HomeMy WebLinkAbout11-108 �.� CITY OF DIAMOND BAR "�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21825 Copley Drive,Diamond Bar,CA 91765 PRESS
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702'7
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� NE55 AND PROFESSIONS CODE:1ME CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPER7V N�iO BUq.OS OR IMPROVES TNEREON,AND WHO DOES SUCH WORK HIMSELF OR HEHSELF OR m
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� DATE OYMER ~
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� LICENSED COMTRACTORS DECLAPATION -� �.
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� I HEREBY AFFIRM UNOER PENALTV OF PERIURV THAT I AM LICENSE�UNDEfi PROVISIONS OF CHAPTER �r r O� �� U'
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� I HEREBV AFfIWA UNDER PENALTV OF VERIURV ONE OF THE FOLIOWMG DECLARA710N5:
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� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOfi WORKERS' .2
� COMPENSATION,AS PROVI�ED BY SECTION 370o OF THE IABOR CODE,FOR THE PERFORMANCE w
OFTNE WORN FOF WHICH THIS PERMIT IS ISSUED. �
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w �I HAVE AND WILL AIAINT/JN WOfU(ERS'COMPENSATION INSURANCE.AS FEIXIIRE�BY SECTION
Q 3'+00 OF THE 1A80R CODE,FOR TNE PERFOPI.IANCE OF TNE WORK FOR WHICH THIS P�0.MIT IS
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jCARRIER ��� �� _ PLAN REVIEW
� POLICV NUlA9ER Z f?{o r)� V ELECTRIC
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Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE M/DRN FOR WHICH iH15 PERMIT IS ISSUED,I
(,�J SHALL NOT EMPLOY ANV FERSON IN ANV MANNER 50 AS TO BECOME SU6JECT TO THE �
� WORKERS'COIdPENSATION lA`NS OF CALIFORNI AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
S SUBJECTTOTHEWORKERS'COMPENSATIONP ISIONSOFSECTION77000FTHEUBOR ISSUANCE
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p DATE; 1 " APPLICANT. � �
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� SUOJECT/�N EMPLOYER TO CRIMINAI PENALTIES AN�CIVIL FMES UP TO ONE HUNORED TFtOUSANO ENERGY PERMIT
DOLLARS(f100.000).IN ADDI710N TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN
J SECTION 3'!oe OF THE UB�R COOE,W tERE57,AND ATfORNEVS FEES. RETENTION FEE: .
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w CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CANSTRUCTION IENDINO AQENCY
� FOR THE PEi7FORMANCE OF THE WORN FOR WHIp1 h115 FERMIT IS ISSUED(SEC.9097,CIK CJ.
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� LENDER'S NAME
� LENDEASADDRE55
� I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT TFIE ABOVE�NFORMATqN IS CORRECT. TOTAL FE ES .
w I AGREE TO CAMPLY WITH AL�CRV M10 COUNTV OFDINANCES MlD STATE UWS FEUTINQ TO BUILDINQ .
� CONSTRUCTION,ANp HEREBV AUTHORIZE REPRESENTATIVES OF 7HI5 COUNTV TO EMEA UPON THE �
ZA90VE-MEMIONED 7ROPERTV FOR INSPECTION PURPoSES. COMMENTS � .
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� WHITE—Department Copy,YELLOW�Inance Copy,PINK—Assessor Copy,GOI�ENROD—File Copy,GREEN—ApplicanPs Copy
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SET BACK • FLOOR JOIST
FTGS/FORMS/STEEL FHA REOMTS
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 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 PQOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICAT�ONS
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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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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