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I _�,�_ CTTY OF DIAMOND BAR � 7 f �`r,
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES /
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(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PP�ESS
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMI7 70 FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll� �
� CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF Tl1E BUSINESS AND PRO- PO01/Sp2
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WIIL DO THE WORK,AND 7HE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.701l,BUSI- J
� NESS AND VROFESSIONS CO�E:THE CONTRAC70RS LICENSE LAW DOES NO7 APPLV TO AN OWNER OF �
VROPERTY WHO BUILOS OR IMPROVES THEREON.AtJD WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES.PROVIDED 7HAT SUCH IMPROVEMEN7S ARE NOT IN7ENDED OR m
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�Q LICENSED CONTRACTORS DECLARATION w
2 I HEREBY AFFIRM UNDER PENPLTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER V.
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF 7HE FOLLOWING DECLARA7ION5: Z - •
Z _I HAVE AND WILL MAMTAIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WORKERS' a
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Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ^�
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER AflE: CONSTRUCTION J��O
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� (IHISSEC�IONNEmNO7BEO7MPLEfEDOFTHEPERMIfISFORCNEFNI�DREDDOLLP3iS(510U)ORLESS} PLUMBING
Z I CER7IFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
C} SHALL NO7 EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJEC7 70 7HE
(/� WORKERS'COMPENSATIONlAW50fCALIFORNIA,ANDAGREETHATIFISHOULDBECAME INSPECTIONFEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF 7HE LABOR �j ((�`�
CADE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �C ���/
p DATE: � � �I APPLICANT: SMIP . �(7
J WARNING:FAILURE 70 SECURE WORKERS'CAMPENy TION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&lEC7AN EMPIOYER 70 CRIMINAL PENALTIES ANb CIVIL FINES UP TOONE HUNOREO THOUSAND ENERGY PERMIT �
DOILARS(5100,000J,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN /]
� SECTION 37oe OF THE LABOR CODE,INTERESL AND ATTORNEYS FEES. RETENTION FEE: r�(r��
a CONSTRUCTION LENDING AGENCY P ALT FEE:
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1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,qV.C.).
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� LENDEFi'S NAME
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� I CER7IFV THAT I HAVE READ THIS APPLICA710N AND S7ATE THAT THE ABOVE INFORMA710N IS CORRECL � � " �
w I AGREE TO CAMPIV WITH ALL CITV AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHOflIZE FEPRESENTATIVES OF THIS COUNN TO ENTER UPON THE
� ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES.
Z COMMENTS
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� SIGN RE F PERMITTEE DATE
= RECPT.NO. PAID BY � VALIDATION
~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assassor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
EL'ECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER . � �'�' � MID H'L BOND BEAM
ROOF Sh e�rjll�'�j�6', 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. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAI
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 ENERGY
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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