HomeMy WebLinkAbout12-1176 . � ��_ CITY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
,�,� . 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Aotline(909)839-7027 Pf;E$S
''"', BUILDING PERNIIT APPLICATION FVRMLY
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� NE55 AND PROFESSIONS COOE:THE COMMC70R5 LICENSE UW DOES NO7 APPLV TO AN ONMER OF ?
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� I HEREBY AFFIqM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PFiOVISIONS OF CMAPTER � � � -
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� WOAKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENAL7V OF�ERJURv ONE OF THE FOLLOWING DEQARA710N5: Z �
� �I HAVE AND WILL MNNTAIN A CERTIFICATE OF CANSEM TO SELF-INSURE FOR WORKERS' _
CAMPENSATION,AS PROVIDED BV SECiION 37000F THE LABOR CODE,FOR THE PERFORMANCE �U
Q OF T1E WORK FOR NM1iICH TH�S PERMIT IS ISSUED. � . ' � '
w _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION ��7 ^
Q 3700 0F THE UBOR CODE,FOR iHE PER WRMANCE�OF THE WOHK FOR WHId1 TH15 7ERM1T 15 /�� � '
ISSUED.MY WORKEAS'CO/APENSATION INSURANCE CARRIER�AND POLICY NUMBER ARE: CONSTRUCTION� ���
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Z I CERTIFY THAT IN THE 7ERFORMANCE OF THE WOHK FOR WHICH THIS 7ERMIT IS ISSUED,1 MECHANICAL
L}' SHALL NOT EMPLOY PNV VEiiSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
N WORNERS'COMPENSATION LAWS OF CALiFORNIA,AND AGREE THAT IF 1 SHOULO BECAME INSPECTION FEE
? SU9IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE UBOR - �� /`
CODE,I SHALL FOHTHWITH COAIPIV WRN THOS PROVI51 5. ISSUANCE 7��
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� SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIViL FINES UP TO ONE HUNDRED THOUSAND ENERGY PEFIMIT
DOLLARS(S1ao,0oD�,IN�ODITON 707HE C0.5T OF COMPENSATION,DAMAGES AS PROVIDED iOR IN �/�
� SECTION 370D OF iHE LABOR CODE,INTEREST,ANDATTORNEYS FEES. ' RETENTION FEE: I�/ • �O
O CONSTRUCTION LENDING AGENCY P E-ALT,FE�r1 ��
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� I HEREBY AFFIRM UNDER�PENALTY OF PERIURY THAT THERE IS A CANSTRUCTION LENDINO AOENCY q��� l.
fOR THE PEfiFORMANCE OF THE WORK f-0R N?iICH THIS�PERMIT IS ISSUED(SEC.3W7,CIV.C.), L' �.
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� LENDER'S NAME
F- LENDER'S ADDRE55
� TOTAL FEES
¢ 1 CERTIFV THAT I HAVE READ THI9 APPLICATION AND STA7E THAT THE ABOVE INFORMATION IS CORRECT. �
� w 1 AGREE TO CqMPLV N7TH ALL CITY AND COUNTV ORDINANCES M1D STATE UWS RELATING TO BUILDING
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� CANSTRUCTION,AND HEREBY AUTHORIZE REPRESEN7A7NE5 OF 7HI5 CWNTV 70 ENTER UPON hIE �
Z ABOVE-MENTIONED PROPERTY FOR INSPECTpN FURPOSES. COMMENTS �'
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FTGSJFORMS/STEEL �_ � FHA REQMTS _ _________ _
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GRQUND PLUMBING j 'UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
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FRAMING/VENTILATION FINAL BOND BEAM
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ROOF COVER 'PRE-GRADING
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SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION 'POOL FINAL
CEILING INSULATION �"OFF SITE IMPS.
DRYWALL NAILING DEQICATIONS
SEWER FINAL ENG.
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