HomeMy WebLinkAbout13380 �� CITY OF DIAMOND BAR � �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190 �
(909)86Q3195 Fax(909)861-3117 PRESS
� ���'�`� BUILDING PERMIT APPLICATION FIRMLY
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Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICAN7 FOH SUCH PERMIT TO FILE A SIGNED
� STATEMEM THAT HE OR SHE IS LICENSEU PURSUANT TO hIE PROVISIONS OF 7HE CONTRACTORS LI- w
� CENSE LAW(CHAPTER i(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSqNS COOE)Ofl THAT HE OR SHE IS EXEMPT 7HEREfHOM ANU THE BASIS FOR 7HE ALlEOED EXEMP-
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NALL DO THE WORK AND THE STRUCNRE IS NOT INTENDED OR OFFEfiED FOR SALE(SEC.701�,BUSI- J
NESS AND PipFE5S10N5 OODE:THE CONTRACTORS LICENSE UW DOES NOT A7PLY TO AN OWNER OF
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Z 'T10N,THE OWNEH-BUILDER M/ILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALk�.
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FQ UCENSED CONTRACTORS DECLARATION w ��i.,i�
CL 1 HEREBV AFFIRAI UNDER PENALTY OF PER1UFiY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �r . �
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� I NEREBV AFFIRM UNDER PEN�LN OF VERIURV ONE OFTHE FOLLOWING DECURATIONS: U
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� IHAVEANDWILLMAINTAINACERfIFICATEOFCONSENT705ELF-INSUREFORWORKERS' 2
� COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE UBOR CODE,FOR 7HE PEHFORMANCE w ' I
OF hIE WORK FOR NM111CH THIS PERMIT IS ISSUED. �
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� _1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSUfUNCE,AS REQUIRED BY SECTION I
QQ 37000F THE LABOR CODE,FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS �]
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER ANO POLICY NUMBER ARE: CONSTRUCTION 1� 'O
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Z I CERTIFV THAT IN h1E PERFORMANCE OF 7HE WORK FOH WHICH THIS PERMIT IS ISSUED,I
(} SIULL NOT EMPl.OY ANY PERSON IN M!Y MANNER SO AS TO BECOME SUBJECT TO THE
� WORKEHS'COMPENSATION UWS OF CALIFOHNIA PND AGREE THA71F I SHOULD BECOME INSPECTION FEE
S SU9IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
CADE,I SHALL FORTHWITI COMPIV W17H THOSE PROVI510N5. ISSUANCE � e� �i
p OATE: APPLICANT: SMIP j ° O
� ENERGY P!C
WARNING FAILURE 70 SECURE WORKERS'COMPENSA710N COVERAGE IS UNUWFUL,AIJD SHALL BE
� SU&IECT AN EMPLOYER 70 CRIMINAL PENAL7IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100,OOD),IN ADDITION TO THE CAST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEFiEST,AND ATfORNEV'S FEES. � RETENTION FEE: ��O�
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d CONSTRUCTION LENDING AGENCY PH�(ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY THATTHERE IS A CONSTNUCTION LENDIN�AGENCY ]/I��
FOR THE PERFORMANCE OF 7HE WORK WR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME � •�Q
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w 1 CER7IFV THAT I HAVE READ THIS APPLICATION NID STATE THA77HE ABOVE INFORMA710N IS CORRECT. TOTAL FEES
� 1 AGREE TO COMPLV N7TH�LL CITY AND COUNTY ORDINANCES AND STATE UWS REUTINO 70 BUILDING
CONSTRUC710N,ANO HEREBV AU7ifORIZE REPRESENTA7IVES OF 7HIS�TY TO ENTER UPON 7HE -
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� RECPT.NO. j � PAID BY VALIDATION
WHITE—DepeAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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CIT'1( OF DIAMO(VD BAR
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SET BACK ��� �� � � 'FLOOR JOIS7��,.). ' ,., '; ;, `- � �
FTGS/FORMS/STEEL ,,� ,' . • FHA REQMTS
ELECTRIC GROUND • ' ` � UNDER FLOOR DUCT . ,•.;� ,
GROUND PLUMBING UNDER FLOOR�U�IDI�iT�.: � ; ��'- :��% ' '�='��;
SLAB GRADE FIREPJ-A E FO,UND/�TION�'=�: �� ._:.' �.. . ' =,.•��``"
TEMP POWER FIREPL � BbND�EAM �� " � � ' � ��
WATER SERVICE - MID HT. BOND BEAM
ROOF SH A`fHING'• ' ':'. '-` � � -•:�=� ' ;� .'�•. i 8 FT. BOND BEAM
FRAMINGNENTILIATION � � FINAL BOND,BEAM•- �;:, . ., •.�;;�, ��y ;, . :. �+ .
ROOF COVER ...��.-� ,1:� PRE-GRAIDINGG: , : �.:. ., ;i,,= , • "
ROUGH HEATWG BENC�9ftfG'. j ;..;..:c�� �� �-:�a' '._- ` .`.,� � ,,._!r,,_
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUfVIBiNG FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING �
WALL INSULATION POOL FINA�
CEILING INSULATION OFF SITE IMPS.
DRYWALI.NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK �, ; ., ,-,, LANDSCAPE/IRRIG.
SEEP PIT/L.L. : ' � �;' � ON SITE IMPS.,
GAS AIR TEST FINAL ZONING
FINAL CONST. p � FIRE DEPT. FINAL
FINAL HEATING ' HEALTH DEPT. FINAL �
FIPJAL ELECTRIC DEV. FEES PAID
FINAL PLUMSING ENERGY •
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