HomeMy WebLinkAbout13373 (135) �� CITY OF DIAMOND BAR F
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
� (909)86a3195 Fax(909)861-3117 PRESS
��`'��' BUILDING PERMIT APPLICATION FIF�MLY
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Z 7URE.PRIOR TO RS ISSUANCE,AL50 REOUIRES THE APPLIGNi FOR SUCH PERMIT TO FILE A SIGNED
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NESS AND PiqFESS10NS CODE:THE CONTMC70RS LICENSE LAW OOES NO7 APPLV 70 AN OWNEH OF
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� LICENSED CONTRACTORS DECLARATION � –' '
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1 HEREBY AFFIRAI UNDER PENALTV OF PERIUIiY 7HA71 AM LICENSED UNOER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WRH SECTION 7000)OF OIVISION 3 OF THE BUSINESS/J!D PROFESSIONS CODE.AND Z
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIRM UNDER PENALTY OF PE0.)UHY ONE OFTHE FOLLOWING DECUMTIONS:
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� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOHKERS' 2
� COMPENSATION.AS PROVIDED BY SECTION 370o OF THE LABOR CODE.FOR THE PERFORMANCE �U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w � I HAVE AND WILL MAINTAIN WORNERS'CAMPENSA710N INSURANCE,AS REOUIRED BY SEC710N � ^
Q 37000f THE LABOR CODE,FOR THE PER WRMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ��, ;�
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
� CMRIER PLAN REVIEW U
� POLICYNUMBER ELECTRIC
0 (fHISSECf10NNE�NOTBEODAREfIDOFhEPEMfTISFORONEMI�ORED00LL�fiS(5100)ORLESS} PLUMBING
w MECHANICAL
Z I CERTIFV 7HAT IN 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
C}' SHALL HOT EMPLOY ANY PERSOIJ IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGfiEE THAT IF I SHOULD BECOME INSPECTION FEE
S SU&IECTTOTHEWORKERS'COMVENSATIONPROVISIONSOFSECTION37000FTHELABOR �SSUANCE ����p
CODE,I SHALL FOfiTliWlhl COMPLV WITH THOSE PROVISIONS. �/
p DATE: APPLICANT: . SM�P �� �1�
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� WARNINU:FAILURE 70 SECURE WORKERS'CAMPENSA710N CAVERAGE IS UNLAWFUL,AND SHALL BE.
� SU&IECTMI EMPLOVER TO CHIMINAL PENAL71E5 Ml�CIVIL FINES UP 70 ONE HUNDRED THOUSAN� ENERGY PERMIT
DOILARS(floo,o00).IN ADDITION TO 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN /�
� SEC7qN 37o80F THE L/�BOR COOE,INTEREST,AND ATTOHNEV'S FEES. RETENTION FEE: � � "
� CONSTRUCTION LENDING AGENCY PRE- FEE:/�
� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV 7HAT 7HERE IS A CONSTRUC710N LENDING AGENCY ����r '
FOR 7HE VERFOfiMANCE OF hIE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oY7,CIV.C.).
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� LENDER'S NAME � �
F– LENDER'SADDRESS
¢ ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATpNISCORRECL TOTAL FEES � �
w I AGREF 70 CAMPLY N7TH ALL CfiV AND COUNTY ORDINANCES PND STATE UWS REIATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUh10RIZE HEPRESENTATIVES OF 7HI5 CAUN7Y TO ENTER UPON THE -
ZABOVE-MEMIONE000.+PE F INSPE auaaosEs. COMMENTS �
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� RECPT.NO. jS PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SLAB GRADE ' FIREPLACE FOUNDATION "'' `' � . , ";:'� ' ' �'�'�`�`'
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TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEi4M
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ROO�SFi�ATFt P!Q•,. ` - " ' ' , ,
FRAMINGNENTILIATION ' �� . �_. , � FINAL BOND BE,AM , .�,,�;,�.•;_; �, , ;;• � 1 � , ,,,� :�, ... !
ROOF COVER ` PRE-GRAD�JG� ` ,•,;'�E` � k.>ti• ;4 :,�... �,. .
ROUGH HEATING � BENC 'dht'(n'•. ��;ti_• ,�;'� ._--f'- - -.�ti•:'s-�:.;�.�,==-
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUPABING FINISH GRADING
SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATH/SIDING � POOL FENCING ' 3
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL iVAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAfVK __ _ �,t LANDSCAPE/IRRIG.
SEEP PIT/L..L. ' �' 1 ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. , o FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FIIVAL PLUMBING ENERGY.
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