HomeMy WebLinkAbout17870 (17) C1TY OF DIAMOND BAR � �
---���--- DEPARTMENT OF CONA�UNTR'&DEVELOPMENT SERVICES �
21825 E.Copley Drive PRESS
(909)860-3195 Fax(909)8613117 FIRMLY
":9�" BUILDING PERMIT APPLICATION
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I HEREBV AFFIRM UNDEFi PENALTV OF PERIURY THAT I AA1 E%EMPT FROM THE CONTRACTORS LI� ��Garage/ 9fPOR � �
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w NRE,PRIOR TO ITS ISSUANCE.�LSO REOUIRES THE A7PLICANT FOR SUCN PERMIT TO FILE A SIGNEO w �
STATEMEN7 THAT NE OR SHE�S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI� �y P�US 8 /
� CENSE LAW(CHAPTER Y�CAMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � P
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V TION.ANV VIOIATION OF SECTION 7037.6 BY ANY IIPPLICANT FOR A PERMIT SU61ECT5 TNE APPUCANT TO Z Re-Roo1
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Z WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRACTOflS LICENSE LAW DOES NOT APPLV TO AN OWNEA OF �
PROVERTVMhiOBU�LD50FIMPROVESTHEREON,ANDVMODOESSUCHWORKHIMSELKORHERSELFOR m
� 7HROUGH H150R HER ON?J EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMSARE NOT INTENDED OR
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� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR `
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_ ❑I,ASOWNEROFTHEPROPERTY,AME%CLUSIVEI�CANTflACTINOWITHLICENSE�CONTRACTORS
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� TO CONSTRUCT TME PRQIECT(SEC.70U,BUSINESS AND PROFESSIONS CODE:hIE CANTRACTORS LI� V8Il18II011
� CENSE UW DOES NOTMPLV TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES iHEREON,AND '
WHOCONTRACTSFORSUCHPROJECTSWITHACONTfiACTOR(S)LICENSEDPURSUANTTOTMECONTMG OUANTITY DESCAIPTION FF. ^.�
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� LICENSED CONTRACTORS DECLARATION �
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2 I IIEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d Y(COMMENqNO WITH SECTION 7000)OF DNISION 3 0F THE BUSWESS ANO PROFESSIONS CODE,AND Z
oMV UCENSE fS IN FULL FOHCE I�ND EFFECT. m
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� I HEREBV AFFlRM UNDER PENALTV OF PERJURY ONE OF THE iOLLOWING DECLARATIONS: Z
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OF TNE WORK FOR WMICH THIS PEFMIT IS ISSUED. �
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W I HAVE AN�WILL MAINTAIN WORKERS'COMFENSATION INSURANCE.AS FEOl11FED BV SECTKKJ � / )
Q 3700 OF THE LABOR CODE,FOR THE PERFORMMlCE OF THE WORK FOR NM111CH THIS PEFiMIT IS </
� ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLIGV NUMBER ARE: CONSTRUCTION
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� (IFLLSSECTqNNE�NOTBENNW.EfEDOFTlfPERR�ISFORONEF4RDRED00LLAR51f10�lORLESS} �PL•UMHNG
Z I CERTIFV THAT IN THE PEFFOAMANCE OF THE WORK FOR WHICH THIS PEHAIIT IS ISSUED,I MECHANICAL
�•} SH�LLNOTEMPLOYANYPERSONINANYMMJNERSOAST09ECOMESUBJECTTOTHE �N���� E
� WORKERS'COMPENSATION LAWS OF CALIFOfiNIA,AND AGREE THAT IF I SFIOULD BECAME
� SU&IECT TO THE WORKERS'COM7ENSATION PROVISIONS OF SECTION J7ao OF THE IABOR ��! �'v �
� CODE,I SHALL FORTHWITH COMPLV WITH OS�Fi E PROVIS�ONS/�/� _� �'IJ.�V�CE
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� �'IO�O L APPUCANT: �=�!Q!-�'
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� WAANIN�:FAILURE TO SECURE WOfiKERS'COMPENSATION CAVERAOE IS UNUWFUL,AND SHALL BE
�y SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100.000�.IN ADDIiION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN ��
� SECTION 370H OF THE UBOA CODE,INTEREST,M7D ATTORNE`fS FEES. �RELENTION FEE: �
w CONSTRUCTION LENDING AGENCY � PRE-ALT FEE:
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� I HEREB�AFFIRM UNDER PENALTV OF PERlUFV THAT THERE IS A CANSTRUCTION IENDINO AGENCV
d- FOR THE PERFORMAIJCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.�OB7.CIV.CJ. �
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� LENDER'S NAME —
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� I CERTIFV THAT I HAVE READ THIS A7PLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES l
W I AGREE TO COMPLV WITH ALL CITV AND COUNTV OPDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUT ZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � �� \�
ZABOVE-MENTIONED�ROPERTV F IN ECTION PURPOSES. COMMENTS
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GROUND PLUMBING ' ' UNDER FLOOR CU�IDUIT �
SLAB GRADE FIREF'LACE FOUNDATION
TEMP POWER FIREPLA'CE BOND BEAM
WATER SERVICE MID HT. 60ND BEAM
ROOF SHEATHING � • ' , 8 FT. BOND BEAM
FRAMINGNENTILIATION , FINAL BOND BEAM
ROOF COVER PRE-GRADING ��
ROUGH HEATING BENCHING
ROUGH ELECTRlC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING i
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSU�ATION POOL FINAL
CEILING INSULATION � � QFF SITE IMPS.
pRYWAL�IVAILING DEDICATIONS
SEWER FINAL ENG.
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SEEP PIT/L.L. ! ON S�TE lMPS.
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FINAL CONST. �� JZ- FlRE DEPT. FINAL �
FINAL HEATING-� � HEALTH DEPT. FINAL
FINALELECTRIC 'f •L�� U`'� DEV. FEES PAID �
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