HomeMy WebLinkAbout1673 MAPLE HILL RD (3) __�„�_ CITY OF DIAMOND BAR (� �C���`�`U
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES /
� 21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 I3uilding Inspection Hotline(909)839-7027 PRESS
� '°"'� BUILDING PERMIT APPLICATION FIIRMLY
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W TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES 7HE APPLICANT FOR SUCH PEFiMIT TO FILE A SIGNED W
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� CENSE UW(CHAPTER 9(COMMENCING WITH SEC710N 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- POOUSpO
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PROPERTY NRiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR �
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� I HEREBY AFFIRM UNDEH PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER ~ �
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� WORKERS'COMPENSATION DECLARATION a
� I HE EBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z
� �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOq WORKERS' _
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. . �
w _1 HAVEAND WILLMAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REQUIRED BV SEC710N
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7 IS I
ISSUED.MV WORKERS'CAMPENSATION INS RANCE CARRIER AND POIICY NUMBER ARE: CONSTRUCTION
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Z I CELiTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
� SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME N FEE
= SU&IECT TO THE WORKERS'COMPENSA710N PROVISIONS OF SECTION 370o OF THE LABOFi
CODE,I SHALL FOR7HWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT:
J WARNING:FAILURETO SECURE WORKERS'CQMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SU&IECT AN EMPLOYER TO CFIMINAL PENALTIES AN�CIVIL FINES UP TO ONE HUNDRED THOUSAND IT
DOLLAPS(flao,00a),IN ADDI710N TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOH IN
� SECTION 3708 OF THE LA80F CODE,INTEfiEST,AND ATfORNEV'S FEES. ETENTION FEE: .
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED�SEC.3097,CIV.C.).
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� LENDER'S NAME
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� TOTAL FEES �
� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CAHRECT.
w I AGREE TO COMPLY WITH ALL qTV AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING
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� CONS7RUC710N,AND HEREBY AUTHORIZE REPRESEN7A71VE5 OF 7HIS COUNTY 70 EN7ER UPON 7HE
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ROOF SHEATHING 8 FT. BOND BEAM •
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ROOF COVER PRE-GRADING
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ROUGH ELECTRIC ROUGH GRADING
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SHOWERlTUB TEST POOL ELECTRIC
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CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL �
FINAL HEATING HEALTH OEPT. FINAL
F�NAL ELECTRIC � DEV. FEES PAID
FINAI PLUMBING ENERGY
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