HomeMy WebLinkAboutFW_ 2514 Reata (Addition) PR25-0519 – RESUBMITTAL(0003)From: Rafi Baghdasarian
Se nt: Wednesday, February 25, 2026 9:54:29 AM
To: Sandi Jimenez
Subje ct: Re: FW: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
Se ns itivity: N ormal
Attachme nts :
Building Permit Application (1).pdf ;
CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders.
Please see the revised application.
Thank you
On Wed, Feb 25, 2026 at 9:39 AM Sandi Jimenez <SJimenez@diamondbarca.gov> wrote:
This is the section.
Regarding payment, I looked up on the payment portal per the instructions and it appears to be showing the correct amount,
Kind regards,
Sandi Jim enez | Permit T echnician
City of Diamond Bar | Building & Safety Div ision
21810 Copley Driv e, Diamond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 main | f (909) 861-3117
S Ji menez@diamondbarca.gov | www.DiamondBarCA.gov
From: Rafi Baghdasarian <rafi@epicremodeling.net>
Sent: Wednesday, Fe bruary 25, 2026 9:36 AM
To: Sandi Jimenez <SJimene z@DiamondBarCA.Gov>
Subject: Re: FW: 2514 Reata (Addi ti on) PR25-0519 – RESUBMITTAL
CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders.
Sorry, which section? I don't see an attachment.
What can we do regarding the payment?
On Wed, Feb 25, 2026 at 9:26 AM Sandi Jimenez <SJimenez@diamondbarca.gov> wrote:
It appears the section below is missing a signature.
Kind regards,
Sandi Jim enez | Permit T echnician
City of Diamond Bar | Building & Safety Division
21810 Copley Driv e, Diamond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 mai n | f (909) 861-3117
S Jimenez@di amondbarca.gov | www.DiamondBarCA.gov
From: Rafi Baghdasarian <rafi@epi cremodel i ng.net>
Sent: Tuesday, February 24, 2026 9:34 AM
To: Sandi Ji menez <SJime nez@DiamondBarCA.Gov>
Subject: Re: FW: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders.
Hello Sandi,
Please see the attached, and the fees have been paid.
Thank you
On Mon, Feb 23, 2026 at 10:04 AM Sandi Jimenez <SJimenez@diamondbarca.gov> wrote:
Good morning,
I have processed your application for the proposed work.
STEP 1: PAYM ENT
The total permit fee is $ 2,552.84. Follow instructions below to access our payment page under the Building Department portal.
1. Click this link to access the payment page https://cvweb.diamondbarca.gov/
2. Click Stat us and Fees under Building Department
3. Enter Application # PR20250000519 in the search field and click Go!
4. Scroll down to the Fees section and click Pay Fees?
STEP 2: PERM IT FORM SIGNATURE
Date and sign the highlighted sections on the last page on the attached Building Permit Application and email back
STEP 3: RESPOND TO THIS EM AIL
Once you email me the above, I will then email your job card and permit to complete permit issuance
Kind regards,
Sandi Jim enez | Permit T echnician
City of Diamond Bar | Building & Safet y Div ision
21810 Copl ey Dri v e, Di amond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 main | f (909) 861-3117
S Jimenez@diamondbarca.gov | www.Di amondBarCA.gov
From: Rafi Baghdasari an <rafi @epicremodeling.net>
Sent: Wednesday, February 18, 2026 2:47 PM
To: Sandi Jimenez <SJimenez@DiamondBarCA.Gov>
Subject: Re : FW: 2514 Re ata (Addition) PR25-0519 – RESUBMITTAL
CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders.
Hello Sandi,
Please see the attached forms
Thank you
On Wed, Feb 18, 2026 at 2:18 PM Sandi Jimenez <SJimenez@diamondbarca.gov> wrote:
Kind regards,
Sandi Jim enez | Permit T echnician
City of Diamond Bar | Building & Safety Division
21810 Copley Driv e, Diamond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 mai n | f (909) 861-3117
S Ji menez@di amondbarca.gov | www.DiamondBarCA.gov
From: Sandi Jime nez
Sent: Thursday, January 8, 2026 3:22 PM
To: 'adnan ayoub' <adnanayoub@yahoo.com>; yamen laktine h <laktineh@hotmail.com>
Subject: RE: 2514 Re ata (Addition) PR25-0519 – RESUBMITTAL
Good afternoon,
Thank you for your email. Your plans have been approved; I will need the information below emailed directly to me to start preparing for permit issuance. Please also
forward this email to the contractor responsible for obtaining the permit or any other applicable party.
