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_____��_ CITY OF DIAMOND BAR ���� �,C'�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70 PRESS
�'°^"� BUILDING PERMIT APPLICATION R. FIRMLY
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w TURE.PRpR TO ITS ISSUANCE,/�150 REOUIPES THE APPUCANT FOR SUCH PERMIT TO FIIE A SIONED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI�
CENSE LAW(CHAPTER�(COMMENCWO WITH SECTION 70oa)OF OIVISION 3 OF THE BUSINESS AND PR4 � POOI/SPB
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Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI- J
� NE55 M1D PROFESSIONS CODE:THE CONTMCTORS UCENSE LAW DOES NOT APPLV TO Ml OWNER OF �
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w TMROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT MTENDED OR m
� Q OFFEREDFORS�LEIF,HOWEVER711EBUILDINGORIMPROVEIAENTISSOLDWITHINONEYEAROFCOMPLE-
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� DATE OWNEq H
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� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEH �
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� WOFKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTV OF GERIURV ONE OF THE FOLLOWING DECIARATIONS: �
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� I HAVE WILL MANJTAIN ACERTIFICATE OF CONSEMTO SELF-INSURE FOR WORKERS' _
Q CO NSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR TME PERFORMMICE U
THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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W _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOIJIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS
ISSUED.MY WORKEFS'COMPENSATION INSURANCE CARRIER ANO POLICV NUMBER ARE: CONSTRUCTION
� CARqIER � ` PLAN REVIEW
� POLICVNUMBER ���'1,,J = ELECTRIC �('�, �
0 (1}ESSECTqNNEIDNOTBECpMLE7mOFTHEPERMTISFOqONEF1l.rOREDDOL!/�AS�t100)ORLESS} PLUMBING
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Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH TFIIS PERMIT IS ISSUED,I MECHANICAL
G� SHALL NOT EMPLOY ANV PERSON IN ANV AIANNER SO AS TO BECOME SU&IECT TO THE
(/� WORKERS'COM7ENSATION LAWS OF CALIFORN10.AND AGREE THAT IF 1 SHOULD BECAME INSPECTION FEE
= SU&IECT TO THE WORKEFiS'COMPENSATION PROVISIONS OF SECTION 37o00F THE LABOR � / ,
CODE,I SHALL FORTHWITH COMPIY WITH THOSE PFOVISIONS. ISSUANCE
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p DATE: APPLICANT. �SMIP
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J WAqNIN6:FARURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
� SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOILARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMNOES AS PROVIDED FOR IN
w SECTION37080FTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER 7ENALTY OF PERJURV THAT THERE IS ACONSTRUCTION LENDINa AOENCV
FOR THE PERFORMANCE OFTHE WORK FOR WHICH TMIS PERMIT IS ISSUED(SEC.�087,CIV.C.�.
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� LENDER'S NAME
� LENDERS ADORE55
w I CEFTIFV ThIAT I HAVE READ THIS APPUCATION/VJD STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES X ���
� I AGREE TO COMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDIN6 CJ ✓
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE �
Z ABOVE-MEMqNED PROPEFTY FOR INSPECTION PURPoSES. COMMENTS
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SET BACK FLOOR JOIST
FTGS/FORMSISTEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE`FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 Ff. BOND BEAM
FRAMINGNENTlLATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERrfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRlG.
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 ENERGY
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COMME(VTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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