HomeMy WebLinkAbout10-777 (11) CITY OF DIAMOND BAR Oy���/'A,1
" DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��
21825 Copley Drive,Diamond Bar,CA 917fi5
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'°"" BUILDING PERMIT APPLICATION FIRMLY
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Z TUHE.PRIOR TO ITS ISSUANCE,�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
Q� CENSE UW(CHAPTER 9(CAMMENCINO WITH SECTION 700a)OF DIVISION 3 OF 7HE BUSINE55 AND PR0. u- PooUSpa
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� WOAKERS'COMPENSATION DECLARATION � A1�.� (�/�f 1
� 1 HEREBY AFFIRM UNDER PENALTV OF 7ERIURV ONE OF THE FOLLOWING DECUAATIONS: V
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� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEIF-INSURE FOR WORKERS' _ �
Q COMPENSATION,AS PROVIDED BY SECTION 3700 OF TME IABOR CODE,FOR iHE PERFORMANCE U
OF THE WORK FOR NMICH THIS PERAIIT IS ISSUED. w
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_I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERA1fT 15 �J
ISSUED.MV WOPKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER AAE: TION q Q���IO
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[/� WORKERS'CAMPENSATION LAWS OF CALIFORNIq AN�AaREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTbN 3700 OF THE UBOR
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1p DATE: APPLICANP. _ ��„�
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� WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUI�AND SHALLBE . ENERGY P/C
� SUBJECTMlEMPLOYERTOCRIMINALPENALTIESAIJDCNILFINESUPTOONEHUNDREDTHWSAND NERGYPERMIT � /`
DOLLARS(f100.o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37ae OF 7HE LABOR CODE.INTEREST,AND ATTORNEVS FEES.
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O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CQ45TRUCTION LENDING AGENCV �A�j�j /Q
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. �
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� LENDER'S NAME
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w I AGREE TO CAIAPLV WITH ALL CfTV AND COUNTV ORDWANCES AND STATE UWS REUTWG TO BUILDINO
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEN7ATNE5 OF THIS COUNTV TO EN7EH UPON THE ' 7/ L 0�C�
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SET BACK FLO�R 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 BE,4M
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST � POOL ELECTRIC
EXT.LATH/SID�NG ' " POOL FENCING
WALL IN.SULATION � rr 4 POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING ` DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITlL.L. QN SITE IMPS.
GAS AIR TEST FIfVAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAIQ
FINAL PLUMBING ENERGY
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