HomeMy WebLinkAbout11-568 ��_ CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 AE$$
'��'� BUILDING PERMIT APPLICATION FIRMLY
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w TURE,PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF 7HE CONTRACTORS LI- �
� CENSE LAW(CHAPTER 8(CAMMENCING WI7H SECTION 7000)OF DIVISION 3 Of THE BUSINESS AND PRO- POOUSPe
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PROPERTV WHO BUILDS OR IMPROVES THEREON,AND VhiO DOES SUCH WORK HIMSELF OR HERSELF OR
wTNROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THA7 SUCH IMPROVEMENTS ARE NO7 IN7ENDED OR m
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QLICENSED CONTRACTORS DECLARATION W
O[ I HEREBY AFFIRM UNDER PENPLTV OF PERJURV 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X AIY UCENSE IS IN FULL FO{iCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELf-INSURE FOR WORKERS' ¢
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COMPENSATION,AS PROVIOED BY SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE `U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION _/
Q 370a OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMI7IS 9 ([.�
ISSUED.M . OFK RS'CAM ENSATION SURA CE CARRIE D POLIc1�1�NUMBERARE: CONSTRUCTION �� /� ?/
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISS ED,I MECHANICAL
C7 SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO B COME SUBJECT TO T E
(n WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGR AT IF I SHOUID COME INSPECTION FEE
? SU&IECTTOTHEWORKERS'COMPENSATI PROVISIONS 5 TION37000F ELABOR — /� ''7
CADE,ISHALLf ORTHWITH COMPLV WIT SE PROVISIO 5. ISSUANCE d /•
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J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERA 'IS UNLAWF ,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(f 700,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,WTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �� .
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBYAFFIRM UNDER PENALTY OF PERJURV THA77HERE IS ACONS7RUC710N LENDING AGENCV �V�����
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUE�(SEC.3077,CIV.C.).
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� LENDER'S NAME
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� TOTAL FEES ���•�II
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CIN/WD COUNTV ORDINANCES AND STATE LAWS FELATING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUN7V TO ENTER UPON TME
� ABO E-MENTIONED PRO FORINSPECTION PUR705E5.
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= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
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GROUNO PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE B�ND BEAM
WATER SERVICE . MID HT. B�ND BEAM
ROOF SHEATHING 8 FT. B�ND BEAM
, FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING PQOL FENCING ___ __ __ _
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS _
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITlL.L. ON SITE IMPS.
GAS AIR TEST �� / FINAL ZONING
FINALCONST. S;l�;►� (���(-�l ��l FIREDEPT. FINAL _ ___ _ •
FINAL HEATING � HEALTH DEPT. F'INAL
FINAL ELECTRIC DEV. FEES PAIQ
FINAL PLUMBING ENERGY
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