HomeMy WebLinkAbout12-1039 �
�� CTTY OF DIAMOND BAR .
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21810 Copley Drive,Diamond Bar,CA 91765 �
(909)839-7020 Fax(909)861-3117 Bailding Inspection Hotline(909)839-7027 PRES
�''^". BUII..DING PERMIT APPLICATION FIRMLY
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ADDRESS a ` �� �-T' DATE � '�2� NUMBER�� �� #
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z TION..7HE�OWNER-BUILDER WILL HAVE T1E BURDEN oF.PROVIN6 THAT�HE OR SHE DID NOT BUILD OR . . .
� W PROVE FOR THE PURP0.5E OF SAL�. . . .
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� I HEREBV AFFlRAI UNDER PENKTV OF PEfUUfiY THAT I AM�LICENSED UNDFA PRpVISION9 OF CHAPTER � • �
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� 1 HEqEBV AFFIR►1 UHDER PENALTV Of PERNRY ONE OF THE FOLLOWINO DECIARATi0N5: U -
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0 _1 HAVE�AND_WILL MAlNTNN A CEATIFICATE OF CONSEMTO SELF-WSUqE FOR NORKER5 � � �
� COIdPENSATION,AS PROVIDED BV SECTION 37000F T1E UBOR CODE,FOR THE PERFORMANCE U�
OF T1E WORK FOR WFi1Gi THIS VERMIT IS ISSUED. W . ..
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Q ��MNVE AND WILL M.UMAIN WORKERS'�COMPENSATION INSURANCE;qg pEOUIRED 9V SECTION
370o OF�7HE LABOF CADE,FOR THE PERFORMANCE OF THE WORK FOR WHlp1 THIS PERMIT IS
ISSUED.MY WORKEAS'COMPENSATION IMSURANCE CARRIERM1D.PolICY�AIMBERAAE CONST'RUCTION�
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C3 SHALL NO7 EM7LOY M!Y FEHSON W ANY NANNER SO AS 70 BECOME SUB,IECT 70 7HE '
[n WORKERSCOMPENSATqNLAV/$OFC/�IIFOqNIA,µDAGREETHATIFISHOULDBECAME INSPECTIONFEE �
S SUBJEC7 TO TFIE K'OAICER5 COMFENSA710N PROViSptJS OF SEC710N 770o OF THE UBOR �� - � �
CODE.�SIiALL FORTHVA7H COMPLY Wlhl THOSE PROVIS10N5. �� ISSUANCE �
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� SUBJECfANEMPLOYERTOCRIMIN�LPENALTIE3ANDGVILFWESUPTOONEHUNDREDT}qU$AND ENER6YPERMIT
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J SECTION 370E OF 7HE LABOR CODE,NREREST,AND ATTORNEYS FEE3. � . ' ' � O
w RETENTION FEE:
O . CONSTRUCTION�LENDINGAGENCY - PRE-ALTFEE �
� I HEREBYAFFlRAI UNDER VEN/LLTV OF PERIURY 7HAT h1ERE 19 A CONSTRUCT�ON LENDWO AOENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH Ti15 PERAUT IS ISSUED(SEC.�3aW,qV.G�.
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�� LENDER'SNAME . , . . ',
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� TOTAL FEES � �
. w �I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STA7E 7HAT THEABOVE INFORAIATqN IS CORRECT.
� I A6REE TO COMPLV H7TH ALL CfTV AND COUNTY ORDINANCES AND STATE UV75 RELATWO TO BUILDWO
� CONSTRUCTION,AND HEREBV AUTIiORIZE REPRESENTATIVES OF 7HI5 COUNTY TO FMER UPON iHE �
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WHITE—Departrnent Copy.YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD--FIIe Copy,(3REEN—
ApplkanYs Copy
� CITY OF DIAMOND BAR
IMSPECTIOPV REC4RD
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SET BACK FLOOR JOIST
fTGS/FORMS/STEEL FHA REQMTS _
ELECTRIC GROUND t)NDER F100R DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER - FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOIdD BEAM
ROOF SHEATHING I 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER __ _ PRE-GRADING
ROUGH HEATING BENCHING '
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAIUNG DEOICATIONS _ __ _
SEWER fINAL ENG. __
SEPTICTANK .; ;� LANDSCAPEIIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST . '� FINAL ZONING
FINAL CONST. FIRE OEPT.FINAL
FINAL HEATING ' � � � _ HEALTH DEPT.FINA� ".
FINAL ELECTRK � DEV.FEES PAID
FINAL PLUMBING � � ENERGY
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C(�MMENTS
SEPTICTANKSIZE
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