HomeMy WebLinkAbout11264 �
- CITY OF DIAMOND BAR / �1,
COMMUNITY DEVELOPMENT DEPARTMENT �
.;,..� . 21660 E.Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-3117 �'
'�^" BUILDING PERMIT APPLICATION FIRMLY
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TURE,PFlIOR TO ITS IS9UANCE.AL50 HEQUIHES THE MPLICANT FOR SUCH PERMIT 70 F14E A SIGNED
� BTATEMENT THAY HE OR SHE IS LIGENSED PURSVANT TD iME PROVISIONS OF iNE CONTRACTOpS l�• W
CENSE LAW(CHAPTER Y(C�MMENGINQ W7TM SECTION ri100)OF DIVISION J OG THE BUSINESS AND PRO- � PoollSpa
FESSIONS CODE)OR THATHE ON SHE IS E%EMPT THEHEFHOM M1D THE BA315 FOR THE�W.EDEO E7(EMP•
� iION.ANYVIOlAT10NOF5ECTION7031.6BYANYMPLIC�NTFORAPERMITSUB.lECiSTHEMPLICANTTO Z qe-Root
r A CIVIL VENALTYOF NOT AAORE THAN FNE HUNORE��DlLAHS(i5ao).):
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M/1LL DO THE WOPoC ANO THE S7RUC7Uf1E 16 NOT INiENDE�OR OFFEFED WR BALE�BEC.�Ost,BUSI- J
� NESS AND PROFESSIONS CODE:THE CONTNACTOi15 LICENSE LAW DOES NOT APFLY TO AN OWNER OF ?
PROPERTY WHO BUIIDS OR IMPROVES THEREON,AN�NTi000ES SUCFI WORK HIMSELFOR HEHSELF OR
� hIROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HI175UCH IMPROYEMENT511fiE NOT INTENUEDOR m
� �FEREDiORS/LEIF.FiOWEVERTHEBUIL0INGORIMPROVEMENT1550LDWRHINONEYEIIROFCOMPLE•
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� M17ROVE FOR THE PUqPOSE OF SALE).
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� M CONSTqUCT 7HE PR0.1EC7(SEC.7aa,eUSINE53 AND PROFESSIONS CODE:THE CONTMCTORS L1- V31119tiOn 0 AOJ.AREA �0
� CENSEUWOOESNOTAPPLYTOANONMEROFAPROPEHTYWFIOBURD90RNAPHOVE9THEREON,AND
WFIOCONiMCT5FOR5UCNiRQIECTSWITNACONTRACTOR(S�LICENSEDPURSUANT70TXECQVTRFG QUAIVTITY DE5CRIPl10N FEE
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� GIAME%EAIP7UNOERSEC. 8.6P.C.FORTHISREASON
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DATE OMMER �
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�Q UCENSED CONTRACTORS DECLARATION W
[C I HEREBY AFFIRM UIJ�ER PENALTV OF VERJURY THAT I AM LICENSE�UNDER PqOYIB10N3OF CHAPTER Vr
d 9�COMMENCINaWIhISECTION7000)OFDMSION30FTHEBUSINESSANDPHOFESSIOHSCODE.AND Z
X MY LICENSE IS M FULL FORCE AND EFFECL m �
0 LJCENSE CUSS C`!� / LIC.NO.� � _ jJ
� DATE Z����� '� CONTRACTOp.�',� E' a .
