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W � WORKERS'COMPENSATION DECLAFATION a = U � IHEREB�AFFIflMUNDERPENALTYOFDERNRYONEOFTHEFOLLOWiNGDECLAfU710NS: � ' � Z Q � �IHAVE�NDIMLLMNNTAINACEfitIFICATEOFGONSENiTOSELF•IhSUREFOAWORKERS' 2 001APENSA7qti,ASPRONDE00Y5EC110N97U00FTHElAB�RC�DEFOfiTHEPE0.PofiMM10E W OF E WORK FOR WHldi THIS PERM17 IS ISSUED. . � � . .. . . .. . .. . - . . .. ' � 1 HAYE AND V�IL MNN7AIN WONCERS'COMPENSATION INSUMNCE,�5 REOUIRED BY SECTqN Q �7Qo OF TFIE UIBOH COOE.FOfl iME PERfOHMANCE OF iHE WOaC FORNMICH THIS PERMIi IS _�U ISSUE�.IAYW'ORK£RS'CO�PENSATIONINSURRNCECARWERhNUPOLICYM1u6ER/JiE�. CONSTRUCTI A - � �r�_-_r Q ,�1 , > daniEa f'/�U LI� IN f1 PLAN EVIEW. _ .. Z POLICY NUM6ER�j'1� .���'� Cr � . ��. . Q o �ss�cnoraramr+ote[a��rmaFn�v�w.�rrsw�a+Eru�f��lu�sR��1�+�1 PLUMBING Z �CENTiFV iNAT IN THE P£AFOAMANCE OF TH£WORK FOR WHICN TN15 PEM4S t5155UEO,I MECFIANICAI, (J SFLLLLNOTEMPLOYANYPERSONINIINYMMlNERSOASTDBEGOMESUBJECTTOTN[ - . . . . . . ... ._ . _ . . � WORKERS'COMPENSATIONUIWSOFCALIFORNI.�,�NOAGREETHATIFISMOULOBECOME INSPEC71ONFEE- S SU&IEGTTOTMEWOFKEHS'W,.�PENSATIONPfiOVI510N50F5ECiqN 7000FTHEUBOA � / �� COOE,I SHALL FORiHWITHCOMPLY W17H SE PNOVISIONS. O SMIP p DATE:�� APPIICA . w ENERGY P!C J WARNING:fAILURETOSECUREWORKERS'CWaPENSAT10NCOVERAGE�SUNUWFULIWDSNAl16E � SUOJEC'�MIEMPLOYERTOCRIMINAL7ENALTIESANOCMLFWE5UPTOONEHUNDREDTl10USM1D ENERGYPEFiM1T OOLLARS(f1o0JD0a1.IN ADOITION TO THE COST OF CA�AVENSATION,DAMACES AS PROVIDED FOR IN J SECTION37oeOFTNELABOACODE,►7TEREST.ANDA770RNEY5FEES. - - RETEN7IONFEE: � . . w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � o.. O ' � IHEREfiVAFFlRMUNDEfiPEN�L7YOFPERJURVTHATTHENEISACONSTRUCTIONLENDINGAGENCY FOR iHE PENFORMANCE OF TME N�ORN FOR WHld/THIS PERMIT IS ISSVEO(SEC.7007,CIY.C.). Z . . W � LENDER'S NAME H LFNOER'SJ�DDAESS ij� � ICERTtF1fTNATINAYENEA0THI5APPlICATONMlOSTATETMATTMEAHOVEINFORMA7qtJI5COFRECL TOTAL FEES , _ � �,� w IAGREETOCOMPLYWiTHALLCrt'IANOCWNTYOW7INANCESANDSTATEUWSREUTWGTOBUILDING �" WNSTHUC710N.ANDHERE6YAUTMOFIZEREPRESEN7ATNESOFTHISCWMYiOENTERUVONTHE . � . - • � � 790VE�MENTqNEDVHOPEA7YFOFlINSPECTIONDUAPDS£5. . Z . � . - COMMENTS � J � . . m P i EENAME(PiL' . Q � �J N GNn7UHEOF �RMITTEE . . , _ �,DATE ,. y(. pq�p gy VALIDATION , ' RECPT.NO. � �WH1TE—Departrnent Copy.YELIOW—Finance Capy.PlNK—Assessor Copy,GOIDENROD—File Copy.GREEN—ApplicanCs Copy � r.{: ;...•..,,,....�..�:��.: �.,.:...�...-..�.-«.�... .r. .,, , . :. . . . .M �r.....K _�..:...�.:. . . �: .4""• ' .,.. .... ...,a. . �.n. � .s u. r. ... . . . . ;'.i.�.1.. .'' _ ClTY.OF DIAMOND BAR . '.� , � -�� - INSPECTION RECORD � � . � .. , ' '� . .. ' . 1 . �. . , w' �. r ` , � • • � • , � • � SET BACK � FLOOR JOISi' - - FTGS/FORMS/STEEL L �' � ' FHA REQMTS - _..,, ,, , , ,. �. -' ELECTRIC GROUND - UNDER FLOOR DUCT_� :;.s.'� — ,-, �,, :-,..', ;�;• GROtJND PLUMBING �� -- � UNDER.��COI�IQUIT•'�'�'' �' `! z �' " •' S�AB GRADE - - � FIREPLACE FOUNDATI�N� ': ` � ` � ' ' TEMP POWER - - FIREPLACE BOND BEAM:' � '� ' �' '� • " '` �`•- ' WA'�ER'SE ICE�, �'�'� =';-•" ':' ".' �"•�`,==' MID HT:BOND BEANI• ' ' � . ROOFSHEArtt11N�•.i`.; ::;�. _��,;�. -,,.,-.:•�-: eFT.BONDBEAM FRAMINGNENTILIATION ' FINAL BOND BEAM . •,; , • ROOF COVER � - - PRE-GRADING �'•' • �� � • ROUGH HEATING - - - - ' BENCNING - ROUGH ELECTRfC - - � ROUGH GRADING ROUGH PLUMBING : - FINISN GRADING. - SHOWER/TUB TEST � POOL ELECTRIC ;:,� EXT.LATH/SIDING - POOL FENCING - WALL INSULATION POOL FINAL ' ' CEILING INSULATION OFF SITE IMPS. • • • - DRYWALL NAILING � DEDICATIONS � ; r SEWER _ ' FINAL ENG. � SEPTIC TANK '' `'.'` �-'� LANDSCAPE/IRRIG. � , .. , � SEEP.PIT/L.L.-. .._ -..-- -. .. - ON SITE IMPS. , � GAS aIR TESt - — = - ' ' - FINAL ZONING � FINAl.CQNST. - - (p r,.� � FIAE DEPT.FlNAL F1NAL HEA7ING —= - HEALTH DEPT.FINAL - F1NAL:ELECTRIC - � -� " - DEV.FEES PAID ; , • FINAL PLUMBING . .. r-� ENERGY •. i .,� � ..� , . . . � . ' • • • • � . ���v r � �t11. - ._.. .. ... _ ..._. _ :_ .�.__. _ ... _. .. .- . _. .. COMMENTS � - • . -. ; ... . , . , --- . . - . . ;. � . . _. � . _.. , . � . . . , _ . � -� - ._ , . _ .. .._ - , , _. , ,- . , . . _ _ � � - .. � . � .� . SEPT(C TANK SIZE SEEP PIT/U SlZE - � ; , , , : —� . � ,...• . . . .. . , . .. 9 �•' � � �_ .' _ _. �_ ��.� ' _. ' ..� __ y�J 4�^�- --- � _.. ' / �