HomeMy WebLinkAbout16447 ��� CITY OF DIAMOND BAR ��
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
- � 21660 E.Copley Drive Suite 190 PRESS
(909)86a3195 Fax(909)861-3117
�4'TM' BUILDING PERMTT APPLICATION • . FIRM
� JOBSITE � 1 APPLICATION � � � I PERMIT � /C
a ADDRESS �50�� 1 I�n Ci
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TURE,PRqR TO ITS 13SUANCE,AL50 REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIONED w
c STATEMENf THAT HE OR SHE IS LICENSED PUNSUMIT TO THE PROVISIONS OF THE COHTMCTOR9 LI� � ,
� CQISE LAW(pUFTER Y(COMMENCWO WITH SECTION 7000)OF DfVISqN]OF THE BUSINESS AND PRO- POOVSP9
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� NESS AND VROFESSIONS CODE THE CONTMCTORS UCENSE LAW DOES NOT MPLV TO AN OWNER OF � .
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Q THRDU(3H WS OR HER OWN EMPLOYEES,PROVIDE�hl/1T SUCH WPROVEMENTS ME HOT INTENDED OR m
w OFFERmGORSALEIF,VqWENER71/EBUILDINOORIMPROVEMENTI550LDWITMINONEVEAHOFCOMPLE 1' •+ n�;..4',
Z 'TION,THE OWNER�BUILOER WILL HAVE T}1E BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFlRAI UN�ER PENALTV Of PERJURV 71/AT 1 AM LICENSED UN�ER PROVISIONS OF CNAPTER �
a i(COMMENCWO WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS Pf1D PflOFE5510N5 CADE,AND Z
X, MY UCENSE IS M fUl FORCE AND EFFECT. r m
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� WORKERS'COMPENSATION DECLARATION Q
� 1 HEREBYAFFIRM UNDER PEN�LTV OF PERIURV ONE OF THE WLLOWWG DECLARA710NS: Z
� _I HAVE AND WILL MAWTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' a ,
Q COMPENSATpN,AS VROVIDED BV SECTION 37000F THE LABOfi COOE,FOR THE PERFOPMANCE U
Q OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. �
Q �I HAVE AHO MALL MAfNTAPI WORKERS'COMPENSATION INSURANCE,AS REOUIqED BV SECTION
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� CARRIER I� �RG� �'1 I
PLAN REVIEW
� POIIC�NUMBER �7 ELECTRIC � �
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Z 1 CEHTIFV THAT M hiE PERFOfUTANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL
SHALL NOT EMPLOY/�M'PERSON W ANY MANNER 50 AS TO BECOME SU&IECT TO THE
(/� WOPo(EFS'COMPENSATION UWS OF CALIFORN10.NdD A�REE TNAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
coo�,i sriul.Foan�wirH coMa�r win�nasE vqohsarrs. ISSUANCE
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p DATE:�—�- v� APPIICANT: SMIP �
� ENERGY P/C
WARNINO:FAILURE TO SECURE WOHKERS'COMPENSA710N COVERAOE IS UNUWFUL,AND SHALL BE
� SUBJECTANEMPLOYERTOCRIMWALPENALTIESMIDCIVIlFWESUPTOONEHUNDREDh10U5M1D ENERGYPERMIT �
DOLURS(f100.00D).IN ADDI7/0N TO THE COST OF COMPENSATqN,DAMAOES AS PROVIDED FOR IN
J SECTpN 3708 OF THE UBOR CODE,INTEREST,AND ATTORNEI"S FEES. �
p� RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFlRM UNOEH PENALTY OF PERIURV THAT THERE IS A CONSTPUCTION LENDIN6 AGENCV � �
FOR THE PERFORMANCE OF THE WOHK FOR NM1/1CH THIS VERMI7 IS ISSUED(SEC.JOD7,CIV.C.).
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� LENDEFYS NAME . ,
F— LENDERSADORE35
' w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORAIATION IS CORRECT. TOTAL FEES ,
� I A6REE TO COMPLV WITM Nl.CfTV AND COUNTV ORDWMICES AND STATE LAWS REU71N0 TO BU0.DIN(i �
. � CONSTRUCTION,ANO HEREBY AUTFIORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ' ' I���
, Z /iBOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS - �
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� RECPL NO. � ,PAID BY . VALIDATION �
WHITE-0epertment Copy,YELLOW—Finence Copy.PINK—Assessor Copy,GOLDEN ile Copy,GREEN—Applicanfs Copy
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FRAMINGNENTILIATION � ' FINAL 80ND BEAM � ' � '�
ROOF COVER � PRE-GRAQING
ROUGH HEATING BENCHING •
ROUGH ELECTRIC _ ROUGH GRADING
ROUGH Pl_UMBING � FINISH GRADING
SHOWER/TUB TEST "� '+ ' POOL ELECTRIC
EXT. LATH/51DING POOL FENCING
WALL INSULATION POOL FINAL
CEILlNG I�lSULATION OFF SITE I(VIPS.
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GAS AIR TEST FINAL ZONWG
FINAL CONST. FiRE DEPT. FINAL
FlNAL HEATit�lG HEALTH DEPT. FINAL
i=iNAL ELECTRIC DEV. FEES PAID
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