HomeMy WebLinkAbout11-379 (5) ^ _�� CITY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
4'9^' BUILDING PERMIT APPLICATION FIRMLY
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� CENSE LAW(CHAPTER o(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 0F THE BVSINESS AND PRO- � POOVSPB
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WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70lI,BUSI� J COlfIrtIBfC181
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70RS UCENSE LAW.). PEE
� ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON �
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� I HEPEBY AFFIRAI UNDER PENALN OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAFTER Z -L ��C O
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� I HEREBV AFFIRM UNDER PENALTV OF PERIUFV ONE OFTHE FOLLOWING DECLARATIONS: V
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� _IHAVEANDWILLMAINTAWACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a
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Q COMVENSATION,AS FROVIDED BV SECTION 370o OF 7HE LABOR fADE,FOR THE PERFORMMlCE U
OF THE WORK FOR NT11CH THIS PERMIT IS ISSUED. W
� �I FIAVE AND WI�L MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIqED BV SECTION �
O 370o OF THE LABOF COOE,FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER FfiE: CONSTRUCTION '
� CAARIER D�P/'�05 �-g. PLAN REVIEW
0 POLICY NUMBER �17 I,C IZr✓�t 20 O?N� ELECTRIC
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Z I CERTIFV THAT IN THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SMALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFOqNI/�AND AQREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECTTOTHEWORNERS'COMPENSATqNPROVI510N50FSECT10N37000FTHEUBOR �� ��
CODE,I SHALL RTHWITH COMPLY VIM11T� ISSUANCE
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1p OATE: �' �� APPLICANT: � � SMIP
J WARNINO:FAILUFE TO SECURE WORKEFS'COMPENSATION CAVERAOE IS UNIAWFUL,AND SHALI BE ENERGY P/C
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� SUBJECTAN EMPLOYER TO CHIMWAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSMID ENERGY PERMIT
DOLURS(f100,000�.IN ADDITION TO THE COST OF CAMPENSATqN,DAMAGES AS PROVIDED FOR IN
J SECTION 37oe OF iHE LABOR CADE,INTEREST,M!D ATTORNEYS FEES. �!�.�
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� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS ACANSTRUCTION LENDINa AOENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3007,CIV.C.).
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� LENDEFS NAME
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w I CERTIFY TNAT 1 HAVE READ THIS APP�ICATION AND STATE THAT THE ABOVE INFOR/AATION IS CORRECT. TOTAL FE ES �-/S'O�
� 1 AGREE TO CAMPLY WITH ALL CI7Y AND COUNTV ORDINANCES AND STATE LAWS REIATINO TO BUILDINO G
� CONSTRUCTION,AND HEREBY AUTHORRE REPRESENTATIVES OF TNIS CWNTV TO EMER UPON THE
Z ABOVE-MENTIONED FROPEi7TV FOR INSPECTION PURPOSES. COMMENTS
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� WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROa—File Copy,GREEN—Applicant's Copy
CITV O� DI�NiOND BAR
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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 B�AM "
FRAMINGNENTILATION 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
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
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 PAIQ
FINAL PLUMBING ' :.{„ �� ,� __ ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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