HomeMy WebLinkAbout12-786 ��„`_ CITY OF DIAMOND BAR / I
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21810 Copley Drive,Diamond Bar,CA 91765
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• (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
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� 1 HEREBY AFFIRM UNDER PENNSY OF VERIURY TMAT IAM LICENSE�UNDER PROVISIONS OF CHAPTER � � - �
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� WORKERS'COMPENSATION DECLARATION Q � � �� -
� I HEREBY AFFIPM 11NDER PENALT'OF PERIUFY ONE OF THE FOLLOWING DEClARA710NS: Z � �
� _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WOHKERS' _
COMPENSATION,AS PROVIDED BY SECTION 37o00F THE LABOR CODE,FOR TME PERfORMANCE W
Q OF THE WORK FOR Vh11CH 7HIS PERMIT IS ISSUED. � � �
w _I HAVE AND WILL MAINTAIN�WORKERS'COMPENSA710N INSURANCE,AS REOUIREO BV SECTION � � �
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ISSUE�.MY WORKERS'CAMPENSATION�NSURANCE CMRIER ANO POlIC1'NUMBER ARE: �CONSTRUCTION ��
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(� SHALL NOT EMFLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SU&IECi TO THE �
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THA7 IF I SHOULD BECAME INSPECTION FEE
� SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SEC710N�7o00F TNE IABOR �- � - - n
� CA E,I HALL FORTHWITN COA/PLY WI7H T SE PROVIS�ON. � ISSUANCE � ' �. v
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� SU&IECT AN EMPIOYER 70 CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDRED Ti0U5AND ENERGY PERMIT
DOLURS�5100.000),IN AD01710N TO THE C0.ST OF COMPENSATION,DMIAGES AS VROVIDED FOR IN
J SECTION 370!OF 7HE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. � -
p� RETENTION FEE:
OCONSTRUCTION LENDING AGENCY Pp ALT F E:
� 1 HEREBY AFFIRM UNDER PENALTV OF PE0.IURY THAT THERE IS A CONSTRUCTION LENDIN6 AOEHCY �j �'� � �
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� I CERTIFY THAT I HAVE FiEAD THIS MPLICATION AND STATETHATTHE ABOVE INFORMATION IS CORRECT.
W I AGREE TO COMPLY N7Ti AlL CT'AND COUN7Y ORDINANCES AND STATE UWS REUTWG TO BUILDINO
� CONSTRUCT�ON,AND HEREBV AUTHORIZE REPRESENTATNES OF 7HI5 CWNTY 70 ENTER UPON 7NE �
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� RECPT.NO. PAID BY r VALIDATION
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FTGS/FORMS/STEEL �FHA REQMTS ________________ ________
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GR�UND PLUiViBING 'UNDER FLOOR CONDUIT
SLAB GRADE 'FIREPLACE FOUNDATION
TEMP PObVER �FIREPLACE BOND BEAM
WATER SERVICE �MID HT.BOND BEAM
ROOF SHEATHING I 8 FT.BOND BEAM
F RAM I NGNENTILATI ON -------------------- �_FI N AL BOND BEAM------.---------__ -----------
ROOF COVER IPRE-GRADING
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ROUGH HEATING I BENCHING
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ROUGH ELECTRIC i ROUGH GRADING
ROUGH PLUMQING �FINISH GRADING
SHOWER/TUQ TEST �PQOL ELECTRIC
EXT.LATH/SIDING ;POOL FENCING
WALL INSULATION �POOL FINAL
CEILING INSULATION 'OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
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SEPTICTANK __ _ _ _ �LANDSCAPE/IRRIG. _ ____
SEEP PIT/L.L. (ON SITE IMPS.
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FINAL CONST. FIRE QEPT.FINAL
FINAL HEATING �HEALTH DEPT.FINAL
FINAL ELECTRIC ;DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
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