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�`_ CITY OF DIAMOND BAR .
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21825 Copley Drive,Diamond Bar,CA 91765 � PRESS
'� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
"�9��" BUILDING PERMIT APPLICATION
� JOBSITE I , APPLICATION- Q �O NU BE�D /03 S P'�j�- o �
Q ADDRESS 370 � DATE �►
� �' ISSUE �/_/�,� �D CONST. j�ROUP
APN LOT TRAC7 e DATE
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Z TUHE.PPIOR TO ITS ISSUANCE.ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
W STATEMEM 7HAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CANTRACTORS LI�
�S CENSE LAW(CHAPTER Y(COMMENCINp WITH SECTION 7000)OF DIVISbN 3 OF THE BUSINESS ANO PRO- LL' PooUSpa
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Z TION,TME�WNER-BUILDEFY W�LL HAYE THE BUROEN OF PROVINQ THAT HE OR SHE DID NOT BUILD OR
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Q TO CONSTFUGT THE PiiOJEC1(SEC.70U,BUSINESS 1JJD PROFESSIONS CODE:TME CONTMCTOAS LI� V8IU8lVOn� ADJ.AREA
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� 1 HEREBY AFFIfUI UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDEF PROVISIONS OF CHAPTER �e �
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� WORKERS'COMPENSATION DE RATION Q _
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N 1 HEREBY AFFIPM UNDEF PENALTV OF PERNR�ONE OF THE FOLLOWING DECLARATIONS: ' ' � '
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� IHAVEMIOWILLA/AINTAINACERTIFICATEOFCONSENTTOSEIF�INSUREFOHWORKERS' _
� COMPENSATION,AS PROVIDED BV SECTION 37000FTHE LABOR CODE,FOH 7HE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w I HAVE AND WILL MAINTAIN WOFl)(ERS'CAMPENSATION INSURANCE,AS REWIRED BV SECTION '
Q 37000F THE LABOR CODE,FOR THE PERFORAIANCE O�F1 HTHE q{{Wyy/O�WWNRK(-0R WHICFI TNIS PERMIT IS
ISSUED.MY WO RS'CAMPENSA N INSUR�C R��POLICV NUMBER ARE: ONST UCTIO
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0 (INIS SECIION NE�NOT BE O]MPLE7ED OFhE PEPM�IS FOR ONE FiIA�DRED�OI.LPAS K100)OR LESS}
w I CERTIFV 7}IAT IN THE PERFORMANCE OF YHE WORK FOR WHICH THIS PERMIT 15155UE0,I ECHA ����
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(� SHALL NOT EMPLOY ANY PERSON IN ANY MANNE O AS TO BECOME SUBJECT TO THE
� WOFKERS'COMPENSATION UWS OF CALIFOR AND A�REE THAT IF I SHOULD BECAME INSPECTION FEE /��,��
� SU&IECTT THE RKERS'COAIVENSATIO VISIONSOFSE ON370oOFTHELABOf7 UANC
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� O I IO APPLICAN� ��•� " .
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� WARNING FAILURE TO SECURE WORKERS' MPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE � . '�✓�
� SUB.VECT AN EMPLOVER TO CHIMWAL PE T{ES AISD CIV��FINES UP TOON£HUNDRED THOUSAND N RGY PE �
OOIURS(f100.oa0).IN ADDITION TO TH OST OF COA/PENSATION,DAMAGES AS PFOVIOED FOR IN
J SECTqN 370!OF THE LABOR CODE,INTEREST,AND A7TORNEV'S FEES. ETENTION FE ' � D�� � .
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w CONSTRUC710N LENDING AGENCY P A FEE:
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CC I NEREBYAFFIRM UNDEF 7ENALTV OF PERJURV THAT THERE IS ACANSTRUCTION LENDINO AGENCV
d FOR THE PERFORMANCE OF THE WORN FOR WHICH iHIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. '
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� LENDER'S NAME
� LENDEfYSAD�RESS �j
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� I CERTIFY THAT I HAVE READ 7HIS APVUCATION AND STATE THAT THE A60VE INFORMATIOfJ IS GORRECT. TOTAL F E ES �� �/. �
W 1 AaREE TQ COMPLY WI�H ALL CRY AND CWNTY OFDINANCES ANO STATE UWS HEUTINO TO BUILOINO
� CONSTFUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS CWNTY TO ENTER UPON THE .
� ABOVE-MENTION D ROPERTV�SPECTION PURPOSES. .
Z � COMMENTS
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SET BACK , FLOOR JOIST �
FTGS/FORMS/STEEL FHA REQMTS ,
ELECTRIC GROUND UNDER FLOOR DUCT •
GROUND PLUMBING UNDER FLOOR CONDUIT �
SLAB GRADE FIREPLACE FOUNDATION �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAivI
FRAMINGNENTILATION FINAL BOND BEAM •
ROOF COVER PRE-GRADING
ROUGH HEATING Z BENCHING
ROUGH ELECTRIC /b ROUGH GRADING
ROUGH PLUMBING !! FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF S�TE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPElIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � � FIRE DEPT. FINAL �
FINAL HEATING ��b _ HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING ENERGY
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