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C1TY OF DIAMOND BAR • %�-
COMMUNITY DEVELOPMENT DEPARTMENT ,�.._
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(909)860-3195 Fax(909)861-3117 ( PRESS
�'°"" BUILDING PERMITAPPLICATION FIRMLY
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A[}DRESS�ir��� ��/Yv.«�1_�Ai�_���__ DATE NUMBER #
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
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OOWMER-BCILDER DECLARATION SFR/ADD/REM
Q 1 HEREBY AFFIR61 UNOER PENA�TY Oi PERNFY THAT I AM EXEMPT FROM THE CANTRACTORS LI- Gflf890/CafpOft
yt,l CENSEtAWFORTHEFOLLOWINGPEASON(SEC.7o]1.SBUSINESSANDPROFESSqNSCWE:ANVCITVOfl
C.� CAUNTYNMICHREOUIpESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLiSH,OPREPNRANYSTRUC- (jf Patio/Deck
� TURE.PRIOR TO ITS ISSUANCE,A150 REOUIRES 7HE APPUCANT FOP SUGN PERMIT TO Fl�E A SIGNE�
� STATEMENT THAY HE OR SHE IS LICENSED OURSLIANT TO THF PROVISIONS OF THE fANTfiACiOF1S L6
CENSE LAW(CHAPTEP 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSWESS AND PRO- PooUSpa
FESSIONSCODE)ORTHATHEOflSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLE6EDEXENR (�
U TION.ANVVIOLAiIONOFSECT10N7o31.59VANYAPPLICANTFOPAPFRMITSU6IECTSTHEAPPLiCANTTO Z Re-Roof
� ACIVII PENAITY OF NOT MORE THAN FNE HUNDRED DOLURS(SSaO).): Q
I,ASOWNEROFTHE7ROPERTV,ORM7EMPLOYEESWIlHWAGESRSTHEIRSOLECOMPENSAT1011, COR11118fCidl
WILL THE WORK,AND TNE STiiUCTURE IS NOT MTEN�ED OR OFFERED FOR SALE(SEC.70N.&1SI- J
� NESS ANO PROFESSIONS CODE THE CONTRACTOFS LICENSE UW DOES NOT APPLY TO AN 011WEFi OF �
PPOPERTY WHO BUILDS OR IMPROVES TMEREON,AND WMO DOES SUCH WORK HIMSEIF OR HERSELF Ofl
SC 7HRouGHHISORHEROWNEMPLOYEES.PROVIDED7HATSUCHIMPROVEMENTSARENOTW7ENOE0OR m
W OFFEREDFOHSr1LEIF,HOWEVERTME8U4.DINGORIMPROVEMEMIS50LDWITHINONEVEAROFC04PLE-
�� TION,THE OWNER-BUILDER WILL HPVE THE BUR�EN OF PROVING THAT HE Ofl SHE Ot�NOT BUIID OR
� IMPROVE FOR THE PURPOSE OF SALE).
C I,AS OWNEF OF THE VROPERTY,AM EXCLl1SIVELY LbNTRACTING WITFI LICENSE�CONTRACTORS
� TO CONSTRUCT THE PfiOJECT(SEC.7044,BUSINE55 ANO PROFESSIONS CO�E:THE CONTMCTORS LI- V8IU8IlOf1 ADJ.AREA
4l1 CENSELAWDOESNDTAPPLVTOANOWNEflOFAPROPERTYWHOBUIl�50RIMPROVESTHEREON,PND
� WHOCONTRACTSf-0RSUCH�ROJECTSWI7HACONTNACTOR(S)LICENSEDGURSUANTTOTHECONTRAG OUANTITY OESCH�PTION FEE
TORS LICENSE LAW.j.
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Q ❑I AA1 EXEMPT UNDER SEC. 8.6 P.C.FOP 7HI5 RFASOM U
LL' DATE �� OWNER ¢ -
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� LICENSEO CONTRACTORS DECLARATION w
CC I MEFEBY AFFIflM UN�ER PENALTY OF PERJUflV THAT I 11M UGENSED UNDEfl PROVISIONS OF CMAP7Efl �
Ci 9(�OMMFNCING wITH SECTION 7000)OF DIVISION 90FTHE BUSINESSAND PROFESSIONS CODE,ANO Z
?G MY LICENSE IS IN FULL FORCE ANO EGFECT, m
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r� WORKERS'COMPENSATION DECLARATION Q
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� I HEREBY AFFIRM UNOER PENALN OF PERJURV ONE OF THE FOLLOWINC DECLARATION6:
Cf� Q
� I NAVL AN�WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INStIRE FOR WORKERS' _
CAMPENSATIDN,ASPflOVIDEDBYSECTION37000FTHEU80RLO�E.FORTHEPERFORMANCE U
� OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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W _�HAVE AND WILL MAINTAIN WORKERS'Ca.APENSATION INSURANCE.AS PEQUIRE�BY SECTION
Q 370oOFTHELABORCODE.FONTHEPERWRMANCEOFTHEWORKWRWHICHTHISPEFlMIT�S
� ISSUED.MV WORKEPS'COMPENSA?ION INSURANCE CARRIER AND POLICY M/M9Eft AflE: CONSTRUCTION �
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w MECHANICAL
Z I CERTIFYTHAT IN THE PERFOFMANCE OF TME WOHK FOR WNICH THIS PERMIT IS ISSUED,I
(� SNALL NO7 EMPLOY ANY PERSON IN ANY MANNER SO AS TO 9ECOME SU6JECT TO THE w�
� � WOiiKERS'COMPENSAT�ONLAWSOFCALIFOANIA,ANDAGREETHATIFISHOULDBECOME �NSPECTIONFEE 1
= SUBJECT 70 THE WORKERS'CAMVENSATION PROYISIONS OF SECTION 37o00F THE U90P
CADE,I SHALL FOiiTF1W17H COMPLY WITH THOSE PROVISIONS. ISSUANCE �
� SMIP
p OATE: APPLICANT.
w ENERGY P!C
J WARNING:FAILURE i0 SECURE K'ORKERS'COMPENSATION COVERAGE IS UNIAWFUL,AND SHhLLBE
� SUBJECT AN EMP�OYER TO CRIMINAL PENALTIES AND CIVIL FINES UO TOONE Hl1NDRED THOUSANO - ENERGY PERMIT
DOLLARS�f70D.o0o),IN AO�ITION TO THE COSTOF COMPENS�TION,DAMAGES AS PROVIDEO FOfl IN
� SECTION37080FTHEtAeORCODE.ttJTEREST.ANDATTORNEY'SFEES. RETENTIONFEE:
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBY AFFIRAI UNOER PENALTY OF PERJURY TMRT THENE IS ACONSTflUCTION LENDING AGENCY
n- FOR THE PERFORMANCE OF THE WORK WR WHICH THIS PEftMIT IS ISSUED(SEC.3097,CIV.C.�.
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� LENDER'SNAME
H LENDER'SADDFESS -
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� I CERTIFY TMAT I HAVE READ THIS APPUCqTION AND 5TA7E THATTHE ABOVE MFORMATION IS CORRECT. TOTAL FE ES
w IAGRFETOCOMPLYWITHAILCITYANOCOUNTYOfiDINANCESANDSTATEUWSREUTMGT06UILDING -
� CONSTflUCTION,AND HEREBYAUTNORRE REORESENTATNES�F THIS COUNTY TO ENTEP UPON THE
� AB���TIONEDPROPERTYFORINSPECTIONPURPOSES.
Q � COMMEN7S
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i .EGf' eRMITT �ATE
_ ��� RECPT.N0. PAID BY VqLlDq � �
~ WHITE—Department Copy,YEILOW—Fnance Copy,PINK—Assessor Copy,GOLDENFOD—File Copy,GREEN—Applicant's Copy -
CITY OF DiAMONID Bi�R
INSPECTI4N RECORD
� • . � • � • r � � � • . •
SET BACK FLOOR JOIST
FT'GSiFORMS/STEEL ' Zy FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNQER FLC)OR COt�DUIT
�
SLAB GRADE FIREPtACE FOUNDATION - `
TEMP POWER FIREPLACE BOND BEAM
WATER SERVIGE MID HT.BOND BEAM
ROOF SHEATHING 8 Ff.BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROC}F COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
RQUGH PLUMBING FPt�ISH GRADING
SHOWERITUB TEST POOL ELECTRIC �
EXT.LATHiSIDING POOL FENCING
WALL INSUTATiON POOL FINA� �
CEII.ING INSULATION OFF SITE IMPS. �
DRYWALL NAILING DEDICATIONS ',
5EWER FINAL ENG.
SEPTtC l'ANK • I:ANOSCAPE/IRRIG.
SEEP PITIL.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING �
FINA�CQNST. / �y � FIRE DEPT. FINAL ,
FINAL HEA7ING HEALTH QEPT. FINAL
FINAL ELECTRIC DEV. FEES PAIp i
FINAL PLUMBING ENERGY �
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COMMENTS . �
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SEPTIC TANK SIZE �
SEEP PIT/U SIZE I
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