HomeMy WebLinkAbout12-519 ��_ CITY OF DIAMOND BAR IJ
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES '� �f U�
21810 Copley Drive,Diamond Bar,CA 91765 v`�
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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p 1 HEREBY AFFlRM UNDEf1 PENAL7Y OF VEfiNRY THAT t AM EXEM7T FROM THE CONTRACTOR,4 L1- Gerage/Carport . .
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, � CENSE UW(pUP7ER e(COMMENpN6 WITH SECT70N�000)OF DMSION J OF THE BUSfNE59 AND PR6 � POOUSpe -
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Z WILI DO THE YVORI(AND THE S7RUCTURE 19 NOT INTENDED OR OFFERED FOR SALE(SEC.7oas.BU51- J � '
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PROPEHTY NM1ID BUILOS OR IMPROVES THEREON,AND V/lq DOES SUCH WORK HIAISELF OR HERSELF OR
w THROUGH HIS OR HER OWN EMROYEES,7ROVIDED 7HAT�SUCN IMP{iOVEMENTSARE NOT fMENDED OR m ,,
Q OFFEREDFORSALEIF,HOWEVER7ME&11LDPlOORIMPROVEMENTISSOLDWR}iP10NEVEAqOFCOMPLE
z TION.THE OWNEREUIIDER WILL MAVE TNE BURDEN OF PROVINa THAT HE OR SHE D!D NOT BUIID OR ,
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� ❑1 AM El(EMPT UNDEA SEC. �B.8 V.C.f-0R THIS REASON � � ��
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� DATE ONMER ��
� UCENSED CONTRACTORS DECLARATION W � � - � � � � � � - �
� I HEREBYAFFIqAI UNDER PENALTY OF PER0.IRY TMAT IAA1 UCENSED UNDER PROVISIONS Of CFIAPTER � ' ' '- -
d. Y(COMMENCIN6 NTTH SECTION 7000)OF DMSIOIJ]OF THE BUSINESS AND PROFESSIONS CODE,AND Z . '
X I,/Y LICEN9E i5 IN NLL FORCE AND EFFECT.
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� WOAKERS'COMPENSATION DECLARATION � � - �� -
� I HEREBYAFFIRM UNDER PENALiY OF PERNRV ONE OF THE FOLLOWW(i DEpAAA710NS V � ' �
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� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF�INSURE FOR WOPo(ERS' � - �
� COMVENSATION,AS PROVIpED BY SECTpN 37DD OF THE LABOR CppE,FOR THE PERFORMANCE U
OF 7HE WORK FOR WHICH THIS FERMIT IS ISSUED. W .
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Qw _�HAVE AND WILL M.UMAIN.WOPoCER3'�COMPENSATION INSUqANCE,/�4 REWfRED BV SECTqN
370o OFTHE LABOR CODE,FOR THEPERFORAIANCE�OF THE WOHK FOR WHIQi THIS PERMI713 �
ISSUED.MVWORKERS'CO�dPQdSAT,1,0�NINSUFANCECAHRIER �D.POLICYNUMBERME: �CONSTRUCTION:
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Z 1 CERTIFV THAT Pl 7HE PERFORMANCE OF THE.WORK FOH WHICli TFII$PERMIT IS ISSUEO.1 MECHANICAL
C7 SHALL NOT EMVLOYlWV PERSON M ANY MANNER SO AS TO BECOME SU&IEC7 70 THE� � �
(/) WORKERSCOMPENSATqNIAWSOFCALIFORM,t(JJDAGREETHATIFISHOUIDBECAME INSPECTIONFEE�
SUBJECT TO THE K'DAKERS COM7ENSAT�ON VROVISIONS OF SECTION 370o OF THE LA00R -
O cooe.i sw�u warrMnTH cw�P�v vnn�nwsE aAov�sror+s. /� ISSUANCE , . . . . .. . . ..
`p DATE 4/�—/ �- APPLICANP.: ��ILlN9 "Q/�4 /�� �SMIP �
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� WAHNINO:�FAIWRETOSECVREWOHICERSCOMPENSATIONCOVEMGEISIINUWFUL,AND.SHALLBE ENERCiYP/C �
� SUBJECf1JJEMPLOYER70CRIMw�1VENALTIESANDpVILFWE5UP700NEHUNDRFATHWSANp ENEROYPERMIT
DOLUIR3(5100.WD).'IN ADDITON TO7HE COST OF COMPENSATION,�AMA�ES AS PROVIDE-0 FOR IN
J SECTION 37ae OF THE LABOR CODE,WTEREST,AND ATfORNEV'S FEES. � ' ''
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� CONSTRUCTION LEN�ING AGENCY PRE-ALT FE�� Q
�. 1 HEREBY AFFlRM UNDER'PENALTV OF PERIURY THAT THERE IS A CqNS7RUCTION LENDW6 AOENCY
FOR THE PERFORMANCE OF 7HE WOR1(WR WHlpi THIS PERMIT IS iSSUED(SEC:30B1,CIY.C.).
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� LEFIDER'S�NAME - . . . ,
� LENDER'SADDRESS �
� TOTAL FEES � �LQ
� I CERTIFY THAT I HAVE READ THIS MPLICATION AND STA7E TFIAT THE ABOVE INfORMATIpN 19 CORRECT.
� W I A6REE TO COMVLY WITH ALL CT'A/JD COUNTY OFIDWANCES AND STATE UWS HEU71N0 TO BUH.DINO
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� CONS7RUCTION,AND HEREBY AlfTHO{UZE qEPqESENTATIVES OF 7Vi15 COUNTYTO EPf(ER UPON THE � �
Z ABOVE�MENfqNED PROPERTY FOR INSPECTION PUR705ES. COMMENTS �
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� WHITE—Deparpnent Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--Ffle GREEPI—
�ADY. Apptk;anl's Copy
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GROUND PLUMEING I UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BQfVD BEANI
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRAQING
ROUGH HEA7ING BENCHING
ROUGH ELECTRIC ROU GRG AH DING
ROUGH PtUMBING FINISH GRADING
SHOWER/TUB TEST I POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WAII INSULATIOPI POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIQNS
SEWER FINAL ENG. �
SEPTIC TANK LANDSCAPE/IRRIG.
5EEP PIT/L.L. ' ON SI7E IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
fINAL HEATItVG HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FlNAL PLUMBING ENERGY
FINAL PLAfJING •
FINAL ENGINEERING . � a
COMMENTS �
SEPTIC TANK SIZE
SEEP PITIU SIZE
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