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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityoffliamondbar.com building@diamondbarea.gov
05Ua r� A'o
JOB SITE ADQRLSS
APN K2 TRACT
OWNER O
ADDRE 6
CITY Ir L. -791 !f
APPLICANT T
CONTRACTOR
ADDRE
CITY ZfP EL.
ARCH/ENG/
DESIGNER
ADDRESSIV
CITY Zip TEL.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasons)
Indicated below by the checkmark(s), I have placed next to the applicable items] [Section 7031.5, Business and
Professions Code: Any city or county that requires a permit to construct, alter, Improve, demolish, or repair, any
structure, prior to its Issuance, also requires the applicant for the permit to fife a signed stalbementthat he or she
is licensed pursuant to the provisions of the Contractor's State License Law (Chapter9) Commencing with Section
7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from Ilcensure and the basis for
the alleged exemption. Any violation of Section 7031.5 by any applicantfor a permltaubfects the applicant to a dull penalty
of not more than live hundred dollars (SS00).
(j I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions
of the work, and the structure is not Intended or offered for sale (Section 7044, Bus€ness and Professions Code: The
Contractors' State L€cense Law does not apply to an owner of property who, through employees' or personal effort, builds
or improves the property, provided that the improvements are not irtendsd or offered for sale. If however, the building or
improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built
or Improved for the purpose of sale.).
U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who
builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' State
License LaW.).
O I am exempt from Ilcensure under the Contractor's State License law for the following reason(s):
Dale: Sign:
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one
year prior to completion of the improvements covered by this permlt,l cannot legally sell a structure that I have built as an
ownor-builder if it has not keen constructed In its entirety by licensed contractors. I understand that a copy of the
applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is
submitted or at the following Web site: http/www.leglnfo.ca.gov/calaw.lrtml.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that € am licensed under provisions of Chapter 8 (comment€ng with Section 7000)
of Division 3 of the Business and Professions Code, and my license Is in full force and If t.
LICENSE CLAS 26 LIC, NO,; i
EXP. DATE: CONTRACTOR'.
WORKER'S GOMF6ii BE R TION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLIO G CLARATIONS:
I have and will ma€ntaln a Certificate of Consent to Self -Insure for Worker's Compensatlan, as provided lay
section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
have and will maintain Worker's Compensation insurance, as required by Section 3700 cfthe Labor Code, for
the performance of the work for which this permit is Issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED4FTHE PERMIT IS FOR ONE H DRED DOLLARS $100 OR LESS),
I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner se as to
become subject to the Worker's Compensation laws of California. And agree that I I should become subject to the Worker's
Compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions.
DATE: APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal
penalties and civil finas up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation,
damages as provided for in section 3708 of the labor coda, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for
which this permit is issued (Sec.. 3087, C). CA
—
LEI NAME:....
LENDER'S ADDRESS:
at I have read this application and stale that the above Information is correct. I agree to comply with all city and
c
un ty or�.;�a.ndslate laws relating to hulldln structlon, and hereby authorize representatives ofthis county to
a e n tv-mentioned property for Ins ct urposes,
ME (PRINT)
SIGNATURE OF PERMITTEE DATE P
APPLICATION DATE:
ISSUE DATE:
TYPE CONST.
7 P/C#
PERI
OCC GROUP:
Scope of Work r
u
# QWEL. UNITS
# STORIES
14
t'1
# BEDROOMS
P/C: PAID BY:
DESCRIPTION SQ. FT.
FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
rn
w
Patio/Deck
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U.
PoCVSpa
ZRe
-Roof
i
Commercial
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Valuation:
Adj. Area:
QUANTITY
ESCRIPTION
FEE
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2
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a
4
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CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE"
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: PAID BY:
VALIDATION'.
RECEIPT # PAID Ei .
_ VALIDATION: Vb
WHITE—Department Copy,YELLOW— Finance Copy, PINK—Assessor Copy
SETBACK/ LE11 ER
CITY OF DIAMOND
INSPECTION
ME
TRACT AND LEDGER
FOOTINGS FORMS
SLAB
.......... .
UG. PLUMBING;
UG: ELECTRICAL
LIFER GROUND
SEWER I ATFRAL
MAIN WA 11-14 LINE
SEW[ It CLEANOUT
ROOF SI IEATHING
FLOOR SI ]EATHING
SHEAR WAILS EXTERIOR ;
SHEAR WALLS INTERIOR
FRAMINGNENTING
ROUGH MECHANICAL
ROUGH ELECTRICAL W( } C
..-.__ ......- .
ROUGH PLUMBING
NAIL,] II ATInN WAI I
LAIH ItvIthilUhi
GAS TEST -
SCRATCH CUA/
ELECTRIC: MF7ER RELEASE
GAS MEIEll RELEASE
SPECIAL INSPECTtON
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
T.C. of OCCUPANCY
E Tn 0 OCCUPANCY _
SWITCH GEAR
COMMERCIAL HOOD .
T -BAR
INTERCEPTER
HOT MOPISHOWERPAN
SFPTICICESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
- -
POOUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P -TRAP
-_.. ...... ---
FENCE 1 GATE/ ALARM
FINAL POOL
WALLS:
WALL FOOiIN(j/S'I'f.CL
__
WALL STI 111'��'( )?.`n( )LIFT
_ -_
WALL GOND BEAN/
WALL DRAIN/ SEAL
WALL FINAL
RO. FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING) PW
- - —-------- ---- --------------
FINAL COMMUNITY SERVICES
_.��_...-_ _...._ —_._ _ _ _ - -----------------
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
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