HomeMy WebLinkAbout12-1308 ,��;,_, ,
_�!_ CITY OF DIAMOND BAR �`��( ���
DEPARTMENT OF COMM�JNIT'Y&DE�'ELOPMENT SERVICES ��
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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Z TKKd.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE DID NOT BUILD OR
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� I MEREBY AFFlHAI UNDER PEWJ,7Y OF PERJUfiY THAT IAM�LICENSED UNDER PROVISIONS OF CHAPTER � A�,,,,�^ � -
d, i(COMMENClNO WITN SECTION 7000)OF DMSION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z �l�,��� �
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� WORKERS'COMPENSATION DECLARATION � � - � - - -
� I HEREBYAFFIRI.1 lR1DER PENALTV OF PERJUflY ONE OF THE FOILOWING DECLARATqNS; V �
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� _I HAVE�AND WILL MNNTAIN A CERTIFICATE OF CpNSENT TO SELF-INSURE FOR Npql(ERS' � � '
COMVENSATION,AS PppV�pm BY 6ECTION 37000F THE UBOR COOE,FOR THE PERWRIAANCE U
OF TFIE WORN FOq NM1i1CH T/{�,q pERMIT IS ISSUED. �
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Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOq WHICH 1HI5 pER1iR 19 � �
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(/) . WORKERS.CAMPENSATqN LAWS OF CAIiF,ORNI�AND AGREE 7HAT IF 1 SNOULD BECAME INSPECTION FEE
SUBJECT TO THE WORI(ERS COMPENSATIDN PROVISIONS OF SECTION�7a0 OF THE UBOR ��
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� `p DATE T`�� APPLICANT. � n��C1.1 l� 1 �SMIP . . 6 .
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WAHNIN(i:�FA1LURE TO SECURE WORKERS'COMPENSATqN COVERAGE IS UNIAWFUL,AND.SHALL 8E
� SUBJECt AN EMPLOYER TO CFIIdINAL PENALTIES MID GVIL FlNES UP TOONE HUNDRED TFKK15ANp ENERGY PERMIT
DOLLARS�5700.000),�IN PODITION TOTHE CQST OF COMPENSATION,OAMA�ES AS PROVIDED iOR M
J SECTION 37oe OF iHE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. � ' ' �
� � � RETENTION�FEE �
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� I HEREBY AFFUiM UNDER'PENALN OF PERIUHY THAT THERE IS A CONSTRUCTION LENOW6 AOENCY
' nZ-' �FOR THE PfRFORMANCE OF THE WORK FOR WHKi/7H13 pERMR IS ISSUED(SEC.30B],CIV.C,).
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� LENDEAS NAME � . -.
� LENDER'SADDRESS ' - '
� ICERTIFYTHATI�HAVEREADTHISMPLICATqNANDSTATE7HATTHEABOVEPlFORAAATIONI9CORRECL .TOI'AL FEES�. '� ♦ - �
� I AQREE TO COMPLy N7TH ALL C(ryµD COUNTV ORDINANCES AND STATE UWS REUTINO TO BURDINO ' � � '� �� '
� CON9TfiUCf�ON,AND HEREBY AUIHORRE REPRESENTATIVES OF THIS COUNTV TO EHTER UPON TNE . , ' ' �
Z A80VE-M MKXJEO PROPERTY FOR INSPECfiON PURPObES. COMMENTS �� '
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� RECPT..NO. PAID BY VALIDATION
WHITE—Departmen[Copy.YELLOW--FNence Copy,PINK—Assessor Copy,GOLDENROD—Ftle Copy, EN—ApplicanYs Copy
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FTGS/FORMS/STEEL _ .;_ - .; _ ` . � .
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EL-KTRIC GROUND - - _ UNDER fL00R d,U,CT... _ _ _ -
GRQUND PLUMBING' ' � �' UNDER FLOOR CONDUlT. ' - - -- •
SLAB GRADE.; ,• - . • � �FlREPLACE FOUNOATlON � � ' "
��P P��ti�E� FIREPLACE BOND BEAM
WATER SERVICE �MID HT.BOND BEAM
ROOF SHEATHItVG 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHIfdG
ROUGH ELECTRIC , ROUGH GRADING
ROUGH PLUMBI?�iG . i FINISH GR.ACING � . , .. � `, . .
SHOWER/TUB TEST � ROOL ELECTRIC '
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING IfJSUTATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST. _ FINA[ZONING - - -
_ . . . ._. . . _ . _� .__ _. _ .
FINAL CONST. •- --.. _ .. FIRE DEPT.FINAL
fINAL HEATING-- ` - - - - NEALTH DEPT.FINAL ��- � -� - � �� � - �
FINAL ELECTRIC -- DEV.FEES PAID - -
FINAL PLUMBING .� �ENERGY
FINAL PLANING "
FINAL ENGINEERING --- . � p
COMMENTS . �� � .`
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SEPTICTANK SIZE
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