HomeMy WebLinkAbout11-353 �,� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21825 Copley Drive,Diamond Bar,CA 91765 RESS I
'� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
��9�� BUILDING PERMIT APPLICATION I
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w TURE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES 7HE APPUCANT FOR SUCH PERMIT TO FILE A SIONED W
� STATEMENT 7HAT HE OR SHE IS LICENSED PUFSUANT TO THE FPOVISIONS OF THE CONTRACTORS ll�
� CENSE UM�(CNAPTER Y(CAMMENCINO WITH SECTION 7000)OF OIYISION 3 OF TME BUSINESS AND PRO- � PooUSpa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGE�E%EMP- '
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Z VALL DO TME WORK,AND THE STRUCTURE IS NOT INTENOEO OA OFFEREO FOR SALE(SEC.7a�,BU51� J
N NESS AND PROFESSIONS COOE:THE CONT{LICTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF �
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� LICENSED CONTRACTORS DECLARATION w
CL 1 HEREBY AFFIRM 11NDER PEN/�LTV OF PERJUFY THAT I M/LICENSED UNDER PROVISIONS OF CHAPTEH �
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� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE Of THE FOLLOWING DECLARATIONS:
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� I HAVE AND WILL MAWTAW A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
� COMPENSATION.AS PROVIDED BY SECTION 3700 OF hIE LABOR CADE.FOR THE PERFORMMJCE `U
OF THE N�OPK FOR N7iICH THIS PEFMIT IS ISSUED. c2
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w _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q a7oo OF TNE LAQOF C OE,fOR THE PERFORMPNCE OF THE W K FOR WHICH 7HI5 PE�iM1T IS
� ISSUED.MV RN P'NSATIONiM9 NCE CAFRIER D POLICV NUMBERME: CONSTRUCTION ���- �
� CARFIER PLAN REVIEW
0 POI.ICV NUMBER ELECTRIC
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0 (f}aSSECfKINNE�NOTBECOAiiETIDaF7FIEPEPMTF'FOfiONEFRII�DRE�DOII/3i�`f51001��`} PLUMBING
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Z I CERTIFV T-IAT IN THE PERFORMANCL OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
�J SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE ��}SPECTION FEE
� W1�RKERS'COMPENSATION LAWS OF CAIIFORNIA AND��REE THAT IF I SHOULD BECAME
SU&IECTTOTHEWOHNENS'CAM7ENSATIONPROVISIONSOFSECTION37ooOFTHELABOH ISSUANCE � ��
S CADE,1 SHALL FORiHWITH COMPLv WITH THOSE PROVISIONS. ` ��
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p DATE: APPLICANT. . �
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� WARNING:FA0.URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,ANO SHALL BE
�y SUBJECTANEMPLOVERTOCRIMINALPENAL7IESANOCIVILFlNESUPTOONEHI'/NDRE�TMOUSMID ENERGYPERMIT
DOLLARS(5100.000).IN�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �f
J SECTION 37oe OF 7HE LABOR CODE,INTERES7,AND ATTOpNEV'S FEES. RETENTION FEE: �"�`� �
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w CONSTRUCTION LENDING AGENCY �F}�-QLT FE�
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� I HEREBYAFFIRM UNDER PENALTV OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCV iiy r,�✓� �'
FOR THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.�OY7,GIV.C.).
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� LENDER'S NM/E
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� I CERTIF/THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE WFOFAIATKKJ IS CORRECT. TOTAL FE ES /�� ��
w 1 A6REE TO CAMPLV WITH ALL qTY M1D COUNTV OGIOINANCES AND STATE UWS REI�TINd TO BUILDINO
� CONSTRUCTION.AND HEREBV AUTHORIZE FEPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTqNED PROPERT'FOR INSPECTION PURPOSES. .
�� _— COMMENTS
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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 HT. 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
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING 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 DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PITlU SIZE
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