HomeMy WebLinkAbout16809 CITY OF DIAMOND BAR EXPIRE(�
`---�'','�` --- DEPARTMENT OF CONIIvfUNTI'Y&DEVELOPMENT SERVICES
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21825 E.Copley Drive J U N 19 2002. ,
(909)860-3195 Fax(909)861-3117 PRESS
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1 HEREBY AFFIRM UNDER PENALN OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- GBfe(Je/CefPOft
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W TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7o00)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa ,
0 FESSIONSCADE)ORTHA7HEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
V TION.ANVVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
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0 ❑I,ASOWNEROFTHEPROPERTY,ORMVEMP�OVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial -
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7odt,BUSI- J
� NESS AND PROFESSIONS CODE:THE CONTFACTORS LICENSE LAW DOES NO7 APPLV 70 AN OWNEP OF �
PROPERTY WHO 6UILDS OR IMPROVES THEflEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m
w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPIE-
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�� ❑I AM EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON Q
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� 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � /���.5� .r�(J e
� B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z s�v /°L /(�_
X MY LICENSE IS IN FULL FORCE AqND ECT. �]
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V DATE /�/ `Q� CONTRACTOR 4 d
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTY OF PEFJUFY ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q COMPENSATI AS PROVIDED BY SECTION 37ooOF THE LABOR CODE,FOR THE PERFORMANCE `U
OF T K FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE S REQUIRED BV SECTION
Q 370o OF THE LABO�R �,FOR THE PERFORMA F T O OR WHICH 7HIS PERMIT IS
ISSUED.MY WO R!E S'�MPENSATION INSU C AR R POLICY NUMBER ARE: CONSTRUCTION
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0 (fHISSECTqNNEmNOTBE00MPlEfEDOFTHEPEM4�ISFORONEHUI�DREDDOLLAf15(E100)ORLESS). PLUMBING ✓ �
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7IS ISSUED,I MECHANICAL
(,'} SHA�L NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
� CODE,1 SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � �
� SMIP
p �ATE: APPLICANT:
J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(S1o0.o00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CADE,MTEREST,AND ATfORNEV'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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2 LENDER'S NAME
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I'— LENDER'SADDRESS
� TOTAL FEES �
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPIV WITH ALL GTY AND COUNTV ORDINA ES AND STATE LAWS RELATING TO BUILDING
� CONSTPUCTION,AND HEREBV AUTHORIZE REPFESENT ES OF THIS COUNTV TO ENTER UPON THE .
� ABOVE-MENTIO D PROPEfl7Y FO ION PU ES.
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SLAB GRADE FIREPLACE F�UNDATIUN _
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TEMP POWER i _ � FIREPLACE BOND BEAM � �
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WATER SERVICE ' __._ _____I MID HT. BOND BEAM
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ROOF SHEATHING ___ __ -}_8 FT. BONb BEAM__ _-----.__ ---L
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FRAMINGNENTIUATION ____ _____'_FINAL BOND BEAtJI __ _._ _____� I
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ROOF COVER PRE-GRADING __ � _� i_
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ROUGH HEATING BENCHING ____ �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING � FINISH GRADING _ __ ______
SHOVdER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
VV,4LL Ii�SULATIOIV POOL FINAL
CEILING IfVSULATIOfV OFF SITE IMPS.
DRYWALL N,4ILIIVG DEDICATIONS
SEWER FINAI ENG.
SEPTIC TANK LANDSCAPE/IRRIG. ;
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIN,4L CONST. FlRE DEPT. FINAL
------ _ � ______
FINAL HE�4TING � I HEALTH DEPT. FINAL
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\� FINAL ELECTFiIC ; DEV. FEES PAID ^_ _
FINAL PLUMBING � � ENERGY �
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