HomeMy WebLinkAbout13364 (144) � CITY OF DIAMOND BAR F
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
_� 21660 E.Copley Drive Suitc 190
(909)86Q3195 Fax(909)861-3117 PRESS
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� STATEMEHT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE COMMCTORS LI-
� CENSE UW(CHAVTER G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � PooVSpa
FESSIONS COOE)Ofl T}IAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR 7HE ALLEOED EXEMP-
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NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE UW DOES NO7 APPLY TO AN OWNER OF
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� UCENSED CONTRACTORS DECIARATION W j_ ; .--.��
� I HEREBV AFFIRAI UNDER PENALTY OF PEfUURY iHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Vr r
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� I HEREBV AFFIRM UNDER PENALTY OF VERIURY ONE OF hIE FOLLOWINO DECURATIONS:
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. � I HAVE AND WILL MAINTAIN A CEHTIFlCATE OF OONSENT TO SELF-INSURE f-0R VYORKERS' 2
� COMPENSATION.AS PROVIDED BV SEC710N 370o OF THE 1A80R CODE,FOR THE PERFORMANCE �U
OF THE WORK FOR WNIq1 THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION /� A
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOFi WHICH THIS PERMIT IS / U
ISSUED.MY WOPKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION o�
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� (fFRSSECfpNNE�NOTBECOAFLETmOF7FEPERAfftSit�RONEHlRL7Fi�DOLLlJiS(5100)ORLESS} PLUMBING I
Z I CERTIFY hIAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL I
() SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE '
N WORKERS'CAMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOU�D BECOME INSPECTION FEE
S SIIBJECTTO THE WORKEHS'COMFENSATION PROVISIONS OF SECTION 370o OF THE LABOR -
CODE.1 SHALL FORTHMATi COMPLV WITH THOSE PROVISIONS. ISSUANCE �
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p DATE: � APRICANT: . . i
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WOHICERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
� SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOIURS(f7oo.o00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SEC7qN 37oB OF THE LABOR CODE,IN7EREST,AND ATTOHNEYS FEES. ' RETENTION FEE: �•
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a CONSTRUCTION LENDING AGENCY PRE./� FEE:
� I HEREBV AFFIRM UNDER PEN/�17Y OF PERIURV THAT THERE IS ACONSTRUCTION LENDING AGENCV ��
FOR THE PERFORMANCE OF THE WORK PDR WHICH THIS PERMIT IS ISSUED(SEC.30W,CIV.C.�. �
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� LENDER'S NAME
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w ICER7IFYTHATIHAVEREADTHISAVPLICATIONANDSTATETMAT7HEABOVEINFORMATIONISCARRECT. TOTAL FEES -
� 1 AGREE 70 COMPLY WITH/�LL CRY AND COUN7Y ORDINANCES ANO STATE UWS REUTINO TO BUILDING
CONSTRUCTION,AND HEREBV AUTVqRIZE REPRESENTATIVES OF THIS UNTV TO EMER UPON 7HE
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GROUND PLUMBING UNDER FLOOR CU�IDI�IT;�° � •'�"-�;;;+��` �:`��•�.`:`
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WATER SERVICE � , MID HT. BOND BEAM
RO'O�`SF�EA'�H1M�� ,:.,'., .;..': +.... , �:..; .� .....�, 8 FT. BOND BEAM.
FRAMINGNENTILIATION � � FINAL BOtyD�B�AM,,.,..,.�, .,� , _ � . ..., ��; '
ROOF COVER ..}.., PRE-GRAD,IN�'� '�F ;� .?r-1.�-;:,� �;�:...'.•,}' •��,,�;,>�•,� •
ROUGH HEATING ` BEN�hII�1G"'•,5.:i•.�`;� � __ , "'r't _;4�+:_,-� .
ROUGH ELECTRIC ROUGH GRADING
ROUGH RLUP+ABING ' " FINtSH GRADING
SHOWEFi/TUB TEST � POOL ELECTRfC � �
EXT. I.ATH/SIDING POOL FENCING
VNALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE I.MPS.
DRYWALL NAILING DEDICATIONS .
SEWER FINAL ENG.
SEPTIC TANK . LANDSCAPE/IRRIG.
SEEP PIT/L.L. ' �,�� ON SITE IMPS.
GAS AIR TEST FINAL ZONING �
FINAL CONST. �y �� � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAIQ .
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