HomeMy WebLinkAbout12-1319 - - - �
_1�`_ CITY OF DIAMOND BAR �� �� I
. � DEPARTMENT OF COD�MUNITY&DEVELOPMENT SERVICES
�,;u . 218I0 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
\ '9^' BUILDING PER14�T APPLICATION F�RMLY
� JOBSITE /,I�P�cf� � �1vv� L.�1 APPLICATIO PERMIT I•�f�_ 131� P/C
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Z N7LL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR 9ALE(SEC.70�(BUSI- J �
� NE55 AND GROFESSIONS CODE:THE CONTMCTORS UCENSE UW DOES NOT APPIY 70 AN OV/NER OF � --
PROPEHfY WliO BUILOS OR IMPROVES THEHEON,AND WHO DOES SUCH WORK HIMSELF OR HEPSELF OR
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u1 OFFERm PDR SALE IF,HOWEVER TME BUILDINO OR IA/PROVEMENT 4S SOLD WRMIN ONE VEAR OF COMP�E-
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� NMOCOHTRACTSFORSUCHPR0.IECTSWITHAOOHTRACTOR�S)LICENSEDPURSUMIfTOTHECONTMG QUANTITY DESCRIPTION FEE �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBYAFFIRM UNDER PENQTV OFPEFUURY THAT I AMlICENSED UNDER PROVISIONS OF CHAPTER � �
� Y(COMMENCINO WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION �"-""`^ Q
� I HEREBV AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEClARA710NS: Z �
� _I HAVE AND�WILL MAINTAIN A CEftTIFICATE OF CqNSEM TO SELF-INSURE FOH WORKERS' _
Q COMPENSATION,AS PROVIDED BY SECTION 370o OF 7HE UBOR CODE,FOR THE PERFORMANCE �U�
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w �I HAVE AND WILL MAIMAIN WORKERS'�COMPENSATION INSUMNCE,AS REOUIRED BV SECTION � �
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCEDF THE WORN FOR WHIp1 THIS PERMR IS
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Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICN THIS PERMIT�S ISSUED,I MECHANICAL
C,'} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECAME SU&IECT 70 THE�
N WORKERS'CAMPENSATIDN LAWS OF CALIFORNIA,AND AGREE TMAT IF I SHOUCD BECAME INSPECTION FEE
SUBJECT TO THE WORKERS'COMPENSATION PROViS10NS OF SECTION 3700 OF THE UBOR - � � �
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� SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED THOUSANO ENERGY PERMIT
DOLURS.(Stoo,oDoj,IN ADDITION 70THE COST OF CAMPENSA7pN.DAMAGES AS PROVIDED FOR IN
� SECTION 37oB OF THE LABOR CODE,INTEREST.ANDATfORNEYS FEES. � RETENTION FEE: � �
OCONSTRUCTION LENDING AGENCY PRE-AlT FEE:
� 1 HEREBV AFFIRM UNDER PENALTV OF PEiL7URV THAT THERE IS A CONSTRUCTION LENDING AOENCY
�FOR hIE PERFORMANCE OF THE WORK FOR MM1iICH THIS PERMIT IS ISSUEU(SEC.�30�,CIV.C.). `„ , . �
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w� �ICERTIFYTHATI�HAVEREADTHISMPL�CATIONAtJDSTATETHATTHEABOVEINFORMATIONISCORRECT.- ' ' TOTAL FEES %�r�
� I AGREE TO COMPLY WITH ALL CITV AND COUNT'!ORDINANCES AND STATE UWS REU7ING TO BUILDING . 1
� CqNSTRUCTION,AND HEREBV All�HORIZE REPRESENUTNES OF THIS CWNTY TO ENfER UPON THE �_ �' ' ' .� ' � � � '
Z ABOVE-MENTIONED PROPER7Y FOR INSPECTION Vl1RPO5E5. ' COMMENTS `
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� S�GNATURE OF PERMtTTEE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Depertment Copy,YELLOYV—Finence Copy,P�NK—Assessor Copy,GOLDENROD--File Copy,GREEt�AppllcanYs Copy
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I�SPECTtON RECORD
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FTGS/FORMS/STEEL - FHA REQtv1T5
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ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNdER FLOOR CONDUIT
SLAB GRAUE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING '8 F�C BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
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ROOF COVER PRE-GRADING �
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ROUGH HEATING BENCHING
ROUGH ELECTRIC �ROUGH GRADING
ROUGH PI_UMBING � FINISH GRAD�NG �
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULAI"IQN POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALI NAILING DEDICATIONS
..._..._ _..._._. _.__._._ .-----._ ___--- -.__._. _. .____ --- --- ----- -- ---- ------- ----.._ _..----- ------ -- --------
SEWER •.FINAL ENG.
5EPTICTANK �LANDSCAPE/IRRIG.
---- �----...-----------------...__._.._-._.......___. ._...-----._....__--...----._.._.
SEEP PIT!L.L. 'ON SITE IMPS.
GAS AIR TEST FINAL ZQNING
FINAL CONST. �FIRE DERT.FINAL -
FINAI HEATING �HEALTH DEPT.FINAL "
FINAL ELECTRIC ;DEV.FEES PAID
fINAI PLUMBING ENERGY
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