Meps breakdown to be completed by contractor to calculate the permit fees (see attachment)
Business License form completed by contractor Business License | Diamond Bar, CA (diamondbarca.gov)
Construction & Demolition form completed by contractor for debris disposal (see attachment)
If you select Self-Haul, then you will be required to complete the attached City’s Self-Haul Application. Please complete and email back. This may take will
take a few business days to review. A separate Self-Haul permit and fees will apply. Please note that the Building Permit issuance will be placed on hold until
the Self-Haul application is approved and a separate permit is issued
Copy of the contractor’s license
Copy of the worker’s compensation certificate
Contractor’s full name, phone number and email address. They will need to digitally sign the permit
Kind regards,
Sandi Jim enez | Permit T echnician
City of Diamond Bar | Building & Safety Division
21810 Copley Driv e, Diamond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 mai n | f (909) 861-3117
S Ji menez@di amondbarca.gov | www.DiamondBarCA.gov
From: adnan ayoub <adnanayoub@yahoo.com>
Sent: Tuesday, January 6, 2026 7:40 PM
To: Sandi Jime nez <SJime nez@DiamondBarCA.Gov>; yamen laktine h <l aktineh@hotmail.com>
Subject: Re: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
**DO NOT open unknown links or any attachments w ithout confirming with IS or the sender directly.**
CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders.
Hello
T his fee was paid on the 4th of December. See previous email which shows no zero fees due please.
Truly Yours,
Adnan
"Only be with someone who respects and appreciates y our presence in their life."
On Tues day, January 6, 2026 at 11:23:21 A M PST, yamen laktineh <laktineh@hotmail.com> wrote:
Good morning Sandi,
Pleas e, just following up on the s ubmittal s tatus . Thanks!
Please feel free to re ach out if you have any questions.
Best Regard
Yamen Laktineh
LAK Development INC.
Phone : (760) 486-1697
E-mail: laktineh@hotmail.com
From: Sandi Jime nez <SJime nez@DiamondBarCA.Gov>
Sent: Thursday, December 4, 2025 8:18 AM
To: yamen l aktineh <laktineh@hotmai l.com>; adnan ayoub <adnanayoub@yahoo.com>
Subject: RE: 2514 Re ata (Addition) PR25-0519 – RESUBMITTAL
Good morning Mr. Yamen,
I’ve proces s ed your s ubmittal and there is a rev is ion fee.
S TEP 1: PAYMENT
The revis ion fee is $21 4.7 0. Follow ins truction s below to acces s our payment page u nder the Buildin g Department portal.
1. Click this lin k to acces s the p ayment page http s ://cvweb.diamondbarca.gov/
2. Click Status and Fees under Building Department
3. En ter Ap plication # PR20250000519 in the s earch field and click Go!
4. Scroll down to the Fees s ection and click Pay Fees?
Thank you,
Sa ndi Jime ne z | Permit Technician
City of Diamond Bar | Building & Safety Division
21810 Copley Drive, Diam ond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 m ain | f (909) 861-3117
SJim enez@diam ondbarca.gov | www.Diam ondBarCA.gov
Connect with Us ... Facebook|Twitter|YouTube|Ins tagram
From: yamen laktineh <laktineh@hotmail.com>
Sent: Tuesday, December 2, 2025 8:12 AM
T o: Sandi Jimenez <SJimenez@DiamondBarCA.Gov>; adnan ayoub <adnanayoub@yahoo.com>
Subject: Re: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
**DO NOT open unknown links or any attachments w ithout confirming with IS or the sender directly.**
CAUTION: This email originated from o uts ide your organization. Exercis e caution wh en op ening attachments or clicking links , es pecially from unknown s enders .
Good morning Sandi,
I just want to inform you that the latest submitted drawings are correct. Thank you for help!
Please feel free to re ach out if you have any questions.
Be st Re ga rd
Yame n Laktine h
LAK De ve lo pme nt INC.
