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PLOLIOun Bim:
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.cityofdiamondbar.com building@dTamoudbarea.gov
JOB SITE ADDRESS kWhiPL
APNLOT TRACT
OWNER if it C11 M III dc, !t
ADDRS
CITY ZIP j EL.
APPLICANT TEL. Y YM
CONTRACTORR�l
ADDRE S 210 Ohl
CITY
ARCH/ENG/
DESIGNER
ADDRESS
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 reasoh(sl
indicated below by the ohDarrark(s), I have placed next to the applicable ifem(s) [5ectiah 7031.5, Business and
Processions 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 file a signed statementthal he or she
is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section
7000 of Division 3 of the Business and Professions Code] or that he or she is exemptfrom licensure and the basis for
the alleged exemption Any violation of Section 7931.5 by any applicant for a permit subjects the applicantto a civil penalty
of not more than five hundred dollars ($500).
U €, as owner of the property, or my employees with wages as their sole compensation, will do U all of or O portions
of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The
Contractors' State License 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 Intended or offered for sale. if however, the building or
improvement is sold within one year of completion, the Owner -Bulkier will have the burden of proving that it was not built
or improved for the purpose of sale.).
CJ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sectlon
7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who
builds of improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State
License Law.).
LJ I am exempt from licensure under the Contractor's State license law for the following reason(s):
Date: Sign:
By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one
year prior to completion of the Improvements covered by this pernuhl cannot legally sell a structure that I have built as an
owner -builder If If has not been constructed in its entirety by licensed contractors I understand that a copy of the
applicable law, Section 7044 of the Business and Professions Cade Is avallable upon request when this application Is
submitted or at the following Web site: http www leginfo.ca.govlcalaw.html.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perlury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is in full force and effect.
LICENSE CLA : LIC, NO,:
EXP. PATEI 0 CONTRACTOR: 01 ii
WORKER'S COMPENSATION OECLA ATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I have and will maintain a Certlflcate of Consent to Self -Insure for Worker's Compensation, as provided by
/ Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
✓ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit Is issued. My Worker's Compensation Insurance Carrier and
Policy Nvmberryar, f!
CARRIER ii%%""
POLICY NUMBER
(IFAS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $190 OR LESS),
I certlfythat In the performance of the workfor which this permit is issued, I shall not employ any person In any manner so as to
become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Workers
Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DATE: APPLICANT
WARNING: Fallure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal
penalties and civil fines up to one hundred thousand dollars (3700,000), in addition to the cost of the compensation,
damages as provided for in section 3708 of the labor code, 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. 3097, Civ, C.).
LENDER'S NAME:
LENDER'S ADDRESS
I certify that I have Lead this application and state that the above information Is correct. I agree to comply with all city and
county ordinances and state laws relating to building construction, and hereby authorize ropmaentatives of this county to
enter u o the above-mentioned propertyfor inspection purposes.
PERMITTE ME (PRIlt- p
SIGNATURE OF PERMITTEE DATE
APPLICATION DATpE: d � � PIC# <_-3-T e_ -
ISSUE DATE: T k PERMIT# :-el t "'q — `-1-1 !S
TYPE CONST. OCC GROUP:
I/
Scope of Work �°
1
# DWEL. UNITS # STORIES
II
Yd
# BEDROOMS
DESCRIPTION SQ. FT- FACTOR PSF
ADJ. AREA/VALUATION
SFFVADD/HEM
Garage/Carport
UO
ui
Patio/Deck
Li
LL
PDol/Spa
ZRe
-Roof
J
Commercial
7
m
Valuation:
Adj. Area:
QUANTITY DESCRIPTION
FEE
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CONSTRUCTION:
PLAN REVIEW:
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ELECTRIC:
PLUMBING:
MECHANICAL:
�I
INSPECTION FEE:
ISSUANCE:
n
SMIP:
ENERGY P/C:
ENERGY PERMIT:
DETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
PIC: PAID BY: VALIDATION:
RECEIPT # 6d.] .sem PAID BY:VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assesscr Copy
OF DIAMOND
1 8 1
SETBACIU LETTER
TRACT AND LEDGER
F00TINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG. PLUMBING
T -BAR
UG. ELECTRICAL
INTERCEPTER
LIFER GROUND
._...._.
HOT MOPISHOWERPAN
-
SEWER I Al Ff3N
SEPTICICFSSP00L
MAIN WA'TF,R LINE
HERS REPORT RECEIVED
SI".WFR CLEANOUT
DEMOL€TION
R00f SIIFAT HING
ROOF DRAINS
FLOOR 5l IEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
P00USPA
SHEAR WALLS INTERIORROUGH
... ........ .... .._
PLUMBING .
FRAMINGIVENTING
ROUGH ELECTRICAL
ROMIl l MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) G ()
....
GAS TEST
_............_
ROUGH PLUMBING
PRE GUNITE
INSULATION WALL
--
POOL PRE DECK BONDING
—._._._._. _....
INSULATION CEILING
P -TRAP
...._. ....,._.._,..----
DRYWALL
FENCE 1 GATE/ ALARM
-
LATH (PRE)
FINAL POOL
.
...... .......... _
LATH EXTERIOR
WALLS:
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 15i( ) 2E0( ) LIFT
SCRATCH COAT
WAIL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECT€ONRO.
..- __ .......
FRAMING PLANNING APPROVAL
- --
FINAL BUILDING
ROUGH FIRE APPROVAL
FINAL MECHANICAL
".)
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PW
T.C. of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT, of OCCUPANCY
FINAL HEALTH DEPT,
FINAL INDUSTRIAL WASTE
COMMENTS:.
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