HomeMy WebLinkAbout12685 _�,�,,,`_ CITY OF DIAMOND BAR � / I
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � �
21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'9�"� BUILDING PERMIT APPLICATION FIRMLY
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p� OWNER-BUtLDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTY OF PERJUFV THAT 1 AA1 EXEAIPT FRORi•J 1{E CONTRACTORS LI� G8f8gB/CefpOR I
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w TUHE.VRIOR TO ITS ISSUANCE.ALSO REW IRES 7HE APPLICANT FOR SUCM PERMIT TO FILE A SIONED W P8�10/DBCI( �
� STATEMENT THA7 HE OR SHE IS IICENSED PURSUAN7 70 THE PROVISIONS OF 7HE CONTRAC70RS LI�
� CENSE UW(CHAPTER e(COMMENCINO WITH SECTION]000)OF DIVISION 3 OF THE BUSINESS AND PRO� LL' POOUSPB
^ FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEGED EXEMP- (� _ ,f
� TION.ANY VIOLATION OF SECTION 70.71.6 BV ANV APPUCANT FOR A PERMIT SU&lECTS THE APPLICMIT TO Z Re-Roof �
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(i500).):
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Z WILL DO THE WORK�ND 7HE S7RUCTURE IS NOT IN7ENOED OR OFFERED FOR SALE(SEC.7a1,BUSI� J -
� NESS AND VROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ? �
PqOPEHTV VYHO BUILDS OR IMPROVES THEREON,AND WHOOOES SUCM WORK HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER OWN EMPLOVEES,PROVIDEO THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORS�LEIF,FIOWEVEf�THEBUILDINGORIMPROVEMENTISSOLDWIT}IINONEVEAROFCOMPLE-
z TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVWO THAT HE OR SHE DID NOT BU�LPOR
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W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVE9THEREON,AND�-
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TORSL�CENSELAW.). '-. � �UANTITY DESCRIPTION FEE
� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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¢� LICENSED CONTRACTORS DECLARATION � ` , w . -
2 I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER � � . �
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X`� MY LICENSE IS IN FULL FORCE AND EFFECT. m
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� WORKEFS'COMPENSATION D LAR y �
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N I HEREBV AFFIRM UNDER GENALTY OF PEFJURV ONE OF THE FOLLOWING DECURATIONS: , Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' � _
'7d- COMPENSATqN,AS PROVIOED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE `U
/'� THE WORK FOR NM1IICH TMIS PERMIT IS ISSUED. �
w ��/� INAVEIWDWILLMAINTAINWORICERS'COMPENSATIONINSURANCE.ASREWIREDBVSECTION
Q �` 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WFIICH THIS PERMIT IS .�' � , �
�� ISSUED.MV WO PENSAT N INSURAN CARRIER AND /ICY NUMBERARE: ' CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C�S SMAIL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE.�"
(/� WORKERS'CAMPENSATION LAWS OF CAIIFOqNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECT TO THE WOR!(EHS'CAMCENSATION PROVISIONS OF SECTION 37o00F THE LABOR
�j CODE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE
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p DATE: �:' APPLICANT. SMIP
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� WAflNING FAILURE TO SECUfjE WORKERS'CqMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
� SU&IECTANEMPLOVEFTOCpIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT
DOILARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR_CODE,INTEi7E5T,AND ATTORNEV'S FEES.
w �� RETENTION FEE: ' �
.� iCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
! � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CANSTRUCTION LENDINO AOENCV
� � FOR THE PERf-0RMANCE OF iHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3ao7,CIV.C.).
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� LENDER'SNWdE
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w I CERTIFV THAT I HAVE READ T,HIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES ]/)�`��
� I AGREE TO CAMPLY WITFI ALL CITY AND COUNTY ORDINANCES AND STATE IAWS FELATWO TO BUILDINO (�
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE�MENTIONED 7ROPERTV FOR INSPECTION PURPOSES. .
o /� /� �� COMMENTS
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m PERMITTEE NAME(PRINT) ' �
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� S%3NANREOFPERMI DATE
� -� RECPT.NO. PAID B VALIDATION
;: WHITE—DepaAment Copy,YELLOW—FInance Copy,P.INK—Assessar Copy,GOLDENROD—File Copy,aREEN—Applicant's Copy
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SET�BACK � � �� FLOOR JOIST �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT •
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM '
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING WSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SiTE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTR�C �— DEV. FEES PAID
FINAL PLUMBING , �,�„` ENERGY
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SEEP PIT/U SIZE
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