Phone : (7 60) 486-1697
E-mail: lak tine h@hotmail.com
From: Sandi Jimenez <SJimenez@DiamondBarCA.Gov>
Sent: Monday, November 3, 2025 12:05 PM
T o: yamen laktineh <laktineh@hotmail.com>; adnan ayoub <adnanayoub@yahoo.com>
Subject: RE: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
Hi Yamen,
Thank you for the update. However, res ubmittals are s ubmitted through our online application portal.
Pleas e s u bmit your revis ion BUILDING PERMIT A PPLICA TION
Thank you,
Sa ndi Jime ne z | Permit Technician
City of Diamond Bar | Building & Safety Division
21810 Copley Drive, Diam ond Bar, CA 91765
t (909) 839-7024| (909) 839-7000 m ain | f (909) 861-3117
SJim enez@diam ondbarca.gov | www.Diam ondBarCA.gov
Connect with Us ... Facebook|Twitter|YouTube|Ins tagram
From: yamen laktineh <laktineh@hotmail.com>
Sent: Monday, November 3, 2025 10:26 AM
T o: Sandi Jimenez <SJimenez@DiamondBarCA.Gov>; adnan ayoub <adnanayoub@yahoo.com>
Subject: Re: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
**DO NOT open unknown links or any attachments w ithout confirming with IS or the sender directly.**
CAUTION: This email originated from o uts ide your organization. Exercis e caution wh en op ening attachments or clicking links , es pecially from unknown s enders .
Good morning Sandi,
W e need to submit an amendment for approved drawings under permit # PR25-0519, See the links below for revised plan and structural calculations for city review.
Pleas e advise if need to submit any other documents.
2514 REATA PL DIAMOND BAR CA 91765.pdf
2025-51 2514 Reata Pl, Diamond Bar, CA 91765 (SC).pdf
Please feel free to re ach out if you have any questions.
Be st Re ga rd
Yame n Laktine h
LAK De ve lo pme nt INC.
Phone : (7 60) 486-1697
E-mail: lak tine h@hotmail.com
From: Sandi Jimenez <SJimenez@DiamondBarCA.Gov>
Sent: Tuesday, July 8, 2025 8:29 AM
T o: adnan ayoub <adnanayoub@yahoo.com>; yamen laktineh <laktineh@hotmail.com>
Subject: RE: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
Good morning,
Thank you for the update. The fo llowing is s till pending:
Meps breakdown to be completed by contractor to calculate the permit fees (s ee attachmen t)
Bus in es s Licens e form completed by contractor Bus ines s Licens e | Diamo nd Bar, CA (diamondbarca.gov )
Cons truction & Demolitio n fo rm completed by contractor for debris dis po s al (s ee attach ment)
Copy of the con tractor’s licens e
Copy of the wo rker’s compens ation certificate
Contractor’s full name, phone nu mber and email addres s . Th ey will need to digitally s ign the permit
Thank you,
Sa ndi Jime ne z | Permit Technician
City of Diamond Bar | Building & Safety Division
21810 Copley Drive, Diam ond Bar, CA 91765
t (909) 839-7020| (909) 839-7000 m ain | f (909) 861-3117
SJim enez@diam ondbarca.gov | www.Diam ondBarCA.gov
Connect with Us ... Facebook|Twitter|YouTube|Ins tagram
From: adnan ayoub <adnanayoub@yahoo.com>
Sent: Monday, July 7, 2025 11:02 AM
T o: yamen laktineh <laktineh@hotmail.com>; Sandi Jimenez <SJimenez@DiamondBarCA.Gov>
Subject: Re: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
**DO NOT open unknown links or any attachments w ithout confirming with IS or the sender directly.**
CAUTION: This email originated from o uts ide your organization. Exercis e caution wh en op ening attachments or clicking links , es pecially from unknown s enders .
Hello
Attached is the Certificate of Compliance aaproved.
Truly Yours,
Adna n
"Only be with someone who respects and appreciates y our presence in their life."
On Wednes d ay , May 21, 2025 at 12:52:06 PM PDT, Sandi Jimenez <s jimenez@diamondbarca.gov> wrote:
Good afternoon ,
Thank you for the update.
Your plans have been routed for review with a 10-bus ines s day turnaround.
