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CITY OF DIAMOND BAR ���
^--""��`-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 P�iESS
,�'°�', BUILDING PERMIT APPLICATION FIRMLY
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT 7HAT HE OR SHE IS LICENSEO PUHSUANT TO THE PROVISIONS OF THE CANTMCTORS LI- �
CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVSPe
, 0 FESSIONS CODE)OH THAT HE OR SHE IS EXEMPT THEREFROM AN�THE BASIS FOR THE ALIEGED E%EMP- �
V 710N.ANV VIOUTION OF SECTION 7031.5 BY ANV APPLICAN7 FOR A PERMIT SUBJECTS 7HE APPLICAN7 TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
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WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70//,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PqOPER7Y Vh10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK NIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPIOVEES,PROVIDED 7HAT SUCH IMPROVEMEN7S ARE NOT INTENDED OR m
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Q TO CANSTRUCT THE PR0.1EC7(SEC.70��,BUSINE55 AND PFiOFE5510NS CODE:THE CANTRACTORS LI- Va1U0110l1 ADJ.AREA �
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� 1 HEREBY AFfIHM UNOER PENALTY OF PERJURV THA71 AM UCENSEO UNDEF PROVISIONS OF CHAPTER � / /�)M?tA n� O`
d D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z ! �����r�F,�� •r
X MY LICENSE IS IN FULL FORCE AND EFFEC7. m
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� WORKERS'COMPENSATION DECLARATION Q i
� I HEREBYAFFIRM UNDER PENALTY OF PEfiJURV ONE OF THE FOLIOWING DECUfiATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q CAMPENSATION,AS PROVIDED BY SEC710N 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE �U
Q OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED. � ,
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION �
Q 3700 0F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 I
ISSUED.MV WORNERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFOiiMANCE OF THE WOPK FOH WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�J SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
�/j WORKERS'COMPENSATIONLAWSOFCALIFORNIqANDAGREETHATIFIS�iOULOBECOME INSPECTI FEE
= SU&lEC7 70 THE WORKERS'CAMPENSATI N PROVISIONS OF SECTION 37do OF 7HE LABOR
CODE,I SHALL FORTHWITH COMPLV WI HOSE PROV1510 . U NCE ���O
p DATE:IO��O APPLICANT:
J WARNING:FAILURE TO SECURE WOflKERS' MPEN ATION COV6 E IS UNLAWFUL./� D SHALL BE ENERGY P/C
� SU&IECTANEMPIOYERTOCRIMINA�PENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN /�
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE: ��+
, � CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBYAFFIRM UNDEF PENALTY OF PERJURV 7HAT THEFIE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WOfiK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ. .
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� LENDER'S NAME
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� TOTAL FEES �j �-'�1,C7
� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
w I AGREE TO COMPLY WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CANS7RUC710N,AND HEREBY AUTHORIZE fiEPRESENTATIVES OF 7HIS COUN7Y TO ENTER UPON 7HE
ZABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES.
0 COMMENTS
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~ WH —Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
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 BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH E�ECTRIC 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. -
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.�. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAI
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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