HomeMy WebLinkAbout10-1137 _��_ CITY OF DIAMOND BAR �
• DEPARTMENT OF COMMUNITY&DE�{�Q������VICES
21825 Copley Drive,Diamond Bar,CA 917 _ (J(j'�j �
(909)839-7020 Fax(909)861-3117 Building Inspection Hothne�'�909)839-7 '2 PRESS
�'°^'� BUILDING PERMTT APPLICATION FIRMLY
o� JOBSITE ,�^ APPLICATION PERMIT p/C
ADDRESS���I �S�L J�[�i-�9SL DATE NUMBE�#
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N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION
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I HEREBY AFFIRM UNDER PENALTY OF PERR/RV THAT I AM E%EMPT FROM THE CANTMCTORS L6 G8fe9B/CBfPOf1
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w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIONED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U-
� CENSE LAW(CHAPTEF B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSPB
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Z ❑I,ASONRJEROFTHEPROPER7Y,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATqN, � COrtIRIBfC18I .
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� NESS AND VROFESSIONS CODE:THE CONTR�CTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WFIO BUILOS OR IMPROVES THEREON,AND NM170 OOES SUCH WORK HIMSEIF OR HERSELF OR
CL THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IA/PROVEMENTS ARE NOT INTENDED OR m
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Z TIDN,THE OWNER-BUILDER WILL HAVE THE BUflDEN OF PROVING THAT HE OR SHE DID NOT BUILA OR
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w ❑1.AS OWNER OF THE PROPEHTV,AM EXCIUSIVELV CANTMCTING WITH LICENSED CONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7W/,BUSINESS AND PROfE5510NS CODE:THE CANTRACTORS ll- V8Il1HIIOf1 A0.1.AREA
W CENSELAWDOESNOTMPLVTOANONMEROFAPROPERTVWHOBUILDSORIMPROVESiHEREON,AND
� N?iOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOF(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
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� O I AM EXEMPT UNDER SEC. 8.8 V.C.FOR THIS REASON � ��.
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� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV TNAT I AM IICENSED UNDER PROVISIONS OF CHAPTER �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTV OF PER1l1RV ONE OF THE FOLLOWING DECURATIONS: V
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0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CqNSENT TO SELF-INSURE FOR WORNERS' _
� COMPENSATION,AS PROVIDED BY SEC710N 3700 OF THE LABOR CODE.FOR THE PERFORMANCE U
OF THE WON7(FOR NTiICH THIS GERMIT IS ISSUED. w
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w _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REQUIPED BV SECTION
Q 37a00FTHE LABOR CODE,FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS .
J ISSUED.MV WOR]KER,S'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
j CARRIER 4�L� PLAN REVIEW
Z POIICVNUMBER IAe1l� "�n; I—S(���?��— �� L+ ELECTRIC
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Z I CERTIFY 1TiAT IN THE PERFORMMICE OF h1E WOR1C FOP WHICH THIS PERMR 4S ISSUED,1 ECHANICAL
.�} SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(/j WORKERS'CAMPENSATION LAWS OF CALIFORNIA�NDA�REE THAT IF 1 SFIOULD BECAME INSPEC FEE
SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR �� ,�l
O CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. UANC d(J
p OATE: APPLICANT: SMIP
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J WARNINO:FAIWRE TO SECUFE WORKER9'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALLBE ENERGY P/C
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� SUBJECTAN EMPLOVEF TO CRIMINAL PENALTIES AtJD CML FINES UP TOONE HUNDRED THWSAND ENERGY�
DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3]OB OF THE LABOq CADE,INTEREST,AND ATTORNEV'S FEES. R FEE: //D"(�
OCONSTRUCTION LENDING AGENCY p �
� I HEREBYAFFIRM UNDER VENALTY OF PERJURV THATTHEFE IS A CONSTRUCTION LENDING AOENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�.
Z
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� LENDER'S NAME _ �
F— LENDER'SADDRESS
w I CERTIFV THAT I HAVE READ 7HI5 APPLICATION AND STATE THAT THE ABOVE INFOHAIATION IS CARREC2 TOTAL FE ES ��
� I AOREE TO CAMPLV WITH ALL CfTY AND CAUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBV AUhiORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE '
Z ABOVE�7.IENTIONED VROPERTV FOR INSPECTION WRPOSES. COMMENTS '
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� RECPT.NO. PAID BY � VALIDATION
ITE—Department Copy,YELLOW�inance Copy,PINK—Aasessor Copy,GOLDEN OD—File Copy,GREEN—Applicanl's opy
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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 BENCNING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION 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 ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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