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� • � _� CITY OF DIAMOND BAR `'�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suitc 190
- (909)86Q3195 Fax(909)861-3117 PRE$$
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V T�OI7.ANV VIOLATqN OF SECTION 70J7.6 BY AHY AYPLICMlT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
� AClVIL VENAL7Y OF NOT MORE 7HAN FNE HUNDRED DOLL.ARS(i6o0).):
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� NE99 MD PROFESSIOHS CODE THE CONTRAC70R9 LICENSE UW DOES NOT MPLV TO AN OWNER OF ?
PROPEHTV NR10 BUQDS OR MPROVES 7NEREON.AND WViO DOES SUCH WORK HIMSELF OR HERSELF OR
CC THROUGH HIS OR HER OWN EMPLOVEES,PROVtDED THAT SUCH UAPROVEMENTS ARE NOT INTENDED OR m
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Z 'TqN;THE OWNEH�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR .
� W PHOVE FOH THE PURPOSE OF SALE�
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� LICENSED CONTRACTORS DECIARATION �
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� �INAVEAHDWILLMAPlTAPIACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORKERS' _
Q COMPEN9ATION,AS PRONDED BV SECTION 3�0o OF THE UBOR CODE,FOR THE PEHFORMANCE U
Q OF THE WORK FOR WHK]1 TMIS PERMIT IS ISSUED. �
_I HAVE N1D WILL MNNTNN WORKERS'COMPENSATqN INSURANCE,AS REOUIRED BV SECTION !
Q � ' 37000F hiE LABOR CODE,FOR THE PERFORMANCE OF THE WOfl)(FOH WHICH THIS PERMIT IS /�� A /�
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Z ' I CERTIFV THAT W THE PERFORMANCE OF THE WORI(FOR WHICH THIS PERIAIT IS ISSUED,1 MECHANICAL
CJ' ' SFIALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
N WORKEP5COMPENSATqNUW50fCALIFORNIA,ANDAOREETMATIFISHWLDBECOME INSPECTIONFEE
SU&IECT TO THE WORKERS'COMPENSATqN PROVISIONS OF SECTION 370o OF THE IABOR
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p DA�:�� APPLICANP. , �SMIP � _ - �- .
� W INO:FA0.URE TO SECURE VIOfLCERS' SATI VEM6E IS UNLAWFUL,AND SHALL BE ENERGY P/C
� � SU&IECTM!EMPLOVER TO CRIMINN.PENALTI AND C FMES UP TOONE HUNDRED TFIOUSAND ENERGY PERMIT
DOUJ�RS(f100.000),W MDITON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
¢ SECTION 3708 OF 7HE UBOR CODE,INTEREST,AND ATfORNEV'S FEES. ' RETENTION FEE:
OCONSTRUCTION LENDING AGENCY ' ^ PRE-ALT FEE:
� �HEREBY AFFIRM UNDER PENALTV OF PERJURV 71NT THERE IS ACONSTRUCTION LENDINO AOENCY
FOq THE PERFORMANCE OF hIE WOHK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.).
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� LENDER'S NMIE �
� LENDER'SADDRESS
,� TOTAL FEES �
� I CERTIFV THAT I HAVE RE/�D THIS AP7LICATION PND STATE THATTHE ABOVE INFORMATpN IS CORRECT. �
� I A�REE TO COMPLV NATH�Ll CRV AND COUNTY ORDINANCES AND STATE UWS RELATINO TO&14AIN0
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE " �
ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES.
COMMENTS
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� WHITE—Uepartment Copy,YELLOW�Inence Copy.PINK—Assesaor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
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SLAB GR�4DE � FIREPLACE FOl1NDATION . . � `^
TEMP POWER FIREPL•A'GE BONQ BE�tM
WATER SERVICE MID HT. BOND.BEAM
ROOF SHEATHING • 8 FT. BOND,BEAM �
FRAMINGNE'NTILIATtON ' ' • ' FINAL 80ND�BE;4M
ROOF COVER t � PRE-GRADING
RO_UGH,HEATING � � BENCHING
R�UGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TES7 POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL• INSULATION POOL FINAL
CEiLING INSULATION OFF SITE IMPS. .
.DRYWAL.L NAILING DEdICATIONS '
�EWER FINAL ENG.
SEPTIC TANK � IANDSCAPE/IRRIG.
SEEP P!T/L.L ,�,�'c 1j. ON SITE IMPS. '
GAS AIR TEST � FINAL ZONING
FI�iAL CONST. FIRE DEPT. FINAL
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Fff�AL ELECTRIC DEV. FEES PAID
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