HomeMy WebLinkAbout17925 (25) ��`_ CTI'Y OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�"-9*� BUILDING PERMIT APPLICATION FIRMLY
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w 7URE.PRIOR TO ITS ISSUANCE,ALSO RC-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE Pf70VI510NS OF iHE CONTflACTOFS LI-
� CENSE LAW(CFUPTER 9(COMMENCWO WITH SECTION 7000)OF DMSION 3 OF THE BUSINESS AND PRO- � Pool/Spa
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� A CIVIL PENALTV OF NOT MOfiE THAN FIVE HUNDREO DOLLARS(f600�.):
Q ❑I,ASOWNEROFTHEPROPERTV.ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1RIBfC18I
Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI- J � �
N NESS AND VROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT A7PLV TO AN OWNER OF �
PROPEHTY WFp BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCF1 WOqK HIMSELF OR HERSELF Oq
wTMROUGH HIS OR HER ON?J EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERT7'1EBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE TME BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILA OR
� IMPROVE FOR THE PURPOSE OF SALE).
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� LICENSED CONTRACTORS DECLARATION W -
� I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � /� O
� B(COMMENCW�WITH SECTqN 7000) DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z l
�� MY UCENSE IS IN FULL CE ECT.
� LICENSE CLASS LIC.NO. • �DS�— �
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� W RKERS'COMPENSATION DECLARATION Q �
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� I HEREBYAFFIRM UNDER VENALTV OF PERIURV ONE OFTHE FOLIOWIN6 DECLARATIONS: Z
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� COMPENSAT PROVIDED BY SECTION 3�o00F THE V�BOR CODE,FORTHE PERFORMANCE U
Q OF N FOR WHICH THIS PEWAIT IS ISSUED. �
Qw _I HAVE AND WILLMAIMAIN WORNERS'COMVENSATION INSURANCE,AS REOIIIRED BV SECTION
37aa OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS
ISSUED.MV WORKEFS'COMPENSAT N IN�CE ER AND POLICV NUMBER ARE: CONSTRUCTION
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Z I CE(iTIFV THAT M T PERFORMANCE OF THE WORK FOR WHICH HIS PER I S I UED.I MECHANICAL
�'} SHALL NOT EMPLO ANV PERSON IN ANY MANNER 50 AS TO BE SU&1 HE
(,/� WORNERS' P SATqNLAWSOFCAIIFORNIA,AND /IE �D ECOME INSPECTIONFEE
= SU&IECT TH RKERS'CAMPENSATqN PROVI bGO T 0 HE LABOR
CO E RpiWITHCOMPLVWITHTHOSE7 VISI ISSUANCE
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p DATE: � APPLICANT: SMIP
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J WARNINO: AILURE O SECURE WORKERS'COMPENSATION CO UNLA AN HALL BE ENERGY P/C
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� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDR OUSAND ENERGY PERMIT
DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: `
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDEF PENALTV OF PERIURY THATTHERE IS ACONSTRUCTION LENDING AGENCV
� FOR THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70B1,CIV.C.).
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� LENDEH'S NAME
H LENDER'S ADORESS
w I CERTIFV TNAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CORRECT. TOTAL F E ES /�� 'iw� \
� I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE IAWS RELATING TO BUILDING �,{� �\,/
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MEMIONED PROPE R INSPECTION P .
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Uj SIGNATURE OF PERMI DATE
= RECPT.NO. PAID BY VALIDATION
~ W —Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO File Copy,GREEN—Applica�t's Copy
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ELECTRIC GROUNQ � UNDER FLOOR DUCT �
GROUND PLUMBING UNDER FLOOR GU1�IDUIT �
Sl.A6 GRADE FIREPLACE FOUNDATION
TEh/IP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
RO�F SHEATHING 8 FT. BOND BEAM
FRAMIfVGNENTiLIATtOlV � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATItdG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINlSH GRADING
SHOWERlTUB TES7 POO�ELEC7RIC —Y_ A
EXT. LATH/SIDING POOL FENCING ! •'
WALL IIVSULATION POOL FINAL
• CEILING INSULATION OFF SITE IMPS.
DRYWAL�NAILIfVG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITIL.L. ON SfTE lMPS.
GAS AIR TEST FINAL ZONiNG
FINAL CONST. 'j ����� �" FiRE DEPT. FINA! F
FINAL HEATING HE/a�7H DEPT. FINAL
FI(�A�ELECTRIC � DEV. FEES PAID
FINAL PLUPi1BING �'/� �i'Z _ � ENERGY
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