HomeMy WebLinkAbout17929 CITY OF DIAMOND BAR
-- --��` --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��'%��y� BUILDING PERMIT APPLICATION FIRMLY
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC70R5 LI-
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa �
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Z WILI DO THE WORK,AND THE STRUCTUqE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7oI4,BUSI- J
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w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWI7HINONEYEAROFCOMPLE-
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2 I HEREBY AFFIRM UNDER PENAL7Y OF PERIURY THA7 I AM LICENSED UNDER PROVISIONS Of CHAPTER Z �.L� �� 61
� 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CODE,AND �'r Y
X MY LICENSE IS IN FULL FOR AND EFF
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� W KERS'COMPENSATION DECLARATION Q �
� I HEHEBYAFFIRM UNDER PENAL7V OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z II
0 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
¢ CAM�N,AS PROVIOED BV SECTION 370o OF THE LABO{i CODE,FOR THE PERFORMANCE w I
Q OF RK FOR WHICH THIS PERMIT IS ISSUED. �
w _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMI7IS •
ISSUED.MY WORKERS'COMP NSATION INSl1RANCE CARRIER AND POUCV NUMBER ARE: CONSTRUCTION
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Z I CE(iTIFY THAT IN THE PERfORMANCE OF THE WORK FO ICH THI RM IS ISSUED,I MECHANICAL
C7 SHAIL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS COM BJE T TO THE
� WORKERS'COMP SATION LAWS OF CALIFOR ,AND I SH LD BECOME INSPECTION FEE
? SUBJECT O TH ORKERS'COMPENSA710N RO N37 OF7HELABOR
CODE, HAL RTHWITHCOMPLVWI7H7 PR 5. ISSUANCE
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p DATE: ��APPLICANT: SMIP
J WARNING: AILUR TO SECURE WOflKERS'COMPENSATION ERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(510o,0ooJ,IN ADDITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIDED FOR IN
� SECTION 37ae OF THE LABOH CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
aw. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMI7IS ISSUED�SEC.3097,CIV.C.). .
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� LENDER'S NAME
F- LEN�ER'SADDRESS
� TOTAL FEES
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
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� CONSTRUCTION,ANDHEREBVAUTHORREREPRESENT FTHISCOUNTVTOENTERUPONTHE '
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~ WHITE—Department Copy,YEILOW—Finance Copy,PINK—Assessor Copy,GOL NROD—File Copy,GREEN—A plicant's Copy
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GROUND PLUMBING _ _ ' UNDER FLOOR CU��DUiT___�i ; __
S�AB GRADE FIREPLACE F�UN�ATiCN __ __ _
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TEMP POWER __ i __. ___r FIREPLACE B�ND BE,4M
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WATER SERVICE _ ` _____� _MID HT. BOND BEA�
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ROOF SHEATHING __ -�— —�_- -8 FT. BOND BFAM ---_ _______i
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FRAMINGNENTILIATION _ �____ FINAL BOtJD BEAM
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ROOF COVER I -.� PRE-GRA�ING �_-- -- -- � �
ROUGH HEATING �- BENCHING ___ I
ROUGH ELECTRIC I ROUGH GRADING
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ROUGH PLUMBING � FINISH GRADING
.__ — --- -----....--
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDINC POOL FENCING
WALL INSULATIOiV POOL FINAL ;
CEILING IIV�ULATION OFF SITE IMPS. � ____
DRYWALL NAI�IIVG DEDICATIONS
SEWER FINAL EIVG. �
SEPTIC TANK LA�lDSCAPE/IRRIG. �
SEEP PIT/L.L. ON SITE IMPS. '
GAS AIR TEST FINAL ZONING
_ _--_ �._......._..____.
FINAL CONST. � F!RE D�P7. FINA�_.
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FINA�HEATING HEAL7N DEPT. FINA�
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FINAL ELECTRIC � DEV. �EES PAID
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FINAL PLUMBIPJG ' �� � ���=�__ � FNERGY
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C06ViNiENTS
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