Thank you,
Sa ndi Jime ne z | Permit Technician
City of Diamond Bar | Building & Safety Division
21810 Copley Drive, Diam ond Bar, CA 91765
t (909) 839-7020| (909) 839-7000 m ain | f (909) 861-3117
SJim enez@diam ondbarca.gov | www.Diam ondBarCA.gov
Connect with Us ... Facebook|Twitter|YouTube|Ins tagram
From: yamen laktineh <laktineh@hotmail.com>
Sent: Monday, May 19, 2025 8:27 PM
T o: Sandi Jimenez <SJimenez@DiamondBarCA.Gov>
Cc: adnan ayoub <adnanayoub@yahoo.com>
Subject: 2514 Reata (Addition) PR25-0519 – RESUBMITTAL
**DO NOT open unknown links or any attachments w ithout confirming with IS or the sender directly.**
CAUTION: This email originated from o uts ide your organization. Exercis e caution wh en op ening attachments or clicking links , es pecially from unknown s enders .
Hello Sandi,
The plans have been revised. Please click the link s below to download PDF's files.
2025-51 2514 Reata Pl (SC)-PCC1-.pdf
2514 REATA PL (PCC1).pdf
2514 Reata Pl., Diamond Bar (PR25-0519) (PC1 response).pdf
Planning response letter.pdf
Please feel free to re ach out if you have any questions.
Be st Re ga rd
Yame n Laktine h
LAK De ve lo pme nt INC.
Phone : (7 60) 486-1697
E-mail: lak tine h@hotmail.com
--
Rafi Baghdasarian
EPIC Remodeling
Phone: (949) 594-6444
Email: rafi@epicremodeling.com
Website: www.epicremodeling.com
"Building the future, one project at a time."
--
Rafi Baghdasarian
EPIC Remodeling
Phone: (949) 594-6444
Email: rafi@epicremodeling.com
Website: www.epicremodeling.com
"Building the future, one project at a time."
--
Rafi Baghdasarian
EPIC Remodeling
Phone: (949) 594-6444
Email: rafi@epicremodeling.com
Website: www.epicremodeling.com
"Building the future, one project at a time."
--
Rafi Baghdas arian
EPIC Remodeling
Phone: (949) 594-6444
Email: rafi@epicremodeling.com
Website: www.epicremodeling.com
"Building the future, one project at a time."
Building Permit Application (1).pdf
PERMIT #: PR20250000519
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS: 2514 REATA PL, DIAMOND BAR, CA 91765
APN:8713049010 LOT#:TRACT#:
OWNER NAME:AYOUB ADNAN N
ADDRESS:2514 REATA PL
CITY:DIAMOND BAR ZIP:91765 TEL:
APPLICANT NAME:TEL:
CONTRACTOR NAME:EPIC Home Remodeling
ADDRESS:405 E Toluca Ave
CITY:Orange STATE:CA ZIP:92866 TEL:(949) 594-6444
ARCH/ENG/DES. NAME:
ADDRESS:
CITY:STATE:CA ZIP:TEL:
P/C DATE:P/C#:
ISSUE DATE:PR#:
TYPE CONSTRUCTION:Type VB (Unprotected)OCC GROUP:R3
SCOPE OF WORK:Addition to 2nd floor to create new game room 380 sf, new balcony 385 sf, and 30 sf elevator. Demolish existing balcony 395 sf
*Revision 12/04/2025 - Relocation of game room and balcony and increasing sq ftg of Game room (391 sf) and Balcony (369 sf)
#DWELL UNITS:#STORIES:#BEDROOMS:
BUILDING FEES
DESCRIPTION SQ. FT.FACTOR PSF ADJ AREA/VALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE-ROOF
COMMERCIAL
TOTAL VALUATION:TOTAL:$0.0000
Mechanical
TYPE QUANTITY AMOUNT TOTAL
Inlet and Outlet Served by A/C System (EACH)1 $0.00 $0.00
Electrical
TYPE QUANTITY AMOUNT TOTAL
Lighting Fixtures, Sockets, or Other Lamp Holding Devices 16 $0.00 $0.00
Receptacle, Switch, Lighting or other Outlets 14 $0.00 $0.00
PLAN CHECK FEES PERMIT FEES
CONSTRUCTION:$1,693.41
PLAN REVIEW:$1,439.40
ELECTRICAL:$169.34
PLUMBING
MECHANICAL:$169.34
INSPECTION FEE:
ISSUANCE:$140.53
SMIP:$9.75
ENERGY:$143.94 $169.34
RETENTION FEE:$189.24
PRE/ALT FEE:
BASF:$3.00
PLOT PLAN:$760.57
ZONING CLEARANCE:
RECYCLING AND WASTE DEPOSIT:
EROSION CONTROL PLAN CHECK FEE:
BUILDING ADMIN SPECIAL REVOLVING
FUND:
PERMIT SYSTEM REPLACMENT FEE:
$151.39
TOTAL FEES:$5,039.25
COMMENTS:
P/C RECEIPT #:PAY METHOD:VALIDATION:
PERMIT RECEIPT #:PAY METHOD:VALIDATION:
PERMIT #: PR20250000519
