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_��` _ CTI'Y OF DIAMOND BAR �
DEPARTIvIENT OF COMMUNTI'1'&DEVELOPMENT SERVICES
21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
"'�9�� BUILDING PERMIT APPLICATION FIRMLY
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o DATE � G� NUMBER � Gl/ p
� ISSUE � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
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� ADDRESS NO.DWEL. NO. NO.
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E7(EMPT FROM THE CANTRACTORS LI- G8f8 0/C8 Ofl
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w NRE,PRIOR TO ITS ISSUMlCE,AL50 REOUIRES THE APPLICANT FOR SUCH PEFiMIT TO FILE A SIGNED w P8I10/DBCk
� STATEMENT THAT HE OR SHE IS LICENSED WFSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LhW(CHMTER 8(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSPe
O FESSIONS CADE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THEALLEQED E%EMP- (�
V TION.ANV VIOLATION OF SECTION 7031.6 BY ANV APPLICANT FOR A PERMIT SU&lECTS THE APPUCANT TO Z Re-Root
A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(f600�.):
� ❑I,ASOWNEROFTHEPROPERTY,ORMVEM7LOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COffl!l16fC181
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a,BUSI� J
N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES iNEREON,PND NM1iO DOES SUCH WORK HIMSELF OR HERSEIF OR
CC 7HROUGHHISORHERONMEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
Q OFFEREDFORSALEIF,HOWEVERTMEBUILOWOORIMPROVEMENTISSOLDWRHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BIIILD OR
� IMPROVE f-0R 7HE PURPOSE OF SALE).
w OI,ASONMEROF7HEPROPERTV,AME%CLUSIVELYCANTRACTINOWITHLICENSEDCONTqACTOFS
� TO CANSTRUCT THE Pq0.1ECT(SEC.70/!,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS U� V81U8I1Of1 ADJ.AREA
W CENSE LAW DOES NOTAPPLV TO/W OWNER OF A PqOPERTV WMO BUILDS OR IMPROVES THEREON,ANO
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� DATE OWNER {—
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PE0.IURV THAT I AA/LICENSED UNDER PROVISIONS OF CHAFTER �
d G(COMMENCINO WITH SECTION]000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
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� WORKERS'COMPENSATION DECLARATION �/��
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� I HEREBV AFFIfUI UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
�Z I HAVEMlD WILLMAINTAIN ACERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' a
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COMPENSATqN,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERf-0qMANCE U
• OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED. w
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w HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURMICE,AS RE�UIRED BV SECTION
Q 3700 OF iHE O CODE,FOR TH PERFORMANC OF THE WORN FOR WHICH THIS PERMIT IS
ISSUED.MV K 8 C P NS bNINS P� CARRIERAN�POLICYNUMBEfiARE� CONSTRUCTION
� CARRIER PLAN REVIEW
Z POLICV NUMBER ELECTRIC
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� (n+I55EcnoNNE�ra76EGUAAaLErIDOFnEPEaAvrlSwaa+E�lUl1)REooaiuis(stoo)oalessE PLUMBING
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Z I CERiIFV THAT IN 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL •
. ' CS SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME �NSPECTION FEE
� SU&IECTTOTHEWORKERS'COMPENSAT NPROVISIONS SECTION�7000FTHELABOR
� yl�l ORTHWITHCOMPLVWITH OS PRO IS ISSUANCE
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p DA7E:� V� APPLICANT: p� SMIP
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J WARNIN6:FAILURE TO SECURE WOAKERS'COMPENSATpN COVEqAOE IS UNLAWFUL,AND SHALLBE ENERGY P/C
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� SUBJECTANEMPIOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTFI0U5AND ENERGYPERMIT
DOLLARS(floo.o00),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF 7HE LABOR COOE,WTEREST,AND ATTORNEV'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURY THATTHERE IS ACONSTRUCTION LENDINa AGENCY
FOR iHE PERFORMANCE OF THE WORK FOR WHICH THIS VERMIT IS ISSUE�(SEC.3007,CIV.C.�.
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� LENDER'S NM/E
H LENDER'SADDRESS
w ICERTIFVTHATIHAVEREAD7HISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ,�J� / /
� I AGREE TO COMPLV WITH ALL CfTY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILOING �/ V
� CONSTRUCTqN,AND NEFEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE �
Z A E�MENTIONED P OP RTV FOR INSPECTION PURPOSES. COMMENTS
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� RECPT.�O. b PA1D BY • VALIDATION
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ELECTRIC GROUND UNDER FLOOR dUCT
GROUND PLUMBING UNQER FLOOR CU�IDUIT
SLAB CRADE FiREPLAGE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM �
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BONQ BEAM
FRAMfNGNENTILIATION FINAL 60ND BEAM '
ROOF COVER ' PRE-GRADING
ROUGH HE�4TING BENGHING
ROUGN ELECTRlC ROUGH GRADING
ROUC,H PLUNIBiNG FINISH uRADING
SHOWEF�fUB TEST POOL ELEGTRIC
EXT. LATH/SIDING P�OL FENCING
WALL IfVSULATION POO�FINAL
CEILIIVG INBULATION OFF SITE IMPS.
DRYWALL NAIUNG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/tRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. , FIRE DEPT. FINA!_
FINAL HEATING HEALTH DEPT. FfNAL
FINAL ELECTRiC �� DEV. FEES PAID
FINAL PLUMBING ' ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE —
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