q
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DEQARATIONS: Z
Z� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKEflS' ¢
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COMPENSATbN,AS PROVIDED BV SECTION 37o00FTHE LABOR CODE,FOR THE PERFORMANCE U
OF7HE WOfiK FOR WHICH THIS 7ERMIT IS ISSUED. W
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� _I HAVE M1D WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF TFIE WORK FOR WHICH THIS PERMIT IS
J ISSUED.MV WORKEAS'COMPENSATION INSURANCE CARRIER ANO POLICV NUMBER ARE: CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C.�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
(/� WORKERS'COMPENSATION LAWS OF C�LIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'CAMPENSATKKJ P�Q VISbNS Ofy��ECEIOeLi eQOF THE LABOP
�j CADE.I SHALL FORTHWITH COMPLV WITH TH SQ EA1 NS ISSUANCE "
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'J WMNINO:FAtLURE TO SECUF7E WOR)(ERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREOTHOUSAND ENERGYPERMIT
DOILARS(f700.000),IN/�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTpN37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFOPMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED(SEC.30G�,CIV.C.).
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� I CERTIFY 7HAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA L FE ES �J
w I AGREE TO COMPLV WITH ALL CfTY AND CAUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
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� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
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GROUNQ PLUMBING � UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLAGE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM �
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING � 8 FT. BOND BEAM !
FRAMIIVGNENTILIATfO(� FiNAL BO(VD BEAM
ROOF COVER PRE-GRAQING
ROUGH HEATING SENCHIfVG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUN181NG FINISH GRADING
SHOWER/TUB TEST � ! POOL ELECTRIC
EX7. LATHlSID1NG POOL FENCING
WAL�INSULATION PQOL FINA�
CEILING INSULATiON OFF SITE 1MF'S.
DRYWALL NAlLIPVG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LAfVDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
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