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION DATE:INSPECTOR:INSPECTION DATE:INSPECTOR:
SETBACK / LETTER TRACK AND LEDGER
FOOTINGS FORMS T-BAR
SLAB POOL DEMOLITION
UG. PLUMBING ROOF DRAINS
UG. ELECTRICAL POOL/SPA:
UFER GROUND GAS TEST, EL, PL, ME
SEWER LATERAL PRE GUNITE
SEWER CLEANOUT POOL PRE DECK BONDING
MAIN WATER LINE P-TRAP
ROOF SHEATHING FENCE / GATE / ALARM
FLOOR SHEATHING FINAL POOL
SHEAR WALLS EXTERIOR WALLS:
SHEAR WALLS INTERIOR WALL FOOTING/STEEL
FRAMING/VENTING WALL STEEL 1ST( ) 2ND( ) LIFT
RO. MECHANICAL WALL DRAIN / SEAL
RO. ELECTRICAL W ( ) C ( )WALL FINAL
RO. PLUMBING RO. FRAMING PLANNING
APPROVAL
INSULATION WALL ROUGH FIRE APPROVAL
INSULATION CEILING FINAL FIRE DEPARTMENT
HOT MOP/SHOWERPAN FINAL PLANNING
DRYWALL FINAL PW ENGINEERING
LATH EXTERIOR FINAL PW MAINTENANCE
LATH INTERIOR FINAL HEALTH DEPT.
GAS TEST FINAL INDUSTRIAL WASTE
SCRATCH COAT FINAL BUILDING
ELECTRIC METER RELEASE FINAL MECHANICAL
GAS METER RELEASE FINAL ELECTRICAL
SPECIAL INSPECTION FINAL PLUMBING
SMOKE & CARBON
MONOXIDE DETECTORS
T.C. OF OCCUPANCY
CERT. OF OCCUPANCY
COMMENTS:
PERMIT #: PR20250000519
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated
below by the checkmark(s) I have placed next to the applicable item(s) [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 file a signed statement that he or she is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter 9, Commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).]:
(_) I as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) 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-Builder will have the burden of proving that it was not built or improved for
the purpose of sale.)
(_) I, 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 for the projects with a licensed Contractor pursuant to the Contractors' State License
Law.)
(_) I am exempt from licensure under the Contractor's State License law for the following reason(s):
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 permit, I cannot legally sell a structure that I have built as an
owner-builder if it 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 Code is available upon request when this application is submitted or at the
following Web site: http/www.leginfo.ca.gov/calaw.html.
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT:DATE:
LICENSED CONTRACTOR’S DECLARATION
I hereby affirm under penalty of perjury 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 CLASS:<Enter License Class>LICENSE NUMBER:1095347
EXPIRATION DATE:CONTRACTOR SIGNATURE:
WORKERS' COMPENSATION DECLARATION:
WARNING: FAILURE TO SECURE WORKERS’ COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY’S FEES.
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_______I have and will maintain a certificate of consent to self-Insure for workers’ compensation, issued by the
Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
_______I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My workers' compensation insurance carrier and
policy number are:
CARRIER:<Enter Workers Comp> POLICY #:EXPIRATION DATE:
NAME OF AGENT:0 PHONE #:
I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to the workers’ 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.
SIGNATURE OF APPLICANT:DATE:
DECLARATION REGARDING 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 (Section 8172, Civil Code).
LENDER’S NAME:
LENDER’S ADDRESS:
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner’s behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of the City of Diamond Bar to enter the above-identified property for inspection purposes.
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT:
DATE:
7039231003 03/20/2026
VALLEY FORGE INSURANCE COMPANY
B
08/31/2026