HomeMy WebLinkAbout17549� ^ _�� _ CITY OF DIAMOND BAR �(
DEPARTMENT OF COMMUNTI'Y 8c DEVELOPMENT SERVICES `
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
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Q I HEREBV AFFIRM UNDER PENALTV OF FERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- Gflf89B/CefPOfl
W CENSE LAW FOR THE FOLLOWINO REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITV OR (n
U ('q�rJn'W�{ICHqE-0UIRESAPEAMITTOCONSTFUCT,ALTER.IMPROVE.DEMOLISH,ORREPAIRANVSTRUC-
W NRE,PRIOR 70 RS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIONED w PdllO/DBCk DO
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI�
�� CENSE UW(CHAPTER D(COMMENCINQ WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � PooUSpa
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANV VqLAT10N OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CML PENALT/OF NOT MORE THAN FIVE HUNORED DOLURS(SSaO�.):
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Z WILL DO hiE WORK�ND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70at,BU51- J �
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV Vhq BUILDS OR IMPFOVES iNEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALE.IF,FIOWEVERTIIEBUILDINOOqIMPROVEMENTI550lDWRHINONEVEAROFCAMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR .
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W ❑I,ASOWNEROFTHEPROPERTY.AME%CLUSIVELVfANTRACTINOWITHLICENSEDCONTRACTORS
� TO CONSTRUCT THE VRQIECT(SEC.7w1,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS U- V8IU8IlOf1 ��� ' ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEHOFAPROPERTYWFIOBUILDSORIMPROVESTHEREON,AND
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� I HEREBV AFFIRM UNDER PENAITV OF PERIURV THAT I AA/LICENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENCINOWITHSECTION7000)OFDIVISION7OFTHEBUSINESSANDPROFESSIONSCOOE,AND Z
��� MY LICENSE IS IN FULL FOFCE M!D EFFECT. m
� LICENSE CIASS � ���.No. 3 6 7 313^ �
U DATE �� O � `Z�. CONTRACTOH�I��'N=? . d
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� �I�I�ERS'COMPENSATION DECLARATION Q
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� I HERE AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z
�Z _I HAVE AND WI�L MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR NORNERS' ¢
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COMPENSATION,AS PROVIDED BV SECTION 3]OOOF THE LABOR CODE,FOR THE VERFORAIANCE U
O OF THE WORN FOR WHICH THIS PERAl1T IS ISSUED. �
w _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BV SECTqN
� 3700 OF 7HE LABOR CODE,FOH THE PERFORMANCE OF THE WORK FOR WHIq1 THIS PERMIT IS � �`� �
J ISSUED.MV WORKERS'COMPENSATION INSURANCE CAARIER AND POLICV NUMBER ARE: CONSTRUCTION _
j CAARIER PLAN REVIEW 1
Z Pa�cv rruMBEA ELECTRIC
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Z 1 CERTIFV THAT IN 7HE PERFORMANCE OF TME M'ORN FOR WHICH THIS PERMIT IS ISSUED.1 MECHANICAL
C} SHALL NOT EMPLOV ANY PEfl50N W ANV MANNER SO AS TO BECAME SU&IECT TO THE
N WORKERS'CAMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHWLD BECAME INSPECTION FEE
SU&IECTTO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 37ao OF THE LABOR .
-�j CODE,ISHALLFORTHWITHCOMPLVWI �E VROVIS1ONS. ISSUANCE v
p DATE: '" �0�O�ppp�ICANT: '�l�=�L�/'fn L!��� SMIP I ` I
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� WAANINO:FAILURE TO SECURE WORKERS'COMP SATqN COVER�GE IS UNLAWFUL,AND SHALL BE
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� SU6IECTAN EMPLOVERTO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5700,000),IN ADDITION TO THE COST OF CAMPENSATKKJ,DAMAGES AS PROVIDED FOR IN .`
� SECTION 3708 OF THE IABOR CODE,INTEREST,AND ATTORNEI"5 FEES. RETENTION FEE: {JU
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THEHE IS A CANSTRUCTION LENDING AQENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3ae7,CIV.C.).
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-�Z LENDER'S NAME
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� LENDER'SADDRESS
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w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTIIEABOVEINFORMATIONISCARRECT. TOTAL FEES
� I AGREE TO COMPLY WITH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS REIATINO TO BUILDING ��.+ •(Y'�
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO EMER UPON THE v \`��
Z ABOVE�MEMIONED PROPERTV FOR INSPEC710N PURPOSES. COMMENTS
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_ � RECPT.NO. PAID BY VALIDATION
~ WHITE—Departmen[Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SLAB GRADE FIREPLACE FC�URIDATION -�
TEMP POWER FIREPLACE BONQ BEAM• ' �
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ROOF SHEATHING J,,?�/�1y _ - 8 FT, BQND BEAM - -
FRAMIiVGNE(VTILIATfON FINAL BOND BEAM
ROOF COVER PRE-GRA�ING
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ROUGH ELECTRIC ���QL �� _ ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUBTES7 _� � ' � PO(�LELECTRIC
EXT.'LATH/SIDING POOL FENCiNG �
WALL INSULATION POOL FINAL
CEfLING INSU�ATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS '
SEWER FINAL ENG. .
SEPTIC TAI�lK LANDSCAPE/IRRIG.
SEEP PIT/L.L. � ON SITE IP�1PS.
GAS AIR TEST FINAL ZONING '
FINAL COIVST. � ��.�Z � , FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINRL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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