HomeMy WebLinkAbout16720 (25). I
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DEPARTIv�NT OF COMMUNTI'1'&DEVELOPMENT SERVICES � �
21825 E.Copley Drive
(909)8603195 Fax(909)861-3117 PRE$$
I "%�M�� BUILDING PERMIT APPLICATION FIRMLY
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w TURE,PRIOR TO ITS ISSUANCE,ALSO RE-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck �
� S7ATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO THE PROVISIONS OF THE CANTqAC70RS LI- LL
CENSE LAW(GIAPTER Y(COMMENCWQ WITH SECTION�000)OF DIVISION 3OF THE BUSINE55 AlJD PRO- POOVSPB
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A CML PENAL7Y OF NOT MOqE TiAN FIVE HUNDRED DOLLARS(f5o0)J:
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Z WILI DO THE WORK u'7D iHE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�I,BUSI� J
� NE55 M!D PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW OOES NOT APPLV TO AN OWNER OF �
PROPEHTV WF10 BUIlAS OR IMPROVES THEREON,AND NTiO DOES SUpi WOHK HIMSELF OR HERSELF OR
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� ❑I AM E%EMPT UNDER SEC. 8.8 P.C.FOR THIS REASON Q
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� I HEREBV AFFIPM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� D(COMMENCIMO WITH SECTKKJ 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z
�� AIY LICENSE IS W FULL f-0RCE AND EFFECT. m
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� WOAKERS'COMPENSATION DECLARATION Q
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� I HEREBV AFFI{iM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
� _I HAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
COMPENSATION,AS PROVIDED BV SECTION 37o00F THE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED. w
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w _I HAVE AND WILL MAINTAIN WORICERS'COMPENSATION INSURANCE,AS qEOUIRED BV SECTqN �
Q 37000F THE LABOR CADE.FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS T
ISSUED.MV WORICERS'COMPENSATION INSURANCE CARRIER M1D POLICV NUMBER ARE CONSTRUCTION ,,A �J
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az ELECTRIC
� (11-IISSECiIONNE�NOTBE00MPLEfIDOFT1-EPEHMrISfiJqONEFiIX�DqEDDOLLMS(f100)ORLESS} PLUMBING
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Z I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL � --
C} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ��¢� � -�� � ti L.�,;
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
�j CODE.I SHALL FOR7HWITN COMPLV WITH THOSE PROVISIONS. ISSUANCE �
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J WARNINO:FAILURE TO SECURE WORKERS'COA/PENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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DOLLARS(5700,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTqN 3708 OF THE LABOF CODE,INTEREST,AND ATTORNEV'S FEES. .r - '
OC RETENTION FEE: —-"-""—
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O CONSTFUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIUFV THAT THERE IS A CONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHIGi THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
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w ICERTIFVTHATIHAVEFEADTHISAPPLICATIONlWDSTATETMATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES (//) b�
� I AGREE TO CqMPLV WITH ALL CfTY AND CWNTV ORDINANCES AND STATE UWS REUTINO 70 BUILDING � ��/ 1 D� ��
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z ABOVE-MEMIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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SLAB GRADE FIREPLAG� FOUNDATION
TEMP POWER FIREF�LAGE BOND BEAM � T—
WATER SERVICE MID HT. BONDBEAM � ' ' " �
ROOF SHEATHING , 8 FT. BOND BEAM
FRAMINGNENT(LIATiON FINAL BOND BERM
ROOF COVER PRE-GRADING ' • . • � _ � i
ROUGH HEATING BENC�ItNG' ' �' � � ' ' � • '
ROUGH ELECTRIC ROUGH GRADING
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SHOWERffUB TES7 POOL ELEGTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL � � �
CEI�ING IN�ULATION OFF SITE IMPS. �
DFIYWALI NAILING � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK � ,-. LANDSCAPE(IRRIG.
SEEP PIT/LL. -' ON SITE IMPS.
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