HomeMy WebLinkAbout13-656 CITY OF DIAMOND BAR �
� � ---��— DEPART1�iENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702 PRESS
�"'""� BUILDING PERMIT APPLICATION FIRMLY
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p OWNER �RL1NC'1►VE H S U DATE CONST.�_r GROUP S�I`
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g APPUCANT LBw •�/tCy�.lte TEL.']Iyl"►7'4040 AEAR �
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� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER B(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' Pool/S a
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� NESS AND PROFESSION3 CODE:THE CANTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPER7V WFIO BUILDS OR IMPROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR
w iHROlX3H HIS OR HER OWN EMPLOVEES,GROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m _ �
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N 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OFTHE FOLLOWING DECLARATIONS: �
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� _I MAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SEIF�INSURE FOR WORKERS' _
� COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFOqMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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�I HAVEAND WILL MAINTAIN WOR)(ERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION �
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOflK FOR WHICN THIS PERMIT IS �� t
ISSUED.MV�fQ�'�RKERS'COMPENSATION INSURANC CARRIER AND P ICV NUMBERARE: CONSTRUCTION
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Z I CERTIFV T}iAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
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(n WORKERS'COMPENSATIONLAWSOFCALIFORN10.M1DAGREETHATIFISHOULDBECAME INSPECTIONFEE
SU&1 T TO THE WORKERS'COMPENSATION 7ROVISqNS OF SECTION 7700 pF THE LABOR
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p DATE: � PPLICANT: L,P�a.�� SMIP � �'�r�
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J WARNINO: PJLURE TO SECURE WORKEFS'COMPENSATION CAVEFAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
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� SU&IECTAN EMPLOVER TO CflIMINAL PENALTIES AND CIVIL FINES 11P TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLAAS(S1ao,a00J,IN ADDITION TO THE COST OF fAMPENSATION,DAMAGES AS PROVIDED FOH IN
J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. "r1
w RETENTION FEE: C�
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� FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ.
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� LENDER'S NNdE
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W I CERTIFV TNAT I HAVE READ THIS APPUCATION�WD STATE THAT THE ABOVE INFORMATqN�S CORRECT. TOTAL F E ES ��S •
� I AOREE TO CAMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS FELATINO TO BUILDING
� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATNESOFTHISCOUNTYTOENTERUPONiHE ' �
Z ABOVE-MENTqNED PROPERTV FOH INSPECTION PUR705ES. COMMENTS -
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m VERMITTEEN (PRINT� 'n� � �
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� NAN OF PERMITTEE DATE
� RECPT.NO. PAID BY VALIDATION �
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPL,4CE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING �, � ( 8 FT. BOND BEAM
FRAMINGNENTlLATION - 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 FINAL
GEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINA�ENG.
SEPTIC TANK LANDSCAPElIRRIG.
SEEP PIT/L.L. ON SlTE IMPS.
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03/05/2013 11:08 17147776110 MCCORMACK ROOFING PAGE 01101
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