HomeMy WebLinkAbout10-1014 CITY OF DIAMOND BAR `/ � _ C 3
�---1��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SER�E �� G�v� 6 �I
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21825 Copley Drive,Diamond Bar,CA 91765 Jp�p�hi y!e �N1[S(J1��
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'"�'� BUILDING PERMIT APPLICATION FIRMLY I
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w TUHE,PRqH 70 ITS ISSUANCE,AL50 REQUIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � �
STATEMENT THAT HE OR SHE IS�ICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAP7ER e(COMMENCING WITH SECTION 70oa)OF DIVISION 3 OF THE BUSINE55 AND PRO� � POOVSPB
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V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z Re-Roof
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WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70��,BUSI� J -
� NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE UW DOES NO7 APPLV TO AN OWNER OF �
PROPER7V NMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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� WHOCANTRACTSFORSUCHPHOJEC7SWITHACANTRACTOR(S�LICENSEDPURSUANTTOTHECANTRAC� QUANTITY DESCRIPTION FEE
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� I HEREBY AFFIRM UNDER PENALTY OF PERJUiiV 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
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� WORKERS'COMPENSATION DECLARATION Q '
� I HEREBV AFFIRM UNDER PENAL7V OF PERIURY ONE OF THE FOLLOWING DECURATIONS: Z �
� _I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' a
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Q COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOH THE PERFORMANCE w
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REQUIRED BV SECTION
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POUCV NUMBER ARE: CONSTRUCTION ��
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
(} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
N WORNERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECT�ONFEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F THE LABOR /�
CADE,I SHALL FOHTHWITH COMPLV WIiH THOSE PROVISIONS. SU NC ..V
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p DATE: APPLICANL �
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREOTHOUSAND ENERGYPERMIT
DOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S fEES. ETENTIO FEE:
� CONSTRUCTION LENDING AGENCY � PR ALT FEE: -
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� I HEREBV AFFIRM UNDER PENAL7V OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY �/G�/�� / �
� FOR THE PEiiFORMANCE OF THE WORK fOP WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). � �Sft'b��� ,
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�Z LENDER'S NAME
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� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. _ I„ „/„�I ,/�
w I ACaREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING L���_-Q ��Y�S�
� CANSTRUC710N,AND HEREBV AU7HORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPEFTV FOR INSPECTION PURPOSES.
� M`�r,� ���� COMMENTS �
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m PEiiMI77EE NAME(PRINT) � �
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� SIGNATUflE OF ERMITTEE DATE
= RECPT.NO. " PAID VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST
FTGSIFORMS/STEEL � 20� FHA REQMTS
ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONQUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING �`I 1� i 8 FT. BOND BEAM
FRAMINGNENTILATION fb FINAL BOND BEAM
� ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCI�G
WALL INSULATION POOL FINAL
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 DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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