HomeMy WebLinkAbout12-370 ��`_ CITY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765 I
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS I
� '9M'. BUILDING PERMIT APPLICATION FIRMLY I
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w NRE,PRIOR TO RS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W PatiNDeck
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� CENSE UW(CHAPTER Y(COMMENCING WI7H SECTION 7000)OF DIVISION 7 OF T1E BUSINESS AND PR6 POOUSPO
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Q THROUGH HIS OR HER OWN EMPLOVEES,PPOVIDED THA7 SUp/1MPROVEMEHTSARE NOT IN7ENDED OR m -
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� I HEREBYAFFIRM UNDER PENALTY OF PERJURV THAT I AM LiCENSED UNDER PROVISIONS OF CNAPTER �� -
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� WORKERS'COMPENSATION DECLARATION Q � � � � ��
� 1 HEREBYAFFIRM UNDER VENALTV OF PERJURV ONE OF THE FOLLOWING DE0.ARATIONS: Z �
� +/I NAVE AND WILL MAMTAIN A CERTIFICATE OF fANSENTTO SELF-INSURE FOR WORKERS' _
COMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE UBOR CODE,FOR THE PERFORMANCE W�
� Q OF THE WORK FOR NM1iICH THIS PERMIT 191SSUED. � '
w 1 HAVE AND WILL MNINTAIN WORKERS'COMPENSA710N INSUMNCE,AS REOUIRED BY SECTION - - � �
Q 3700 OFTHE LABOR CODE,FOR THE PERFORMANCE�OF THE WORN FOR WHICH THIS PERMI715
ISSUED.MY WORqKEAS'CAMPENSATION INSURANCE CARRIER AND.POLICY NUMBER ARE: CONSTRUCTION
j CARRIER <�(�7E�.� M IT*'�1�1 PLAN REVIEW
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Z I CERTIFY THAT IN THE PERFORMANCE Of THE WORI(FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SOAS TO BECAME�SU&IECT TO THE,
� WORNERS'COMPENSATIONtAW50FCALIFORNItiANDAGREETHATIFISHOULDBECAME INSPECTIONFEE
SUBJECT TO THE WORKERS'COM7ENSATIDN PROVISIONS OF SECTION 97000F THE LABOR '�1
� CODE,I SIULL fORTHWITH COMPLV WITH 7HOSE PROVIStONS. ISSUANCE _ _ �.I v
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p DATE: �'Z3��L APPLICANT:� IG�7 L rt ��%T L2 �SMIP
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P!C
� SUBJECT AN EMPIOYER TO CRIMINAL PENALTIES AND CIViL FWES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOILARS(S1a0,o00),IN ADDITION TO THE COST Of COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SEC710N 37oe OF THE LABOR CODE,INTEREST,AHD ATfORNEV'S FEES. ' RETENTION FEE:
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OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFIRM UNDER PENAL7V OF PERIURY THAT THERE IS ACANSTRUCT�ON LEN�INO AGEHCY
FOR T1E PERFORMANCE OF THE WORK FOR WHICN hilS PERMIT IS ISSUED�SEC.3067,qV.C.).
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� LENDER'S NMIE
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� I CER7IFY THAT 1 HAVE READ THIS APPLICATIONAND STATE TiAT7HE ABOVE INFORMATIOM IS CORRECT. TOTAL FEES �� � 3
w I AGREE TO CAMP�Y WITH ALL CITV AND COUNTV ORDINANCES�llD STATE UWS REU7WG TO BUILDINO
� CANSTRUCTION,AND HEREBV AlfTliOR12E REPRESENiATNES OF THIS COUNTY TO EMER UPON THE �
� A80VE-MENTIONED PROPERTV FOR INSPECTION 7URPQSES. -
Z COMMENTS
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CITY C?F DIANiO(VD BAR �
INSPEGTION REC4�tD �
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FTGS/FORMS/STEEL � � ';FHA REQMTS
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ELECTRIC GROUND 1 ;UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
-- � �--- -
SLAB GRF�DE ' '�FIREPLACE FOUNDATIQN
TEMP POWER � i FIREPL/�CE BOND BEAM
WATER SERVICE 'M�D HT.QOND BEAM
ROOF SHEATHING '8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER :PRE-GRADING
ROUGH HEATING ~BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING 'FINISH GRADING
SHOWER/TUBTEST �POOL ELECTRIC
EXT.LATH,'SIGING ;POOL FENCING
WALL INSUI_ATION �POOL FINAL
CEILING INSULATION 'OFF SITE IMPS.
DRYWALL NAILING =DEDICATIONS
SEWER -- --------- - -- ----- ;FINAL ENG. --------- ------ --- — —
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FINAL CONST. ;FIRE DEPT.FINAL
FINAL HEATING ;HEALTH DEPT.FINAL
FINAL ELECTRIC i QEV.FFES PAID
FINAL PLUMBING i ENERGY
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