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_�� CITY OF DIAMOND BAx
,, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE5
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
'�^°•�, BUILDING PERMIT APPLICATION FIRMLY
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ADDRESS DATE NUMBE �..J K
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� I NEREBY 11FF7iM INYDER PENALTY OF PERJURY 1HA71 MI UCENSEU UNDER VROVISIONS OF CHACTER �
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WORKERS'COMPENSATION DECLARATION �
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Q OF THE WOfiN FOR WMMJI TWS PERMIT IS ISSUED. �
p �1 HAVE AND WILL MAIHTAN YNDRKERS'GOMPENSATION INSURANGE AS HEW IflED BY SECTION
370o OFT11E LABOR WOE.FOR THE PEHFOHMANCE OF 7HE WORK FOH WHICH THIS PERMIT IS
� ISSUED.MYWORKEH' PENSATIONINSURANC IERAN�POLICYNl1M6ERAqE: CONSTRUCTION
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� SHALLNO7EMPLOYM1vPER30NM1ANYMAIR1ER50aSTOBECOMESUBJEC7TOTHE
(n WORNERS'COMPENSATIONLIIWSOFCALIFORNIA,pNDAOREETHATIFIS/qULDBECOME INSP EE
� SV&IECT TO hIE WORKERS'CqAPENS�TION PFlOY1510N5 OF SECTION 97ao OF THE IABOfl
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� ENERGY P/C
WARNINf3;FALURE TO SECUFlE M�ORKERS'COMPENSATION COVERAGE IS UNLAWFUI,µD SHALL BE
� BUBJECTAN EMPIOYER 70 CRIMINAL PENALTIE9 ANO CIVII FINES UP TOONE FWNDRED TFKIUSAND ENERGY PERMIT �
DOLLARS(ita0,o0o),IN ADUfT10N TO THE COSTOF COMPENSRTqN,DAMAGES AS PROVIOE�FOR IN
.-}J SECTDN 97D!OF7HE U90RCOOE,N7EREST AND AT70RNEY5 FEES. RETENTION FEE:
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� IENDER'SHAME
� LENDEH'SADDHESS
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2 RECPT.NO. PAID BY VALIDA110N
F WHITE--Department Copy,YELLOW—Flnance Copy,PINK—Aseeaea Copy,GOLDENROD—file Copy.GREEN—ApplicenYs C.opy
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INfSPECTION RECQ�D
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SET BACK , FLOOR JO1ST ,
FfGS/FORMSlSTEEL FHA REQMTS , � -
ELECTRtC GROUND UNDER FLOOR DUCT - i
GROUND P�UMBING UNDER ELqDR CO�l�uIT ;� . ,� 1�_:-_�
SLAB GRADE FIREPLAGE FOUNDATION ---- ' � • . _
TEMP POWEfi FIREPLACE BOND BEAM
WATER SERVtCE - • MID HT BONd BEAM � -
ROOF SHEATHING : ,�. - � . 8 FT: BOND BEAM :� ' . _.. _ . _ .. _ : . ,
FRAMINGNENTILIATION FINAL BOND BEAM
R�OF COVER ' PRE-GRADWG �
ROt}G!-I HEATING BENCHING
R�UGH ELECTRIC I -2 • ROU�H GRADING
ROUGH P�UMBING , FINISH GRADING
SHOWER/TUB TEST POOL ELECTRlC
EXT.LATH/51DING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION I OFF 51TE IMPS. -
DRYWALL.NAILING DEDICATI�PJS
SEWER . FINAL ENG. �
SEPTIC TANK j LANDSCAPE/IRRIG. � --
SEEP PIT/L.L. I ON SITE tMPS.
G�S F,IR�EST •� FINAL ZONING � -
�lNRL CONST. • � � j• FIRE DE?T. FINAL f �
F�NAC HEATING � ' ' � - HEALTH QEPT. FINAL j �
F1NAL EL�CTRIC , •Q� '' ; DEV. FEES PRlD ; j
FINAL PlUMBING ; ENERGY ,�� � __
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COMMENTS
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