HomeMy WebLinkAbout10-1066 CITY OF DIAMOND BAR ��,s'�� •
--- ��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �"'s'� ;���,��
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� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 �, - - PRESS
'"�'� BUILDING PERMIT APPLICATION � FI�iMLY
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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W TURE.PRIOR TO ITS ISSUANCE,AL50 REOUIfiES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT hIAT HE OR SHE IS LICENSED PURSUANT TO TNE PROVISIONS OF THE CON7RAC70R5 LI� �
� CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSPB
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V 710N.ANV VIOUTION OF SECTION 7071.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICAN7 TO Z Re-Roaf
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N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
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wTHROUGH HIS OR HER OHM EMPLOVEES,FROVIDED THA7 SUCH IMPROVEMENTS ARE NO71N7ENDED OR m
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� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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� 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THA7I AM LICENSED UNDER PROVISIONS OF CHAPTER � G,I._� t ry� ��,p •
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z J�LU v� z
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� WOAKERS'COMPENSATION DECLARATION Q -• ; 1 i •
� I HEREBY AFFIRM UNDER VENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z �
� �I HAVE AND WILI MAIN7AIN A CER7IFICA7E OF CONSEN7 TO SELF�INSURE FOR WORKERS' ¢
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Q CAMPENSATION,AS PROVIDED BV SECTION 37000FTHE LABOR CODE,FOR THE PERFORMANCE U
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BV SECTION '
Q 370o OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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� CARqIER PLAN REVIEW
Z POLICY NUMBER ELECTRIC
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0 (iHISSECTIONNE�NOT8E00A4'LETEDOFhIEPEW�MISWRONEHUIDREDOq1?AS�S100)ORlESS� PLU BIN � b �'CJ
Z I CERTIFVTHAT IN THE PERFORMANCE OF THE WOHK FOH WHICH THIS PERMIT IS ISSUED.I MECHANtCAL
�} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOA O BECOME SUBJECT TO THE
� WORKERS'COMPENSA710N LAWS OF CALIFORNIA,AN GRE T AT IF I SHOULD BECOME INSPECTION FEE
� SU&IECTTOTHEWORKERS'COMPENSATIONP NS CTION37000FT OR ^` �^Q
� CADE,I S�WITH COMPLV WITH .O VI51 J��(�
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p DATE: \� � I.� APPLICANT: SMIP
J WARNING FAILURE TO SECURE WORNERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(f1o0.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDEO FOR IN r�
� SECTION 3708 OF THE LABOP CODE,MTEREST,AND ATTORNEV'S FEES. RETENTION FEE: /v ll ,
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEfiEBY AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ. .
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� IENDER'S NAME
H LENDER'SADDRESS
� 1 CER7IFY THAT I HAVE READ THIS APPLICA710N AND S7A7E THA7 THE ABOVE INFORMA710N IS CORRECT. TOTAL F E ES ��'�
w I AGREE TO COMPLV WITH ALL CITY AND CAUNTY ORDINANCES AND STATE LAWS REIATING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7V TO ENTER UPON THE
ZABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
� COMMENTS
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� SIGNATUREOFPERMITTEE DATE
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~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
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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. LATHlSIDING 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 1 ENERGY
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