HomeMy WebLinkAbout10-1086 (5) _
CITY OF DIAMOND BAR
----��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'�^'� BUILDING PERMIT APPLICATION FI�iMLY
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w TURE.PRIOR TO ITS ISSUANCE,ALSO HE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE CAN7RAC70R5 LI- �
� CENSE UW(CHAPTER e(CAMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- POOVSP2
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PROPERTY WHO BUIlDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPIOYEES,PROVIDED THA7 SUCH IMPROVEMENTS ARE NO7 1N7ENDED OR m
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� I HEREBY AFFIRM UNDEH PENALTV OF PERJURV THA7 I AIA LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 Of 7HE BUSINESS AND PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWINCa OECURATIONS: Z
Z _IHAVEANDWILLMAIN7AINACERTIFICA7EOFCONSENTTOSELF�INSUREFORWORKERS' _
Q CAMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE W
Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � .
Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION /�
37oa OF THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT 15 • /�, /'y�
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: � CO STRUCT 7!�(V
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Z I CERTIFY THAT M THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
(3 SHALL NOT EMPLOV ANY VERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORNERS'COMPENSATION LAWS OF CALIFORNIA,AN�AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE.1 SHALL FORTHWITH COMPIV WITH THOSE PROVISIONS. S UANC ��
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p DATE: APPLICANT.
wWARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&lEC7ANEMPLOVERTOCFIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLAFS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOH IN
� SECTION 3708 OF 7HE LABOR CODE,IN7EREST,AND ATTORNEV'S FEES. NT . � L
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY ��i ��
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). .
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� LENDER'S NAME
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� I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOPMATION IS CORRECT.
w I AGREE 70 COMPLV WITH ALL CI7V AND COUNTV ORDINANCES AND STA7E UWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HI5 COUN7Y 70 EN7ER UPON 7HE -
� ABOVE-MEN710NED PROPERTY FOR INSPECTION PURPOSES.
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~ WHITE—DepaAment Copy,YE OW ance Copy,PINK—Assessor Copy,GOLDEN a—File Copy,GREEN—Applicant's Copy
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SET BACK , FLOOR JOIST
FTGS/FORMS/STEEL � FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUNO PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BQND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
FiOUGH PLUMBING 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.
SEPTIC TANK �ANDSCAPElIRRIG.
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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COMMEIVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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