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_��� CITY OF DIAMOND BAR �]/
DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES -I
21660 E.Copley Drive Sirite 190
(909)860-3195 Fa�c(909)861-3117 ` PRESS
�'��', BUII.DIIVG PERMIT APPLICATION FIRMLY
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� STA7EMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO TME PRONSIONS OF 7HE CONTRACTOR9 U� �
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LICENSED CONTRACTORS D TION W �OO A /'YJ GG
� I HEREBY AFFlRM UNDER PENKTY OF PEitIUHY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
d Y(COMMENCWO WITH SECTqN 7000)OF DMSION 3 OF hiE BUSINE55 M1D PROFESSIONS CODE,AND / ZOOA P�9r1�L 2
X MY LICENSE tS W FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION � n� � -+
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� I HEREBY AFFIRM UNDER PENALTY Of VERIURV ONE OF hIE FIX.IOWINO DECI.ARAT ✓
� _INAVEANDMALLMAMTAINACERfIFlGTEOFCONSENTTOSELFaNSUREFORWORKERS'
COMPENSA7qN,AS PROVIDm BV SECTION 370o OF 7HE LABOR COOE.FOR THE PERFORMANCE
OF 7HE WORI(FOR NM111CH THIS PERMI7IS ISSUED.
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� _I HAVE AND WILL MAVfTAIN WORKEIiS'COMPENSA710N INSURANCE,AS REOUIRED BY SECTION' . �
Q 3700 0F THE U�BOR CODE,FOR THE PERFORMMICE OF THE WORN f-0R WHICH THIS PERMR IS
� ISSUED.MY WORKERS'COMPEN9ATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION '(
� CARRIER PLAN REVIEW
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U' SHALL NOT EMPLOY ANY PERSON P!ANY MAN S AS TO BE E SU ECT THE
(/J WORKERS'COMPENSATIONIAWSOFCALI 10. DAO TI HOUL BECOM INSPECTIONFEE
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CODE,I SHALL FORTMVITM COMPLV WI P ISSUANCE
O ��'APPLICANT SMIP �ITY-8�'����Y�DTfi
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� WARNINO:FNLURETOSEWREWORKER S ION OEISUrMwFlIL,MIDSHALLBE ENERGYP/CDTT7T m�r
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�y SU&IECTMIEMPLOVERTOCRPIPIALPENALTIES D SUPTOONEHUNDREDTI10U9AND ENERGYPERMIT
DOLW19(iloo,o00J.IN�DDITION TO iHE COST O TION,DAMA�ES AS PROVI�ED FOR IN
J SEC710N 3708 OF 7HE UBOR CO�E.INTEREST,AND ATTORNEVS FEES. �
� RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFlRM UNDER PENALTY OF PEFLIURY THAT 7HERE IS A CONS7RUC710N LENDIN(i AOENCV �,
Z FOR THE PERFORMANCE OF THE WORK WR MRiICH THIS PERMR IS ISSUED(SEC.�oW,CIV.C.�. ,
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� IENDERS NAME . �
F- LENDERSADDRESS
� TOTAL FEES (/f �
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE 7T/AT THE�BOVE INFORMATqN IS CORRECT.
W I A(iREE TO COMPLV N7TH ALL CRV M1D COUNTV ORDINANCES AND STATE UWS RELATINO TO BUdDINO
� CONSTRUC710N,AND HEREBV AUTHORIZE REPRESENTATNES OF 7HI5 COUNTV TO ENTER UPON THE �
ZABOVE-MENT%NlED PROPERTV FOR INSPECTqN PURPOSES. COMMENTS
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� g o�TE RECPT.NO. PAID BY VALIDATION
� WHITE—Deparlment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,pOLDENROD--File Copy,GREEN—ApplicaM'y Copy �
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CITV OF DIAMOND BA�i
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SET BACK • FLOOR JOIST - . .
FTGS/FORMS/STEEL FHA REQMTS -
ELECTRIC GROUND UNDER FLOOR DUCl' � . ' '
GROUND PLUMBING UNDER FLOOR CO�IDUIT �
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER ' FIREPLACE BOND BEAM .
WATER SERVICE � MID HT. BOND BEi4N1' ' ' '
RUOF SHEATHING 8 Ff. BONQ.BEAM ;.t.
FRAMINGNENTILIATION FINAL BOND BEAM•, '
ROOF COVER PRE-GRADING � � . ��,.' � ;
ROUGH HEATING BENCNING••'� ', • . . ' � :'..•.. :., ', s
ROUGH ELECTRIC ROUGH GRADING
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ROUGN PLUMBING ' FINISH GRADING
SHOWERlTUB TEST POOL ELECTRlC
EXT. LATH/SIDING POOL• FENCING
WALL INSULATION POOL FINAL
CEIIING INSULATION OFF SITE IMPS. ---
DRYWALL NAILING QEDICATIONS
SEWER FINAL ENG. • -
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/i..L. ON SITE IMPS.
-�AS AIR TEST � FINAL ZONlNG
FINAL CONST. ---., ' •"� � � FIRE DEPT. FlNAL
FINAL HEATlNG � , . ,,, � �� � � HEALTH DEPT.FINAC , •
FINAL ELECTRlC ,,, •,�,: �.' � DEV. FEES PAID - �
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