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��_ CTTY OF DIAMOPID BAR
� �; DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�� 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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I HEREBYAFFIRAI UNDER PENALTV OF�PERJURV THAT I AM'UCENSED UNDEfl PROVISION9 OF C}IAPTER �
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_ � WORKERS'COMPENSATION DECLARATION Q� �� � � � � � - �� - -
� 1 HEAEBV AFFIR►1 UNDER PENALTV OF PERIUFY ONE OF THE FOLLAWW(3 DECLARATIONS: � ' �
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� _I HAVE�AND WILL�WNTAW A CER7IFICA7E OF CONSENT TO SEI,F-W$URE FOR NqPo(EHS' � . . . .
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� _I HAVE AND WILL MAINTANIINORKER3'�COMPENSATION INSURANCE;AS REOUIRED BY SEC710N � � �
Q �7000F'THE LABOH CODE,GOq THE PERFORMMJCE OF THE WOPo(FOR WHldf THIS PERMIT IS. / O
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Z I CERTIFV THAT IN THE PERFOHMANCE OF THE WORK FOR WHICM THIS PERMIT IS RSUED,1 MECHANICAL'
C}� SHN.L NOT EMPLOY ANY 7ERSON M ANV AUNNER 50 AS TO BECOME SU&IELT TO THE � � �
(,/) WOR)(ERS'COMPENSATION LAWS OF CALIFORNIA,AND A6REE THAT IF 1 SHOULU BECOME �NSPECTION FEE
SUBJECT TO THE WORKERS'COMFENSIITIDN PRONSIONS OF SECTION 97a0 OF TME UBOR " '- � � � ��
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� SU&IECT AN EMPLOYER TO CRIMWAL VENALTIES AND CML FW ES UP TO ONE HUNDRED i}KKI$AND ENEROY�PERMIT
DOlUR3(5100.OD0),W ADDI710N TO THE COST OF CO/APENSATION,DAAIAOES h5 PROVIDED FOR IN
J 6ECTION 370!OF TIE L/i80R COOE,W7ERE5T,ANDATTOqNEYS FEES. � ' �
W . . . . . RETENTION FEE: /J. .
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� 1 HEREBYAFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRULTION LENDINO A�EHCY �S�� �
Z FOR THE PERFORMANCE OF THE WOPo(FOR WHICH THIS PERMIT IS ISSUED�SEC:30D7,dV.C.).
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� LENDERS NAME . . . _ .. . . � ,
; � LENDER'9 ADDRE55 -- � -
� I CERTIFV THAT I HAVE READ THI9 APPLICATION AND STATE 7NAT THEABOVE PIFORAIATION IS COqRECT. TOTAL FE ES 31�'
� I A6REE TO COMPLY WITH ALL GTV AND COIRRV oRDWANCEs AND STA7E LAWS REIATINO 70 BUILDINO
.� CONSTHUCTION,ANp HEREBY AUiIiOR/ZE REPRESENTATIVES OF 7HIS COUH7Y 70 EMEH UPON THE "
ABOVE-MENTqNED PROPERTY FOR INSPECTION vURP0.5ES. COMMENTS � ' '
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CIT'Y OF DIAM4fVD BAR
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SLAB GRADE FIREPLACE FOUNDATIOfJ
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHItdG
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.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON 51TE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. � F(RE DEPT.FINAL
FINAL HEATtNG HEALTH DEPT.FINAL
FINAL ELECTRIC QEV.FEES PAID
FINAL PLUMBING ENERGY '
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SEPTlCTANK SIZE
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