HomeMy WebLinkAbout17228 CITY OF DIAMOND BAR
I � ---�'',''�`----- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES EXPIRED
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21825 E.Copley Drive •
'� (909)860-3195 Fa�c(909)861-3117 ,1UN 19 2002 PRESS
'`%��*�� BUILDING PERMIT APPLICATION FORMLY
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p I HEREBY AFFIRM UNDEfi PENALTV OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gdf29B/C0lpOlt
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w TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- �
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
O FESSIONS CADE)OR THAT HE OR SHE IS EXEMPT THEREFROM ANO THE BASIS FOR THE ALLEGED ExEMP- (�
V TION.ANVVIOLATIONOFSECTION7o31.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE THAN fIVE HUNDRED DOLIARS(f500)J:
Z ❑I,ASOWNEROF7HEPROPERTV,ORMVEMPLOYEESWITHWAGESAS7HEIRSOLECOMPENSATION, � Commercial –
WILL DO THE WORK,AND THE STRUC7URE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.7oda,BU51� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTY WHO BUI�DS OR IMPiiOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTEN�ED Ofi m
w OFFEREDFORSALE.IF,HOWEVER,hIEBUILDINGORIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE-
� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
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� ❑I,ASONRJEROFTHEPROPERTV,AMEXCLUSIVEIYCONTRACTINGWITHLICENSEDCANTRACTOFS
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� TO CONSTRUCT THE PR0.IECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU2SIOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(5)LICENSEDPURSUAN7TOTHECONTHAC- OUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
�� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEFiEBV AFFIFM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �
� 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESSAND PROFESSIONS CODE,AND Z
`X MY LICENSE IS IN FULL FORCE AND EFFECT. /-��/^ /1 m
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
Q CAMPENSATION,ASPROVIDEDBYSECTION37000FTHEUBORCODE,FORTHEPERFORMANCE w
OF THE WORK FOR WHICH 7HIS PEPMIT IS ISSUED. � ,
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w _I HAVE AND WILL MAMTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SEC710N
Q 37000FTHELABORCODE,FOR7HEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS
ISSUED.MY W RKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� CARRIER /7/���}T��` P1 � /� PLAN REVIEW
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� (THISSECTqNNE�NOTBE07MREfEDOFTiEPERMfTISFORONEHUI�DREDDOLLARS(5100)ORLESS). PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(.�J SHAIL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME �NSPECTION FEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 97000F THE LABOR �{,
CODE,ISHALLFORTHWITHCOMPLVWITHT E DVISIONS. ISSUANCE o�l
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p DATE: APPLICANT:
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AN�SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST Of COMPENSATION,DAMAGES AS PROVIDED FOR IN /
� SECTION37080FTHELABORCO�E.INTERES7,ANDATTOHNEY'SFEES. RETENTIONFEE: I .Ol,
� CONSTRUCTION LENDINC,AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIRM UNDEF PENALTY OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
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� � LENDER'S NAME
� LENDER'SADORESS
� TOTAL FEES �� s�
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEflEBV AUTHORIZE REPFESENTATNES OF THIS COUNTY TO ENTER UPON THE
� ABOV MENTIONED PROPERTY FOR INSPECTION PURPOSES.
Z � COMMENTS
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� SIGNAT R OF P MITT E DATE
= RECPT.NO. PAID BY VALIDATION
~ - WHITE—De artment Copy,YELLOW—Finance Co PINK—Assessor Copy,GOLDENROD—File Co GREEN—A IicanYs Co
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SET BACK FLOOR JQIST
FTGSlFORPdiS/STEEL ; FHA REQMTS �
ELECTRIC GROUND � , UNDER FLOt�R DUCT _ �
GROUND PLUMBING __ _ ; UNDER FLOOR CU�!DUlT � � ___ _
SLAB GRADE _ _ ____ FIREPLACE FOUNDATION____ _.
-- __
TEMP POWER I FIREPLACE BOND BEAM '
----- ------ ___. ....-�---.._--.--_ ......____
WATER SERVICE � I MID HT. BdND BEAM _ . __
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---- --.._.__._.— _.____ ____
ROOF SHEATHING _ _---- ! 8 FT. BONQ BEAM __ ------------_i
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ROOF COVER TIUATION � pRE.-GR�ADD GEAM �__---i__------�� __ __
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ROUGH HEATING BENCHING __ I _
ROUGH ELECTRIC RDUGH GRADING
._...._._. ----- -----
ROUGH PLUNIBI�IG --�'- _ i FINISH GRADING
- -- --- ----..._.-- ---__--
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL If�SULATIOiV POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYINALL NAILING DEDICATIONS
SEWER FINAL ENG. ;
SEPTIC TAfVK LAfVDSCAPE/IRRIG. j
SEEP PIT/L.�. ON SITF_ IMPS. j
GAS AIR TEST � FINAL ZOiVING � `� �
FINAL CONST. �lRE DEPT. FINA�
__. .�-._.._......__ .._._ __.__
FINAL HEATItJG , _ � HEALTH CEPT. FINAI. _
FINAL ELECTRIC ; DEV. FEES PAId `_
FINAL PLUMBING � j ENERGY _ i _
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SEF'TIC TANK SIZE
SEEP PIT/U SIZE __.__ _.__-._-
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