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�R� CITY OF DIAMOND BAR ' �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� ,y 21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 PRESS
�'��� � BUII.DING PERMIT APPLICATION �IRMLY
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W TURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMEHT THAT HE OR SHE IS UCENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(QUPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSIONS CODE)OR TNAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEDED EXEMP-
TIOH.ANVVIOLATIONOFSECTION7031.6BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A CML PENALTY OF NOT MORE 7TiAN fNE HUNDRED DOLURS(5500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMVLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIf1lBfCl81 �
WILL DO THE WORK AND THE STRUCTURE IS NOT IHTEN�ED OR OFFERED FOR SALE(SEC.70M,BU51- J
NESS AHD VROFESSIONS CODE:THE COHTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PROPENT'/MRIOBUttDSORIMPROVESTHEREON,ANDWHODOESSUC1iWORKHIMSELFORHERSELFOR �
Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Z �TION,THE ONMER-BUILDER WILL HAVE THE BURDEN OF PROVINO�THAT HE OR SHE DID NOT BUIID OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,AS OYMER OF THE PROPERTI',AM EXCLUSIVELYCONTMCTIN4 WITH LICENSED CONTRACTORS
[[ TO CONSTRUCT THE VHOJECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U- VelU8fI0f1 ADJ.AAEA
W CENSE UW DOES NOTAPPLV TOAN OVMER OFA PROPER7V WHO BUILDS OR IMPROVES THEHEON,AND
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O ❑I AM IXEAIFT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER V
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� LICENSED CONTRACTORS DECLARATION W I
� I HEREBY AFFIRM UNDER PENALTV OF FERIURV 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Ur . i,y�.�
� Y(OOMMENCINO WITH SECTION 7000)OF OIVISION 3 Of THE BUSINESS AND PROFESSIONS CADE,AND Z
MY LICENSE IS IN FULL FORCE M1D EFFECT. m
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� WORKERS'COMPENSATION DECLARATION a IL, �g Ug' A."1.L'�y�`-""
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� I HEREBY AFFIRM UNDER PEN�LTV OF PERIUtiV ONE OF THE FOLLOWING DECLARATIONS: Z �v�L�.s�RI��-1 1��� v
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� IHAVEANDWILLMAINTAIHACERfIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' 2
� COMPENSATION,AS PROVIDED BV SECTION 370o Of TME IABOR CODE.FOH THE PERFORMANCE W
OF THE WORK FOR WHICH THIS GERMIT IS�SSUED. �
�
w _1 HAVE AND WILL MAIMNN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 OF 1HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK WR WHICH hi15 PERMIT IS `/y
ISSUED.MY WORKERS'COMPENSATION INSURANCE CAHRIER AND POLICY NUMBER ARE: CONSTRUCTION _ is 1��/ /V
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ZPOLICV NUMBER ELECTRIC � �
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� (1TCSSECiXXJNE�N0TBE00AilETmOFhfPERARiSFaRONEF0.MNiEDDOLWLS(t100)ORLE55� PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 ISSUED,1 MECHANICAL
(,�J SHALL NOT EMPLOY ANY PERSON IN ANY MPNNER SO AS TO BECOME SU&IECT TO THE ,
� WORKERS'CAM7ENSA710N LAWS OF CALIFOFiNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
SU&IECT 70 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
CODE,1 SHALL FORTHWITH COMPLV WITH 7HOSE PROVISIONS. ISSUANCE �r �CY��y
p DATE: � APPLICANT: SMIP f �U`
� ENERGY P/C
J WARNINO:FA�LURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE
� SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(iloo.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN
J SECTION 37oa OF T1E LABOR CODE.IH7EREST,AND A770NNE1"S FEES. RETENTION FEE:
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� d CONSTRUCTION LENDING AGENCY PR �LT FEE: . � r /S I..�l 1 � �
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS ACONSTRUCTION LENDING AGENCY �
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS 7ERMIT IS ISSUED(SEC.3oG7,CIV.C.). �
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� LEHDER'S NAME /�j
F— LENDER'SADDRESS �
W ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDS?A7ETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES
� I AGRE�70 COMPLV N7TH ALL CRV AND COUNTY ORDINANCES AND STATE UWS REU7ING TO BUILDING
� CONSTRUCTION,AND MEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EMER UPON 1HE
Z ABOVE-MENTIONED PROPEFTY FOR INSPEC�ION PUR70SE5. COMMENTS "
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� RECPT.NO.���7 PAID BY VALIDATION
WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
CITY OF DIAM06VD B�1R
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FTGS/FORMSJSTEEL � FHA REQMTS
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WA7ER.SERVICE . MID HT. BOND BEAM
ROOF'SF��AThiING,',"':..�� .�' � ,'�; �., >� ,� �j•.` - 8 FT. BOND BEAM
FRAMINGNENTILIATION � � y FINAL BOND,,.�AM ., : ,-,� �, :�. ;, •,,, , ,�,;
ROOF COVER PRE-GR,QDING � ".t ;''.,•. -•.,� ��,� t" `'
ROUGHHEATING � BENC�I �"� '�`- �: . � � '''`:� , _%' ��� '`'
ROUGH ELECTRIC ROUGH GRADING
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EXT. LATH/SIDING POOL FENCING �
WALL INSULATION � POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK �. __ ,,� LANDSCAPE/IRRIG.
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GAS AIR TEST FINAL ZOIVING
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