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�`_ CITY OF DIAMOND BAR � � '
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 �
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
�'��' BUILDING PERMIT APPLICATION FIRMLY
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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1 HEREBY AFFIRM UNDER PENALTV OF PEPJURV THAT I AM EXEMPT FROM THE CONTRACTOFiS ll� G8fH9B/CefPOff
W CENSEIAWFORTHEFOLIOWINGREA50N(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANYCITYOR (n
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Z TURE,PRIOR 70 ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
� STATEMENT THAT HE OR SHE IS IICENSED PURSUAN7 TO THE PROVISIONS OF THE CANTRACTORS LI- �
� CENSE UW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVSpe
, 0 FESSIONS CADE)Oq THAT HE OR SHE IS EXEMPT THEREFFiOM AND THE BASIS FOR THE ALLEGED EXEMP� C7
V TION.ANV VIOUTION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z Re-Roof
� A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOLURS(5500).):
Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � COffIfIlBfCle1
WILL DO THE WOqK,AND THE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7otl,BU51- J
� NESS AND PROFESSIONS CADE:THE CANTRAC70FS IICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND NMO DOES SUCH WORK HIMSEIF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPqOVEMENTS ARE NOT IN7ENDED OR m
Q OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCOM7LE�
z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
� �MPROVE FOR THE PURPOSE OF SALE).
W OI,ASOWNEROF7HEPROPERN,AMEXCLUSNEIYCONTRAC7INGWI7HLICENSEDCANTRACTORS
Q TO CANSTRUCT THE PRQIECT(SEC.7oa1,BUSINESS AND PROFESSIONS CODE:THE CONTqACTORS LI- V81U8�i0f1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� NM1IOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTMC- OUANTITY DESCRIPTION FEE
TORS LICENSE LAW.).
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENPLTY OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS Of CHAP7ER �
d Y(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSANO PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULI FO AND EFFECT.
� LICENSE CIASS -� ���.No.�4� 7''�' j
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� WORKERS'COMPENSATION DECIARATION Q
� I HEREBV AFFIRM UNDER PENALTY OF PEqJURV ONE OF THE FOLLOWING DECURATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF•INSURE fOR WORKERS' a
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Q CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE IU
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �"— �� O �
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: . CONSTRUCTIO
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j CARRIER PLAN REVI _
� POLICV NUMBER � � I � �
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� (iHISSECTqNNE�NOTBEOJA1PLEfEDOF71-�PEFUHTISWfiONEHUI�DREDDOLLARS(5700)ORLESS} PLUMBING
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Z I CEHTIFY THAT M THE PERFOqMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,l MECHANICAL
(�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGREETHAT 1SHOULDBECOME INSPECTIONFEE
SUA1 CTTOTHEWORKERS'COMPENSATIONPROV SOF.�SE M�S7600FTHELABOR
� C!AaD,I SHA FOFTHWITH COMPLY WITH THOSE O ISIONS. SSUANC /�
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p DATE: V I� APPIICANT: IP �
J WARNING:FAILUfl TO SECURE WORKERS'CO ENSATION COVERAGE IS UNIAWFUL.AND SHALL BE ENERGY P/C
� SUBJECTANEMPL YERTOCRIMINALPENA SANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. TENTI FE ' i
OCONSTRUCTION LENDING AGENCY PR LT FEE: ` �
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY ��'J� /
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
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y LENDER'S NAME
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F— LENDER'SADDRESS
� TOTAL FEES �� �
� I CERTIFY THAT I HAVE READ THIS APPLICA710N AND S7ATE THAT THE ABOVE INFORMATION IS CORREC7.
w I AGREE TO CAMPLV WITH ALL GTV AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEN7A71VE5 OF THIS COUIJTY TO ENTER UPON 7HE
� ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES.
Z COMMENTS
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� Im PERMITTEE NAME(PRINT) � �
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� SIGNATURE OF PERMITTEE DATE
= RECPT.N0. PAID B • VALIDATION
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUN� PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION 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 FINA�
CEILING INSULATIQN OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEINER � FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
' FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC � �� DEV. FEES PAID __
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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