HomeMy WebLinkAbout12-1048 ��_ CITY OF DIAMOND BAR '
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
,.;�W 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'�^'. BUILDING PERMIT APPLICATION FURMLY I
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1 HEREBY AFFIRM UNDER PEN�LTY OF PER0.IRV THAT 1 AM EXEMPT FROM THE CANTRACTORS LI• GefeJB/CBIpOA
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V COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTERIMPROVE,DEMOUSH;ORREPAIRANYSTRUG �
w TURE.�PRqR TO RS ISSUANCE,AlSO REOUIRES THE APPLICANT FOR SUCM PERMIT TO FILE A SIONED W Patio/Deck
� STATEMENT THAT HE OR SHE 4S LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTMCTORS LI- . . .
� CENSE UW(CHAPTER Y(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND-PRO- u- PooUSpe
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ACML PENNL7Y OF NOT MORE THANFNE HUNORED DOLURS(iSOD)J:
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Z VALL DO THE WORI(AND THE STPUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BUSI- J �
� NESS�AND PROFESSIONS CODEi THE CONTMCTORS UCENSE UW DOES NO7 APPLY TO AN OWNER OF � �
PROPEHTY WHO BUILD3 OR IMPROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR MERSELF OR
Q THROUGHHISORHEROWNEMPLOYEES,PHOVIDED7HATSUCHIMPROVEMENTSARENOTiNTENDEDOR m - �
Q OFFERmFORSALEIF,FiOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWfTHINONEYEAROFCOM7LE-
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� DATE � ONMER F- � � � �
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LICENSED CONTRACTORS DECLARATION �
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I HEREBYAFFIRM UNDER PENALTY OF PERJURY TNAT IAM�LICENSED UNDER 7ROVISIONS OF CHAPTER
d, 9(COMMENCINO WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE,AND �i/ '
X ►IY UCENSE U^W FULL FORCE AND EFFECT. - � S
� UCENSE CLASS �✓ � �v UC.NO. ��K ..7 I ! �
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� WORKERS'COMPENSATION DECLARATION Q ' �
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIUFlY ONE OF 7HE FOLLOWING DECIARAT10N5: Z �I � � �
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� _IHAVEAND�WILLMAINTAINACEHTIFlCATEOFCONSEMTOSELF•INSUREFORWORKERS' • �
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.Q OF 7HE WORK FOR NMICH THIS VERMI7IS.ISSUED. � � �
w _IHAVEANUWILLM/UMAINWORKERS'COMPENSATIONINSURANCE,�ASREWIREDBYSECTIDN � �
Q 3700 OF 7HE UBOR COOE,FOfl THE PERFORMAtJCE OF THE WORK FOR WHlpf THIS PERMIT IS. �
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER�AND POLICY NUMBER ARE: �CONSTRUCTION.
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Z �CERTIF`/THAT IN hiE PERFOHMANCE OF 7HE.WORK FOR WMICN 7HIS PERMIT IS ISSUED,I MECHANICAL _ • � I
C7 SHALL NOT EMVLOY ANY VERSON IN ANY MANNER SO AS TO BECAME SU&IECf 70 THE � � �
� WORNERS'CAAIPENSATION LAWS OF CALIFORNI�AND AGREE THAT IF I SMOUID BECAME INSPECTION FEE
� SUBJECT TO THE WOHKERS'COM7ENSATION PROVISIONS OF SECTION 3700 OF THE LABOR - - � � ,
� CADE,I SHALL FOFiTHWIiH CAMPLY WITH THOSE PRONSIONS. ISSUANCE �
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p DATE: , �� ��^'APPLICANT: _� t�-c.i.' C�ar1� ` �SMIP
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J WARNINO:FARURE TO SECURE WORKERS'COMPENSATqN CAVEMGE IS UNUWFUL,AND SHALL BE ENERGY P/C .
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHWSANU ENERGYPERMIT
DOLLARS(5100,000),iN ADDIiION 70 THE COST OF COMPENSA710N,DAMAGES AS PROVIDED WR IN
J SECTION 370!OF THE V�BOR CODE,INTEREST,ANDATTORNEV'S FEES. � . �
p� RETENTION FEE:
OCONSTRUCTION LENDINGAGENCY PRE-ALT FEE:
� I HEREBY AFFlRM UNDER PENALTY OF PE0.IURY THAT THERE IS AOONSTRUC710N LEHDINO AGEHCY
�� FOR hIE PERFORMANCE OF THE WORN FOR HMICH 7HI5 PERMIT IS ISSUED�SEC:3oW,CIV.G).
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��. LENDEfTS�NAME �
F_- LENDER'SADDRESS
w 'ICERTIFYTHATIHAVEREADTHISMPLICATIONANDSTATEh1ATT1EABOVEiNFORMATIONISCORRECT. TOTAL FEES I� � .
� I AGREE TO CAMPLY WI7H ALl CfTY AND CAUNTY ORDINANCES M1D STA7E UWS REUTING TO BUILDINO
.� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATNESOF7HISCWNTYTOENTERUPONiNE �
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� SIGNATURE�PERMI7fEE DATE /
= RECPT.NO. PAID BY VALIDATION
~ WHITE-De rtment Co YELLOW—Finence C
pa py, opy,PINK=Assessor Copy,GOLDENROD--File Copy,GREEN—Appllca�t's Copy
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INSF'ECTION REC4RD
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SET BHCK _ _ _� FLOOR JOIST _ _ ___ __ __________
FTGS;FORMS/STEEL --� FHA REQMTS ___ __ _______
ELECTRIC GROUND ; �UNQER FLOOR DUCT
GROUNO PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE �FIREPLACE FOUNDATION
TEN1P P�WER I 'FIREPLACE BOMD BEAM
WATER SERVICE � `MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM '
FRAMING/VENTILATION �FINAL BOND BEAM
_..---------------------- ------------------_ ;----.._------�----_ _-------- ----------._.._..---------
ROOF COVER 'PRE-GRADING
____ - - -- ----------- - ------ -- - ---- --- _._ _._ --- --- - - ----- -- ---- __ - --
ROUGH HEATING �BENCHING
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ROUGH ELECTRIC Z�f n'" � i ROUGH GRAbING
ROUGH PLUMBING 'FINISH GRADING
SHOWER/TUBTEST �POOL ELECTRIC
EXT.LATH/SIDING ;POOL FENCING
WAL�INSULATION j POOL FINAL
CEIUNG INSULATION �OFF SITE IMPS.
�RYWALL NAILING �DEDICATIONS
-------- ---------- Y-------- ---------------- -------------
SEWER i FINAL ENG.
--- ;------- ------ ----- —
SEPTICTANK i LANDSCAPE/IRRIG. __ __ ___
SEEP PIT/L.L. �ON SITE IMPS.
GAS AIRTEST ;FINAL ZONING
FINAL CONST. �FIRE DEPT.FWAL
FINAL HEATING P O' �lZ- ' ;HEALTH DEPT.FINAL
FINAL ELECTRIC ;DEV.FEES PAID
FINAL PLUMBING � �ENERGY
FINAL PLANING
FINAL ENGINEERING -- -- -- --- . '� a -_ ---------------- ------------
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