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���.�., CITY OF DIAMOND BAR �
�I --- -���-— DEPARTMENT OF COTRvIUNITl'&DEVELOPMENT SERVICES
21825 E.Copley Drive PRESS
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"�»;�'�W BUILDING PERMTT APPLICATION FIRMLY
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� ADDRESS PROPOSED USE
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DESCRIPTION SQ.FT. FACTOA PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLAAATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURY TF1AT�M1 E%EMPT FROM THE CONTRACTORS LI� G8f8QB/CBf�IOR
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W CENSELAWFOflTHEFOLLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR .
C1 COUNTVWHICHREWIRESAPENMITTOCONSTRUCT,ALTERIMPROVE.DEMOLISH,ORREPAIRANVSTRUC- W P8�10/DBCI(
WTURE,PRqR TO ITS ISSUANCE..4LS0 FEOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMENT T}1AT HE OA SHE IS LICENSED WASUANT TO THE PROViS10N5 OF THE CANTRACTORS LI� � POOVSp2
� CENSE LAW(CMAPTER G(COMMENCINO WITH SEGTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO�
O FESSIONSCOD�ORhiATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP- (�
U TION.ANVVIOLATIONOFSECTION7071.SBVANVAPPLICANTFORAPEfiMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOIURS(f600)J: .
O ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESW17HWAGESASTHEIRSOLECOMFENSATION, � COf1lR10fC�81
Z WILL DO THE�NORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR S/�LE(SEC.70a�,BUSI� J
N NESS AND PROFESSIONS CODE:TME CONTRAC70R5 LICENSE UW DOES NO7 APPLV TO AN OWNER OF �
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a 7HqOUGH HIS OR HER ON?J EMPLOYEES,PFOVIDED THAT SUCFI IMPROVEMENTS ARE NOT INTENDED OR
� OFFEREDFOPSALE.IF,HOWEVERTF7EBUILDINGORIMPROVEMENTISSOLOWfTHINONE�EAROFCOMPLE-
Z T�ON,TNE OWNER�BUILDER WILL HAVE 7HE BURDEN OF PROVINO YHAT HE OR SHE DID NOT BUILD OR
� W PROVE FOR THE PURPOSE Of SALE).
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Q TO CONSTRUCT THE PR0.IECT(SEC.704/,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� VellleflOfl ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPHOPERTVWHOBUILDSOHIMPROVESTHEREON,AND
� WFIOCAMMCTSFORSUCMPRQ1EC75WITHACONTRACTOR(S)LICENSEDPURSUANTTOTMECONTfUG OUANTITY DES IPTION FEE
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� LICENSED CONTRACTORS DECLARATION -�
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1 FIEHEB��FFIRM UNDER PENALTY OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Ur
n„ Y(COMMENCINO WITH SECTION 7000)OF DIVISqN J OF 7HE BUSINESS AND PROFESSIONS CODE.AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT, m
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� WORKERS'COMPENSATION DECLARATION • J .
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� I HEREBV AFFlRM UNDER PEN4I.TV OF PERIURV ONE OF TNE FOLLOWINQ DECIARATIONS: Z
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O __.I HAVE AND WILL MNINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' 2
Q COMPENSATION,AS PROVIDED BV SECTION�700 OF THE LABOR CODE.FOR THE PERFORMANCE w
OF THE WORK FOR WFfICH TH�S PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAW WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION -
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � `�
� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERAAE: CONSTRUCTION
� CARFIER PLAN REVIEW
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p (fHLSSECTqNNE�NOTBENNF'LEfEDOFTFEPERMTISFOfiOIdEFl1N7REDD01l.Af16(S70UlOqLESS} � PLUMBWG
w I CERTIFY THAT IN THE PERFORIAANCE OF THE WORK FOR WHIG1 THIS PERMIT IS ISSUED,I MECH NICAL
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L) SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE N ECTION FEE -' ,^
� WORNERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SMOULD BECOME
� SU&lEC7TO7HE WORNERS'COM7ENSA710N PROVISIONS OF SECTION 370o OF THE 1A80R I SUA ��S
� CODE.I SHALL FORTHWITH CW.�PLV WITH THOSE PROVISIONS. t�"'
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� ENERGY P/C
WARNW�:FA�LUHE TO SECURE WORKEHS'COMPENSATION CAVERAGE IS UNLAW FUL,AND SHALL BE
� SU&IECTANEMPLOVERTOCFIMINALPENALTIESANDCIVILFWESUFTOONEHUNDREDTIqUSAND E
OOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION.DN.IAGES AS PROV�DED FOR IN �^
J SECTION 37DB OF THE LABOR CODE.INTEREST.AND A7TORNEY'S FEES. �n� ccc•
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w CONSTRUCTION LENOING AGENCY PRE-A
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� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT 7HERE IS A CANSTRUCTION LENDINa AOENCY
n- FOR TNE PERFORMNdCE OF THE WORK FOA WHICH THIS PERMIT IS ISSUED�SEC.30H7,CIV.C.). '
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� LENDEFYS NAME
F�- lEN0ER5 ADDRE55
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wI CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES
� I AGREE TO COMPL�WITH ALL CITV AND CAUNTY ORDINANCES AND STATE UWS RELATING TO BUIL�INO
� CONSTRUCTION,AND HEAEBV AUTHORIZE REPRESENTATIVES OF THIS 70 ENTER UPON THE
Z P80 � ENTI�NEO PROPERN FOR INSPECTI�N PURP�SES. COMMENTS
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� i NANREOF PEPA11TfEE DATE RECPT.NO. PAID BY VALIDATION
� WNITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Capy,GO�DENROo--File Copy,GREEN—Applicant's Copy
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SET BACK ' � FLOOR Jb1ST ',
FTGSIFORMS/STEEL ; FHA REQMTS �
ELECTRIC GROUND ' UNDER FL�OR DUCT .
GROUND PLUMgING ` � UNDER FLOOR CU(�{DUIT -
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER �IREPLACE BONa BEAM
WATER SERVICE MID HT. BOND BEAM �
ROOF SHEATHING 8 FT. BOND BEAM i
FRAMIfVGNEfVT(LIATiON ��� FItVAL BOND BEAM
ROOF COVER PRE-GAADlNG �
ROUGH I-lEATING ~ BENCHING
ROUGH ELECTRIC FIQUGN GRADI�VG
ROUGH PLUNIBING FINISH GRADiNG
SHOWER/TUB TES7 I PUOL ELECTRIC �
EXT. LATH/SIdING POUI FENCING
WALL INSULATION POOL FINAL ^ '
CEILING 1NSULATION I OFF SITE {MPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. "
SEPTiC TANK LAtVDSCAP�/IflRIC.
SEEP PIT/L.L. C71V 5lTE IMPS.
GAS AIR TEST � F1tJAl ZONiNG
FlNAL CONBT. �j� /�f�,� � � FlRE DEPT. FINA�.
F1NAL HEATING HEP,LTH DEPT. FINAL
F1NAL ELEGTRIC ��f„tl�� �,/�� DEV. FEES PAID
FINAL PLUMBING ENERGY
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