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CITY OF DIAMOND BAR r�
._ DEPARTMENT OF COMMI LAITY & DEVELOPMENT SERVICES
&7f 21825 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7
`4'�" TM' BUILDING PERMIT APPLICATION
JOBSITE I
ADDRESS
APN �% T RACT _
OWNER 1
ADDR SS
CITY IP TEL.
APPLICANT 6 TEL.
CONTRACT
ADDRE S
CITY ZIP TEL
ARCFVENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LH
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITY OR
CW NTY WHICH REOUIRESA PERMR TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC-
TURE. PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF
CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE P.;ISINESS A,'O PR-
FESSIONS CODE) OR TXAT HE OR SHi: IS EXEMPT THEREFROM AND THE BASIS FDF, THE ALLEGED EX.EM'P-
TION. ANY VIOLATION OF SECTION 7631.6 BY ANY APPLICANT FOR A PERMIT SUBJEC..S THE APPLICANT Tr,
A CIVIL PENALTY OF NOT MORE THAN ME HUNDRED DOLLARS (SSW).k
O I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 701, BUSI-
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE.LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE.
TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE}
❑ LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 70L1. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
VA 10 CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
❑ 1 AM EXEMPT UNDER SEC. B. i P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
B (COMMENCING WRH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL EFFECT.
LICENSE C1,ASS LIC. NO.
..,GATE
_ 1
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFRRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT To SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 37M 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 REWIRED BY SECTION
37000F M!T
LABO CODE, FOR THE PE FORMANCE OF THE WORK FOR WHICH THIS PERM171S
ISSUED. G' GpA S TIO N S R CE CIE AND Pf1LICY NUMBER ARECARRIER V q
(THOS SECTION NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE H U NDREDDOLLARS MOD) OR LESS)
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1
SHALL NOT EMPLOY ANY PERSON W 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 PROVISI 700 OF THE LABOR
I ALL THWITHCOMPLr c OVISIONS.
DATE: APPLICANT:
WARNING: FAILURE TO SECURE W(OB(ERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
LA
DOLRS ($7 D0,000). W ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3700 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CIV. C.).
LENDERS NAME
LENDER'SADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
NMPLY WITH ALL CRY AND COUNTY O WAN CES AND STATE LAWS RELATING TO BUILDING
N, AND HEREBY AUTHORIZE REPRES NTATIVES OF THIS COUNTY TO ENTER UPON THE
NED PROPERTY FO INSP CTION SES.
ME (PRINT) EE DATE
PRESS
FIRMLY
APPLICATION
DATE
PERMIT P/C
NUMBER z3�7a
ISSUE'/�
TYPE
OCC
DATE 7 C L QL
CONST.
GROUP
ZONING SETBACKS
FRONT
RW
REAR
p
SIDE/SIDE STREET
RW
p
SIDE
PROPOSED USE
NO. DWEL NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
co
Garage/Carport
WPatio/Dock
LL
0
PcottSpa
Z
Re -Roof
Commercial
_
M
Valuation
ADJ.AREA
QUANTITY DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
LLCIr i niC.
PLUMBING
—�1
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL F/ S
COMMENTS v V
RECPT. NO. PAID BY O�C
VALIDATION
...... --i....... n wpy, 7 cLLvrv—r-Inance L.opy, VINK—ASSessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
CITY OF DIAMOND- BAR
INSPECTION RECORD
111,111gill F jWjj-wdw= a,- I �*�o
SET BACK
FLOOR JOIST
FTGS/FORMS/ST:_EL j
FHA REQMTS
ELECTRIC GROUND j
UNDER FLOOR DUCT.
GROUND PLUMBING
G . RADE
UNDERFLOOR CONDUIT
FIREPLACE FOUNDATION
-SLAB
TEMP POWER
FIREPLACE BOND BEAM
WATER -SERVICE
MID HT BOND BEAM.
ROOF SHEATHING i
8 Fr. BOND BEAM
FRAMING/VENTILATION
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING'
WALL INSULATION
POOL FINAL
CEILING INSULATION I
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
ON SITE IMPS.
GAS AIR TEST I
-FINAL ZONING
FINAL CONST. 1
FIRE DEPT, FINAL
FINAL HEATING 7-
HEALTH DEPT FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
Mew,
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE