HomeMy WebLinkAbout12-1208 _�� _ CITY OF DIAMOND BAR � L- �5������
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
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(909)839-7020 Fax(909)861-3117 Building Inspection flotline(909)839-7027 PRESS
: 'A�'. BUILDING PERMIT APPLICATION FIRMLY
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1 HEREBY AFFIRM UNDEH PENALTY OF PERIURY THAT 1 AIA E%EMPT FRDA1 THE CONTMCTORS LI• Gef0J0/C9fpOR
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PROPEHTY W/i0 BUILDS OR IMVROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR �
CC iHROUGH HIS OR HER ONM EMFLOVEES,PROVIDED THAT SUd11MPROVEMEHTSARE NO71N7ENDED OR . m . .
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� I HEREBYAFPIRM UNDER PENALTY OF PERIURY 7HAT I AMlICENSED UNDER PROVISIONS OF CHAPTER � J -� � -
d, 9(COMMENCIMO W17H SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z �
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� WORKERS'COMPENSATION DECLARATIO �� U - � _ -
� 1 HERFBY AFFIRM UNDER PENALiV OF�ERJURV ONE OF THE FOLLOWING DECIARATlO S: Z �
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT 70 SELF-INSURE FOR WORNERS' _ ., �
COMPENSATION,AS PROVIDEO BV SEC710N 37oo�OF THE UBOR COOE.FOR THE PERFORMANCE W�
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w I HAVE AND WILL MAIMAIN WORNERS'COMPENSA710N INSUMNCE:AS REQUIRED BV SECTION � � �
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� GOLICVNUMBER � _ _, _ ELECTRIC
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH iHIS PERMIT IS ISSUED,1 MECHANICAL V, J.
C�3 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME�SU&IECT 70 THE �
� WORKERS'CAM7ENSA710N LAWS OF CALIfORNIq AND AGREE 7HAT,-,IF I SHOULD BECAME INSPECTION FEE
� SU&IECT TO THE WORKERS'�COMP N PROVISIONS OF�SECTI� o00F THE LABOR - �
� �DE,I SH F1 FORTHWITH COMP 7 E PROVISIONS. ISSUANCE
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DOLURS(5100.0oo),�IN ADDITION TOTH COST OF COMPENSATION,DAM ES AS ROVIDED FOR IN
� SECTION 370!OF 7HE LABOR CODE,INTEREST;ANDATTORNEYS FEES. ' R�ENTION FEE: I �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFIRM UNDER�PENALTV OF PERIURY THAT THERE IS ACONSTRUCTION LENDINO AOEHCY
�FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.So77,CIV.C.).
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� 1 CERTiFY THAT I HAVE READ THIS APPLICATION AND STATE T}IAT THE ABOVE INFORMATIOH IS CORRECT.
� 1 AGREE 70 COMPLY WITH ALL CI7Y AND COUNTV ORDINAIJCES M1D STATE lAWS HELA7ING TO BUILDINO
� CANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA7NES OF THIS COUNTY 70 EHTER UPON THE -
Z ABOVE-MEMIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS '
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CITI� CJF DIAMOND �AR �
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SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER �FIREPLACE BOND BEAM
WATER SERVICE 'MID HT.BOND BEAM
ROOF SNEATHING '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/TUQTEST 'POOL ELECTRIC
EXT.LATH/SIDING �POOL FENCING
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QRYWALL NAILING i DEDICATIONS
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SEWER �FINAL ENG.
SEPTI�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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