HomeMy WebLinkAbout18160 CITY OF DIAMOND BAR �
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AA1 EXEMP7 FROM THE CONTRAC70RS LI� G8fdg0/C3fpOR
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w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PpOVISIONS OF 7HE CONTRACTORS LI- �
� CENSE LAW(CHAP7ER B(CAMMENCING WITFI SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
� FESSIONSCODE)ORTHATHEOFiSHEISEXEMPT7HEREFROMANDTHEBASISFORTHEALIEGEDEXEMP� (�
U TION.ANYVIOLATIONOFSECTION7031.SBVANYAPPLICANTFORAPEHMITSU&lECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL 7ENALTY OF NO7 MORE 7HAN FIVE HUNDRED DOLURS(SSoo).):
Z ❑I,ASONTJEROFTHEPROPEfiTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfi1R10fC18I -
WILL DO THE WORK,AND THE STRUCTUqE IS NO7 INTENDED OR OFFERE�FOR SALE(SEC.7o4I,BU51� J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF
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Q OFFEREDFORSALE.IF,MOWEVEf1,iHEBUILDINGORIMPROVEMENTIS50lDWI7HINONEYEAROFCOMPLE- '
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR
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w ❑I,ASOWNEROFTHEPROPER7V,AMEXCLUSIVELVCONTRACiINGWITHLICENSEDCANTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.70�a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� VelUeSlOfl ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN ONRJER OF A PROPERTY WHO BUILOS OR IMPROVES THEREON,AND
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Q ❑I AM EICEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER H
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PPOVISIONS OF CHAPTER �
� B(COMMENCING WITH SECTION 7oao)OF DIVISION 90F THE BUSINESS AND PHOFESSIONS CODE,AND Z
'X MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. j
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z �
� _IFIAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' a
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CAMPENSATION,AS PROVIDED BY SEC710N 37o00F7HE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION `` \
Q 3700 0F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 �� �� � 7 � V
ISSUED,MV WORKERS'COMPENSATION INSURANCE CARRIER AND POUCV NUMBER AflE: CONSTRUCTION _\ �/�'
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� CARRIER PLAN REVIEW
� POLICYNUMBER ELECTRIC
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� (IHLSSECi10NNE�NOTBEO�MPLEfFDOFTHEPERMffISFONONEFNPDfiEDD0UAR5(f10o)ORLESS). PLUMBING
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK fOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
�}' SHALL NO7 EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANO AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECT TO THE WOFKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR �
� CODE,I SHAIL FORTHWITH COMPIV WITH THOSE PROVISIONS. ISSUANCE �
� SMIP , .�—��/
p DATE: APPLICANT:
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f700,000J,IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEY'S FEES. RETENTION FEE:
d CONSTRUCTION LENDING AGENCY PRE-ALT FE :
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HAT7HERE IS ACONSTRUC710N LENDING AGENCY
FORTHE FERFOFMANCE OFTHE WOFiK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS /�
� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES � ��.' �O -' D L.
w 1 AGREE TO COMPLV WITH ALl CITV AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING (�
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7V 70 EN7ER UPON THE
z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant Copy
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ELECTRIC GROUND j _j_; UNDER FLOC�R DUCT
GROUND PLUMBING _ ; UNDER FLOOR CUI�IDUIT 1 __
SLAB GRADE � FIREPLACE FOURlDATION _ _
TEMp POWER FIREPLACE BOND BEAM ___ ___
WATER SERVICE � , MID HT. BOND BEAM _ _ _
--- -- �_. _.._ --
ROOF SHEATHING ____ � 8 Ff BOND BEAM �
-- -�-_.__ � - ----�— __..............
FRAMING/VENTILIATIdN --- ---._ _�. ���1AL BC)ND BEAM ;
__ --__ _ __. ........__._. ____ ___._._...._ .___
ROOF COVER ' PR�-GRADING � �
ROUGH HE,4TING BENCHING _ _____
ROUGH ELECTRIC � ROUGH GRADING _
ROUGH PLUiV161NG i FINISH uRADING ____
SHOWER/TUB TEST � I P�OL ELECTRIC _
EXT. LATHISIDING � POOt_FENCING _ � ___
WALL IIVSULATION ; POflL FINAL j
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CEILING INSULATI�N __J_---- ---- _�_t7�F S1TE IMPS. - ---------�--
DRYt�/ALL NAILING �EDIGA710NS
SEWER FINAL EI�G.
SEPTIC TAR1K LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON StTE IMPS.
GAS AIR TEST FlNAL ZONING
FINAL CONST. FIRE DEPT. FINAL.
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FINAL HEATING � j _HEAI_TH DEPT. FINAL
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FINAL ELECTRIC I, � �EV. �EES PAID
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FINAL PLUMBING � � ENERGY i ___ _
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SEPTIC TANK SIZE
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