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� _ CITY OF DIAMOND BAR�
�DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
. (909)860-3195 Fax(909)861-3117 PRESS
��'�• BUII.DING PERMIT APPLICATION FIRMLY
o�' JOBSITE 7'?�' I �,M�I� '_ f�G v ��• APPLICATION ' PERMR rJ P/C
ADDRESS�-✓ ��F �^� r� DATE NUMBER � #
� ISSUE TYPE OCC
APN LOT ' TRACT DATE CONST. GROUP
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�n DESCRIPTION SQ.FT. ' FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ApD/REM
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p I HEqEBY AFFlRM UNDER PENALTY OF PERNRY hiA7 I AM EXEMPT FROM iHE CONTMCTORS LI- Gef9gB/CefpOR
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� TURE,PRIOR TO I7S ISSUANCE,ALSO REOUIRES h1E MP�ICANT FOR SUCH FERMIT TO FILE A SIONED W _
STATEMENT THAT HE OR 9HE 19 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll-
� CENSE LAW(CHAP7ER B(COMMENCWO WITH SECTION 7000)OF DMSqN�OF THE BUSINE53 AND PRO � POOUSPB
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� ❑4�.40WNEROFTHEPROPERTI,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � CpmmgfClBl �
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� ❑1,A90NMEROFTHE PROPEHfY.AM IXCLUSIVELV COMRACTINO WfTH LICENSED CONTMCTORS .
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CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPEHTV WFq BUILDS OR IMPROVE3 7NEREON,M1D �
' � N'/1000HIRACT9FORSUCFIPROJECTSWITIACONTRACTOR(9)LICENSEDPURSUAHTTOTHECONTRAG (]UANTITY DESCRIPTION FEE .
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� LICENSED CONTRACTORS DECLARATION w
� I HEREB'/AFFtRAI UNDER PENALTV OF PENUM THAT 1 AM UCENSED UNDER VROVISIONS OF CHAPTEp �
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�� MY LICENSE t51N FULL FORCEAND EFFECT. m
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� WORKERS'COMPENSATION DECLARATION �
N1 HEREBV AFFUiM UNDER PENAL7Y OF PER0.1fiY ONE OFTHE FOLLOWIN�DECLARA7qNS: Z '
� _IHAVEAHDWILLMAMTNNACEHTIFICATEOFCqNSENTTOSELF-INSUREFORWORKERS' _
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Q OF 7HE WORK FOR NMlpt THt3 PERMR IS ISSUED. �
' Q _I HAVE AND WILL MNN�API WOFKERS'COMPENSA710N fNSURANCE,AS REOUIRED BY SECTqN / �//—�
Q 370o OF 7HE LABOR COOE,FOR THE PERFORMANCE OF THE WORK WR WNICH THIS PERMI715 /
ISSUED.MY RKFj��S'COMPENSATION INSUR/JICE CARRIER AND POIICv NUMBER AAE: CONSTRUCTION �-
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Z I CERTIFY THAT W THE PERPoRMANCE OF 7HE WORK FOR WHICH THIS PERMR IS ISSUED,I MECHANICAL
C7 SHALI NOT EMPIOY ANY PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO7HE
(n NORKERS COMPENSATqN UWS OF FORN10. D A6REE THAT IF I S/IOULD BECOME INSPECTION FEE
'SU&IECTTOTHENqRKERS'COM7ENSA PRO I IONSOFSECTION97ooOFTiELABOR .
O2000�,i sriul wRnnvrrH coMr�r vn ase rons. ISSUANCE —
p DATE: 7 �DO ppp����; SMIP �
w ENERGYP/C — pA ��+�
� WARMNO:FMURE TO SECURE WOFiI(ERS' P 7SAT1 OVERAOE IS UNLAWFUL,ANO SHALL BE ����� d.£-��
� �y SUBJECT AN EMPLOYER TO CRW PIAL PENALTI CIV INES UP TO ONE HUNDRED THOUSAND v��
���(i100,000),IN ADDITION TO THE COST COMPENS�TpN,DAMAQES AS PROVIDED FOR IN ENERGY PER
� SECTION 370E OF THE LABOFi CODE,INTEREST,M!D ATTOFWEY'S FEES. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
� I HEREBV AFFIRM UNDER PENALTV OF PERNRY hiAT hiERE IS A CONSTRUCTION LENDINO AOENCY �
Z FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS.PERMIT IS ISSUED(SEC.9ov7.CIV.C.). .
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� LENDERS NAME . �
� LENDER'SADORESS /� /��
� ICERTIFYTHATIHAVEREADTHISMPLICATqNANDSTATETMATTIEABOVEMFORMATIONISCORAECT. TOTAL FEES � / - / �
W 1 AOREE TO COMPLV WfTH ALL CITV/�ND COUNTV ORDINMICES AND STATE UWS REU71N0 TO W0.DIN0 ( /
� .CONSTRUC'f10N,AND HEREBY AUh10RIZE REPRESENTATIVES OF THIS COUNTY TO EHTER UPON 7HE '
� S� �BO �MEM ED PROPERiY FOR INSPECTION PURPOSES. COMMENTS �
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� ��N � oA� RECPT.Np. i PAID BY VALIDATION '
� WHITE—Deparlment C.apy,YELLOW�inence Copy,PINK—Assaasw Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy
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FTGS/FORMS/STEEL • FHA REQMTS
ELECTRIC GROUND ' UNDER FLOOR DUCT - ,
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GROUND PLUMBING UNDER FLOOR CO�IDUIT . ��.� ..� =
SLAB GRADE FIREPL`'A�E FOUNDATION`�� �° -••''•`;' • �
TEMP POWER � ' FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM �� � '''��'�''` ' ��`''''
ROOFSHEATHING`' ' '"' �. �`"�`'':"`";'�`".� . . '
., �. „ 8 FT. BOND BEAM� ,�. :
FRAMINGNENTILIATION FINA�BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGN PLUNIBING FINISH GRADING
SHOWER/TUB TEST - POOL ELECTRIC �
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEIUNG INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK . .. '. , LANDSCAPEIiRRIG.
SEEP PIT/L.L. ' � ON SITE IMPS.
GAS AIR TEST FINAL ZONlNG
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATlNG HEAtTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
F1NAL PLUMBING ENERGY
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