HomeMy WebLinkAbout11-1470 ^ _�„` CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building[nspection Hotline(909)839-7027 PRESS
;4'°�"� BUILDING PERMIT APPLICATION FIRMLY
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� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
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� I HEREBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLAAATIONS: Z
Z� ,�I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSUHE FOR WOHKERS' ¢
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w _I HAVE AND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REWIqED BV SECTION
Q 3700 OF THE LABOR CADE,FOR THE PERFORMMICE OF THE WORK FOR WHICH THIS PERIAIT IS
ISSUED.MV WORKERS'COMPENSATION INSUHANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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Z 1 CERTIFV THAT IN THE PEFFORMANCE OF THE WORN FOR WHlp/THIS PERMIT IS ISSUED.I MECHANICAL
(} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(/� WORNERS'CAMPENSATION LAWS OF CALIFORNIA AND AQREE THAT IF I SHWLD BECOME INSPECTION FEE �
SU&IECT TO THE WOqKERS'COMPENSATION PROVISIONS OF SECTION 37o00F THE LABOR
O CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE _ `�t � �
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� WMNING:FAILURETO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C �
LL SU&IECTANEMPLOVERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT
DOLURS(5100.000),IN PDDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOq IN
J SECTbN 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES.
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� I HEREBV AFFIRAI UNDEP PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AQENCY
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� LENDER'S NAME '
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W I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL F E ES ///J� / �
� I AGREE TO C0IAPLV WI7H ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDINO ` w
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTEF U70N THE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS '
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Uj SIGNA OFPERMITTEE DAT
� RECPT.NO. PAID B ' VALIDATION
WHITE—Depertment Copy,YELLOW�inance Copy,PINK—Aasessor Copy,GOLDENROD—File Copy,GREEI�Applicant's Copy
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FTGS/FORMS/STEEL FHA REQMTS
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GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BE,4M
ROOF COVER PRE-GRADING
ROUGH HEATING ;� BENCHING
ROUGH ELECTRIC ��.25'� ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB 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 LANDSCAPElIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC j,` _`� 4 � DEV. FEES PAID
FINAL PLUMBING Y � ENERGY
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