HomeMy WebLinkAbout1155 DIAMOND BAR BL (13) � CITY OF DIAMOND BAR �������
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 �j,� v
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702�'�'�� � U f`"�� PRESS
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w TURE,PRIOH 70 ITS ISSUANCE,ALSO REOUIRES THE APVLICANT FOR SUCH PERMIT TO FILE A SIQNED w
� STATEMENT THAT HE OR SHE IS 110EN5ED PURSUANT.TO THE PROVISIONS OF THE CONTMCTORS LI�
C CENSE LAW(CHAPTEH B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPB
`1 FESSIONS CODE)OR THAT HE OR SHE IS E%EMPTTHEREFROM ANO TNE BASIS FOR THEALLEOED E%EMP- �
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A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5600)J:
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Z VALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED f-0R SALE(SEC.7MI,BUSI� J J
� NE59 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
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� Y(COMMENCING WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z '
XL' MY LICENSE IS IN FULL FORCE AND EFFEC7. m
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBY AFFIRM UNDER PENALTY OF FERIURV ONE OF THE FOLLOWING DECURATIONS: Z
� _I HAVE ANO WILL AUINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WORKERS' a
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COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE U
OF THE WORK FOR WHlpi THIS PERMIT IS ISSUED. W
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QW �I HAVE AND WILL MAINTAW WOqKERS'COA/PENSATION INSURANCE,AS REQl11RED BY SECTION
3700 0F 7HE LABOR COOE,FOR THE PERFORMPNCE OF THE WORK FOR WHICH THIS PERMIT IS /J�
J ISSUED.MY WORKEFS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION !/
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
C} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS 70 BECOME SUBJECT TO THE
(/y WORKERS'CAMPENSATqN UWS OF CALIFORNIA,AND AGREE TMAT IF I SHOULD BECAME INSPECTION FEE
SU&IECT TO THE K'OH)(ERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE IABOR �
s CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVI�^ION ISSUANCE �D
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p DATE:_��� APPLICANT: _/l��if ���ti/ SMIP �(�
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J WAFiNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHAI.L BE
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� SU&IECT AN EMPLOYER TO CRIMINM.PENALTIES AND CML FINES UP TO ONE HUNDRED TNOUSAND ENERGY PERMIT
DOLLARS(f100,000�,IN ADDITION TO THE COST OF COMPENSATqN,DAMhGES AS PROVIDED FOR IN
J SECTqN 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. �1
w RETENTIONFEE: L,O�
O CONSTRUCTION LENDING AGENCY � PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV i}U.T THEHE IS A CONSTRUCTION LENDINO AOENCY
� FOR THE PERf-0RMANCE OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDERS NAME
F— LENDER'SADDRE55
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w I CEHTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES / � W 9 �D�OO
� I AGREE TO COMPLV WITH.LLL CITV AND CWNTY ORDINANCES AND STATE L1WS REUTINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ' /
Z ABOVE-MEMIONED GROPERTV FOR INSPECTION PURPOSES. . COMMENTS_ ' � �(Q�
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WHITE-0epartment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,OREEN—Applicant's Copy
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ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FfNAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRlC ROUGH GRADlNG
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEIIING INSU�ATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/(RRIG.
SEEP P(T/L.l. � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
�F1NAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COIVI M E iVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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