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DEPARTIv1ENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRE$$
`'����� BUILDING PERMIT APPLICATION ,GQ � FIRMLY
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� I HAVE AND WILL MAINTAIN WOHICERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 3700 OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHIp1 THIS PERMR IS
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Z I CERTIfV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
CS SHALL NOT EMPLOV ANY PERSON IN A MANNER SO AS TO BECOME SU&IECT TO THE ■•
(n WORKERS'COMPENSATION LAWS OF C LIFORNIA,lWD AOREE THAT IF I SHOU BECOME INSPECTION FEE
= SU&lE T TO THE WORKERS'COMPENSA ION PROVISIONS OF SEC KKJ 3700 O HE ,
CODE SHALL ORTHWITH COMP PROVISIONS. ISSUANCE �D�
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� SU&IECTANEMPLOVERTOCqIMINPIPENALTIESANDCMLFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
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J SECTION]708 OF THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. � , O�
w RETENTION FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDINO AGENCV '
FOR THE PERFORMANCE OF THE WORK FOR WHIC}17HIS PERMIT IS ISSUED�SEC.JaB7,CIV.C.�.
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� LENDERS NAME
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w I CERTIFY iNAT I HAVE RFJ�D THIS APPUCATION AND STATE THAT THE ABOVE INFORMATpN IS CORRECT. TOTAL F E ES Z�. D
� I AGREE TO CAMP V WITH ALL CI7Y AND COUNTV ORDINANCES AND STATE LAWS REIATING TO BUILDING
� CONSTRUCTION, D HEREBV AUTNORRE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z ABOVE�MEMqN PROPERTY FOR INSPECT PURPOSES. COMMENTS
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� RECPT.NO. _ PAID BY _ � VALIDATION
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EL.ECTRIC GROUND _ i UNDER FLOOR DUCT
' GROUND PLUMBWG UNQER FLOOR CUNDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BONQ BEAM • � �
FRAMING/VEfVTILiATION FINRL BOR1D BEAM
ROOF CaVER � ' PRE-GRADING
ROUGH NEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBIPVG FINISH GRADING
SHOWER/TU8 TEST PQOL ELECTRIC
EXT. L4THISIDING POOL FENCING
WALL INSULATIOiV �v , POOL FINAL �
CEILIPJG IPlSULATIOIV OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FtNAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS. -'
GAS AIR TEST FINAI.ZONING
FlNAL GO(�ST. � �IRE DEPT. FINAL
FIPVAL HEATiNG �/j��'L,�— HEALTH DEPT. F1NAL
F(NAL ELEGTRIC f� �r � DEV. FEES PA1D
FINAL PLUMBING � � ENERGY
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CONiiViENTS ' - — ,
SEPTIC TAPVK SIZE
SEEP PIT/U SIZE
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