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DEPARTMENT OF COMMUNTI'Y&DEVELOPIv�NT SERVICES
21825 E.Copley Drive
� (909)860-3195 Fax(909)861-3117 � PRESS
��'%�^� BUILDING PERMIT APPLICATION FIRMLY
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w 7URE,PRIOR 70 I75 ISSUANCE,ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT 70 FILE A SIONED w Patlo/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U� �
CENSE LAW(CH�PTER e(COMMENCINO WITH SECTION�000)OF DIVISION 7 OF THE BUSINESS AND PR0. POOVSPB
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Z WILL DO hIE WORN,M!D THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BU51- � � I
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Q TYIROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS AFE NOT IMENDED OR m
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I HEREBY AFFIfU/UNDER PENALTV OF PERIURY THAT I AM UCENSED UNDEfl PROVISIONS OF CHAPTER � �
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� I HEREBY AFFIRM UNDER PENA�TY OF PERIURV ONE OF THE FOLLOWINO DECLARATKKJS: Z
� _I HAVE AND WILL MAINTAW A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WOqKERS' ¢
� COMPENSATION,AS PROVfDED BV SECTION 370o OF THE LABOR CODE.FOR THE PERFORMANCE U
Q OF 7HE W RN f-0R WHICH THIS PERMIT IS ISSUED. �
Qw I HAVE AND WILL MAINTAIN WORKERS'COMVENSATION INSURANCE,AS REOUIRED BV SECTION
3700 OF TH LABOR CODE,FOR THE PER RMANCE OF THE WORK FOR WHIp1 THIS PERAIR IS
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Z I CERTIFV THAT IN 7HE PERFORMlWCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL '
CJ SF7/�LL NOT EMPLOY ANY PERSON IN ANV MlWNER 50 AS TO BECOME SU&IECT TO THE
(n WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AQREE THAT IF 1 SHOULD BECOME INSPECTION FEE
S SUBJECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37ao F THE UBOR
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DOLURS(f 100.000),W ADDITION TO THE COST OF CAMPENSATION,OAMA(iES AS PROVIDED FOR IN �
J SECTION 370e OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFlRM UNDER PENALiY OF PERIURV THAT THERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.�.
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� LENDER'S NAME
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� I AGFEE TO COMPLV WfTH ALL CITV AND CAUNTV ORDINANCES AtJD STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUT}K)RIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE� ENTIONED PROPERTV FOR INSPECT PURPOSES. COMMENTS
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Fi'GS/FORMS/STEEL FHA REQMTS
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GROUND PLUMBING UNDER FLJOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. Bt�ND BEAM - •
ROOF SHEATHING ---- -- --- 8 FT. BOND BEAM - --- .
FRAMIIVG/VENTILIATION � � 'FiNAL SOND BEAM
ROOF COVER PRE-GRAQING
ROUGH HEATIfdG BENCHING
ROUGH ELEGTRIC RQUGH GRADIN.G
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SHOWER/TUB TEST �I POOL ELEGTRIC
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SEEP PIT/L.L. � ON SITE IMPS. i
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FINAL CONST. , FIRE DEPT. FINAL
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FINAL ELECTRIC DEV. FEES PHID
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