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��_ CI'TY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
> 21825 Copley Drive,Diamond Bar,CA 91765 -
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I Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED Oq OFFERED FOR SALE(SEC.70N,BU51� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS IICENSE LAW DOES NOT APPLV TO AN OWNER OF �
�ROPEHTY WFIO BUILDS OR IMPROVES h1EREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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� LICENSED CONTRACTORS DECLARATION W .
� I HEREBY AFFIRM UNDER PE/ULTV OF PERJURY THA7 I AM LICENSED UNOER PROVISIONS OF CHAPTER �
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� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
� COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE.FOq THE PERFORMMICE U
OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. W
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I HAVE AND WILL MAIMAW WORKERS'CAMPENSATION INSURMlCE.AS REQUIRED BV SECTION
Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PEFMIT IS
ISSUED.MV WORNERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
� CARRIER ��=� `��(�� .LIV�Ul PLANREVIEW
�Z POLICVNUMBER �ZLl9CG2 33c�o ELECTRIC �,�
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Z �CERTIFV 7HAT IN THE PERFORMANCE OF THE WORI(FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
(/� WORKEFS'CAMPENSATION LAWS OF CAIIFORNIA,AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE
= SU&IECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION77000FTHELABOR �j , r .^
CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE ' S v
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p DATE: qPPLICANP. SMIP
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J WhRNINO:FAILUflE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENEFGY P/C
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� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(5100.000�,IN ADDIiION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
w SECTqN37080FTHELABOqCODE,INTEFEST,ANDATTORNEV'SFEES. RETENTIONFEE: 1
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNOEfl PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AQENCV
FOq THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3oD7,CIV.CJ.
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� �ENDER'S NAME
F— LENDER'S ADDRESS
w I CERTIFY THAT I HAVE READ THIS APP CATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �y
� I AGREE TO COMPLV N7TH ALL CRV D NTY ORDINANCES AND ST�TE LAWS REI.ATING TO BUILDING �
� CONSTRUCTION,AND HEREBV AU R E RESEMATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTpNED PR07ER F I P T N puaaosEs. COMMENTS
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m PERMITTEE NAME(PR1NT)
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� SI�NATURE OF PERMITT DATE
� RECPT.NO. PAID BY VALIDATIO
WHITE—Department Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,G EEN—Applirant's Copy
CITV O� DIAfVdON� ��+R
INS��CT104� RECORD
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT.LATHlSIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC 1 �^ a L� DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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