HomeMy WebLinkAbout11-406 �,ti,`_ CITY OF DIAMOND BAit
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�,W . 21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'`�"'� BUILDING PERMIT APPLICATION FIRMLY
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Q ADDRESS l�� � T�7 1�J vN � � C;}- APPLICA ION PERMIT P/C
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w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 70 THE PROVISIONS OF THE CONTRACTORS LI- �
� CENSE UW(CHAP7ER 9(CAMMENCING WITH SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- POOVSPO
, � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
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WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7ou,BUSI- J
N NE55 AND PROFESSIONS CODE:THE CANTRACTORS IICENSE lAW DOES NOT A7PLV TO AN OWNER OF �
PROPER'TY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THFlOUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m
w OFFEREDFORS�LE.IF,HOWEVERTHEBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCOMP�E�
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� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS Of CHAP7ER" �
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� WORKERS'COMPENSATION DECLARATION � �� Q
� I HEREBV AFFIRM UNDER 7ENAL7V OF PERJURY ONE OF THE FOLLOWING DECURA710N5: Z
ZI HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
. Q COMPENSATION,ASPROVIDEDBYSECTION37000FTHELABORCODE,FORTHEFERFORMANCE U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOF WHICH 7HIS PERMI715 �;,��
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POL/ICY NUMBE�R A�R�E: CONSTRUCTION 1��] �
j CARRIEF ��+� U�� , �'���(y,�� C1��1�./J"1 �i–�'�C}.�� PLANREVIEW
0 POLICV NUMBER N/S I��y`O�',L L�?'j OC'r ELECTRIC
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0 (fHLSSECfIONNE�N0T8ECOA1PLEfEDOF7HEPEW.YTISFORONEHUPDREDDOUJ�FiS(f100)ORLESS} PLUMBING
Z �CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C,�} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BE ME SUBJECT TO THE
N WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE T IF I SHOULD BECOME INSPECTION FEE
= SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF 5 ION 3700 Of THE LABOR ��. A S
CODE,I SHALL FORTHWITH COMPLY WITH T OSE PROVISIONS. �SSUANCE T�
p DATE: �" �1�APPLICANT: '� i/J,•• 1 SMIP , • �.,,/
J WARNING:FAILURE TO SECURE WORNERS'COMPENSATION COVERA, IS NIAWFUL,AND SHALL BE ENERGY P/C
� SUBJECT AN EMPLOYER TO CRIMINAL PENA�7IES AND CIVIL FINES UP 7 NE HUNDRED THOUSAND ENERGY PERMIT
OOLLARS(i100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ^
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: Ol•�G
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBYAFFIRM UNDER PENALTV OF PERJURY THA77HERE IS ACONS7RUCTION LENDING AGENCV Q�� i 1•QO
FOR THE 7ERFOflMANCE OFTHE WORK FOR WHICH TMIS PERMIT IS ISSUED(SEC.3097,CIV.C.�.
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� LENDER'S NAME
F- LENDER'SAD�RESS
� TOTAL FEES �
� I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. a�� _
w 1 AGREE TO COMPLY WITH ALL CITY ANO COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUN7V 70 ENTER UFON THE
� ABOVE-MENTIONED PPOPER7Y FOR INSPECTION PURPOSES.
Z COMMENTS
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� RMITTEE NAME(PRINT) � �
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� SIG �TUREOF PERMITTEE DATE -��i
= RECPT.NO. �Q,g PAID BY � �S oy.� VALIDATION
~ � WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK � � FLOOR JOIST
FTGS/FORMS/STEEL i -- FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCNING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING � FINISH GRADING -
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING P�OL FENCING
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 QEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEEP PIT/U SIZE
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