HomeMy WebLinkAbout12-594 _�F�_ CITY OF DIAMOND BAR /
DEPARTMENT OF COMMUNI'I'Y&DEVELOPMENT SERVICES ��
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection HoUine(909)839-7027 PRESS
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TURE,VRIOR 70 RS LSSUUAIJCE.ALSO REWIRES h1E APPLICANT FOR SUCH PERMIT TO FILE A SIONED W
� STATEMEHT THAT HE OR Sl1E IS LICENSED FURSUANT TO THE PHOVISIONS�OF hiE'COMMCTOFi9 LF
� CENSE LAW(CHAPTER e(COMMENpNO VA7H SECTION 7000)OF DIVISION 7 OF 7HE BU57NE55 M1D�PRo- � POOUSpO
, � FESSIONSCODtjORTHATHEOq3HEISEXEMP77NEREFROAIANDTHEBASISFORTHEALLEOEDEXEMP- � (�
TION.ANY.VIOlAT10NOFSECTION7o37.68vANYAPCLICANT�FORAPERMITSUAIECTS7HEAPPLICANTTO . Z RB-ROOf
� A CIVd VENA�iY OF NOT AqRE R1AN FNE HUNDRED DOt1AH5(f50D).): �-
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� NE53 AND PROFESSIONS CODE:THE CON7RACTORS LICENSE�UW DOES NOT AVPLV TO AN OWNER OF � � ��
PROPERTY W/q BUILDS OR IMPROVES THEREON,M1D WHO DOES SUCFt MqRK HIMSELF OR HERSELF Ofi
� TiROUGHHISOqHERONRJEMPLOVEES,PROVIDEOTHATSUCNIMPROVEMEHTSARENOTWTENDEDOq . m -
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Z TION..THE OWNER-BUILDEP VALL HAVE THE BURDEN OF PROVIN(i TFiAT�HE OR SHE DID NOT BUILD OR . .
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TORS LICENSE LAW.).
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� OATE ONRJER �
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� LICENSED CONTRACTORS DECLARATION �
� 1 HEREBY AFFIRAI UNDER PENALTV OF PERJURY THAT I AM�LICENSED UIJDEfl PROVISION9 OF CFIAF7ER �� � � -
� Y(COMAIENCMO W17H SECTION 7000)OF DMSIDN J OF 7HE BUSINESS ANO PROFESSIONS ODDE,AND Z.
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� WORKERS'COMPENSATION DECIARATION Q� � � � � �
� 1 HER�Y AFFIRII UNDER PENALTV OF PERIURY ONE OF iHE PoLLOW WG DECIARAT10N3: �
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� _I HAVE�AND WILL WUNTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR Vpql(ER5' � � - �
CONPENSATION,AS PROVIDED 8Y 6ECTION 37000F THE UBOR CppE,FOR THE PERFOPMANCE W�
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � �
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Qw _i HAVE AND WILL AWNTAW WORKERS'COMPENSA710N MSUqANCE;AS qEWIRED BV SECTION
37ao OF THE LABOR CODE,FOR THE PERFOfiMANCE�OF THE WOPo(FOR WFIIGI THIS PERMR IS,
�SSUFD_MY WOPo(EA5 COMPENSA710N INSURANCE CARRIEH�AND POLICY NUMBER M@ �CONSTRUCTION ��� ��
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0 70lICY�NUMBER
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p (rmSs�ctqr�N�npTSE�TIDa�n�a�,+Ts�na+E�ax�o�oauaslstao)ota�ssi PLUMBING �
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Z I CERTIFY THAT W THE PERFOiUTANCE OF THE wORK FOR WMICH THtg pERMR IS ISSUED,1 MECHANICAL
CS SNALL NOT EM7LOY ANV PERSON W ANY MANNER SOAS TO BECOME�SU&IECT 70 THE - ��� �
(n N4RNER5'CAMPENSATION LAWS OF CA�IFORNIA,AND AOREE THAT IF I SFIOULD BECOME INSPECTION FEE
S SU&IECT TO THE WORKERS COMFEN9AT10N PROV15qNS OF SEC710N 770o OF THE IABOR �� � � A
cooE,i sruu warriwin�coMa�v win�n�osE aaov�s�a+s. ISSUANCE 'V
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p DATE pppucqtar. .SMIP
� WA/iN�NO:�FAILURE TO SECURE WOH!(ERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
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DOLLARS.(S10o,00D),�W ADDITION TO THE COST OF CAMPENSATqN,DAMAQES AS PROVIOED FOR IN
J SECTION 370!OF 7HE UBOf{CODE,WTEREST,AND ATfORNEV'S FEES. � � � - �
� AETENTION FEE:
O� � , CONSTRUCTION LENDING AGENCY pp_�p . �
� I HEREBYAFFIRM UNDER PENAL7Y OF PERIURY THA7 THERE IS ACONSTRUC710N LENpWp ApENCY P�d fjE j�
z �FOR hIE PERPoRNANCE OF THE WORK FOR WFIHa/7HiS PERMR IS ISSUED(SEC:3oW,CIV.C.�
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�. LENDERS NMIE , . . ..
f— LENDERSADORE55 � � � �
� u-' �ICERTIFVTHATIHAVEREADTHISMPLICATIONANpSTATE7HATTiEABOVEINFORIAATIONISCOqRECT. TOTAL FEES ��1 • ` 'a I���, �
W 1 A6REE TO CAMPIY N7TH ALL CfTY AND COUNTY ORDINANCES AND STATE UWS REIATiNO TO BUI�pIN6
� CONSTRUCTION,M1D HEREBV AUTHO{3IZE REPRESENTATIVES OF THIS COUNTy TO EMER UPON THE
Z ABOVE-MEMIONED PROPERTV FOR WSPECTION PURPOSES.
o COMMENTS '
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m PERMI7TEE NAME(VRINn " �
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� �IG ���s �.b�
Uj �SH3NATURE OF PERMITTEE DA7E
� RECPT..NO. PAID BY VAUDATiON
� WHITE—Department Capy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR ile Copy,OREEN—
APP���anYs Copy
Cil'Y OF DIAMOfVD �AR
IfVSPECTIORI RECORD
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SETBACK FLOORJOIST ' . . , ; ..
FTGS/FORMS/STEEL FNA REQMTS
ELECTRIC GROUND UNDER rL00R QUCT
GR�UND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMINGIVENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRRDING
ROUGH PLUMBlNG FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTI�TANK � LANDSCAPE/IRRIG. �
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. FIRE DEPT.FIM1IAL
FINAL HEATING � HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FlNAL PLUM8ING �ENERGY
FINAL PLANING i
FINAL ENGIIdEERING • e o
COMMENTS '�trn c,� �1C--1Ti("AA��O`� C ,,Z � �_
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SEPTICTANK SIZE
SEEP PIT/U SIZE
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