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� WORKERS'COMPENSATION DECLARATION �
� IMERE9YAFFIqMUNDERPENALTVOFPERJURYONEOFTFIEWLIAWW6�ECU1HAiIDN3: Z
� _IiUYEAN�WI��MANT/UNACERTIFICATEOFCONSEMTOSEIF-AISUREFORYKIRKER5' _
COMPENSATION,AS PROYIDED BY SECTION J10u OF THE LABOii CODE,FOR ME PERFORMANCE �U
OFTNE WOFK FOR WXICFI THIS 7ERMIT IS ISSUEO. �
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_I HRVE AN�WILI MANTAIN WORKERS'COMPENSATION INS4RANCE.AS REQUIRED BV SECTION
Q4 a7oo OF 7HE IABOR CODE,FOiI THE PERFORMIwCE OF THE WORN PoR WHICHTHIS PERMIT 16
ISSVEO.MY WORKERS'COM�[NSATION INSURPNCE CARqI N AND POLIGY NUMBER ME: STRUCT�ON ZO C�
j CIWRIER SIf�/��PfT ¢-r' IEW
� Pq.ICYNUMBER I�I�M1 � �,xt/• � ELECTRIC
4
o �n�ssecrpxr��wrseca.r�ErEooFn�rewRr�swnowe�onE000wwsM�l��ss1 PLUMBING
ZICERTIFYTHATINi}IEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITLSISSUE�.1 MECHANICAL
C�S SHALLNOT EMPLOYANY GERSON W ANY MNd�ER SOAS TO BECOME SUBJ TTO THE
N qIORKERS'COMPENSATIONLAWSOFCALIFORN10.�NDACREETHAT IS OULDBECOME INSPECTIONFEE
SUBJEC7iOTHEWORKERS'COMPENSATIONPROVISIa1SOF5 OFTHELABOR
CODE,I SHALL�F�ORT�I/i`MTN COMPIY WITi THOS�PJROVI NS. S A E �S�
bDATE:�'�// APPLICANT: % � '�^'� EMIP / ! `
� ERGY P/C
WARNINO:FAILUflE TO SECURE YlOANERS'CAAIPENSATION COVERAG IS UNUWFUI.ANO 6HALL BE
�y SUBJECTPNEMPLOYEHMCRIMINALPENALTIESANUpVIIfINESUPTOONEHUNOHEOiHOl15AN0 ENERGYPERWaT
UOLLARS(i100,OW),W A�DITION TO TME COSTOF COMPENSATION,DNAAOES AS PflOVIDED FOF IN
� 5ECTION 3708 Of iHE LABOR CODE,INTEREST,ANO A770RNEY5 FEES. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE•ALT FEE:
� I HEREBY AFFIRM UNDER PENALTY OF PERJURYTHATTHERE IS A CONSTflUCT10N LENOINO AGENCY
FOR THE PER WRMANCE OF THE WOHK FOH WMICN THIS PERMIT IS ISSUED�SEC.7097,CIV.C.).
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� LENDER'S NAME
F— LENDEi7SADOHESS
� TOTAL FEES
� I CEflTIFY 1F1NT 1 NAYE REl�THIS IIPPLICATION AND STATE TIi�TINE A60VE INFORMATION IS CARRECT. /��r ^/1
� I AGREE TO COAIPLY WITH ALL CITY AND COUNTY OROINANCES M1D STATE lAWS NELATING 70 BUIL�ING �1/ /
� CONSTRUCTION.ANOHEREBVAUTHORIZEREPRESENTA7IVESOFTHISCAUNTYTOENTERUPONTHE /V�
z ABOVE-YENTIONED PROPEHTY FOR INSPECTIO UR705ES .
COMMENTS
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¢ PERMITTEE N/JAE�P _ ^ /. '
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� 810NATURE PE MITTEE .� �/,• , DATE
� RECPT NO. PAID BY ^ �- VAUDATI .%
WHITE-0epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR06—File Copy,GREEN—ApplicanYe Copy
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CITY OF DIAMOIVD BAR �
INSPECTION RECORD
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SET BACK � FLOOR J�IST
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FTGS/F(�RMS/STEEL " FHA REQMTS
ELECTRIC GROUND UNDEA FLOOf��DUCT j' �
GRUUND PLUMBING UNdER F'LOOR CG�I�IDUIT ; �
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM . ~� � �
WATER SERV{GE ' .- .I ' ' MID HT,BOND BEAM
ROQF SH.EATNING � � $ • • � 8 FT. BOND BEAM
FRAMINGNENTILIATION FINAL BON�BEAM
ROOF COVER z PRE-GRADING
ROUGH HEATINCa 'BENCHING
ROUGH ELECTRIC ROUGH GRAQING
R011GH PLUMBING ' FINlSH GRADING �
SHQWER/TUB TEST POOL E�ECTRfG
EXT.LATHlSIDING POOL FENCING
WALL INSULATCON POOL FI":%•.�
CEILING INSULATION OFF SIT". :.1PS. •
DRYWALL NAILING DEDICA-;�:NS �
SEWER , FINAL ENG.
SEPTIC TANK ' LANDSCAPE/IRRIG.
SEEP PIT/L.L. � � ON SITE IMPS. ! �,
GAS AIR TEST - j __ -- i FINAL ZONING I
FINAL CONST. 1 FIRE DEPT. FINAL
FINAL HEATING � � HEALTH pEPT. FINAL .
FINAL ELECTRIC ' DEV. F�ES PAID �
FINAL PLUMBING 1 ENERGY . i
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