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� _ CITY OF DIAMOND BAR �
' � -' ^�-���— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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•� �,w . 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
� ''^' BUILDING PERMIT APPLICATION 1�3�j FIRMLY
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p I HEREBV AFFlRM UNDER PENALTY OF PERNRY THA7 I AM EXEMPT FROM 7HE CONTMCTORS LI- Gflf8g8/CBfPOR
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w NRE,PRIOR TO RS ISSUANCE,ALSO REOUIRES THE APPLICANi FOR SUCH PERMIT TO FILE A SIONED �w Patio/Deck
� STATEMEM THAT HE OR SHE IS UCENSED PURSUANT TO TiE PROVISIONS OF THE'COMRACTORS LI- � -.
� CENSE UW(CHAFTER e(COMMENCING WI7H SECTION 7000)OF OIVISION 3 OF THE BUSINE55 AND PRP POOUSpB
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V TION.ANYVIOLA710NOFSECTION7031.SBYANYAVPLICANTFORAPERMITSU&IECTS7HEAPPLICANTTO Z RaRoot
A CIVIL PENALTY OF NOT MOHE THAN FNE MUNDRED DOIURS(f5oo).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 Commercial - ,
1Nll DO THE WOflK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.1o�(BUSI- _J � -
� NESS AND PROFESSIONS COOE:7HE CON7MC70R5 UCENSE LAW DOES NOT APPLY 70 AN OWNER OF � � ,
PROPEHTY WFIO BUILOS OR IMPROVES THEREON,M!D WHO OOES SUCH WORK HIMSELF OR HERSELF OR
� CC THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THA7 SUCH IMPROVEMEMSARE NO7INTENDED OR m
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Z TION,THE ON7JERAUILDER WILL HAVE THE BURDEN Of PROVING 7HAT-HE OR SHE DID NO7 BURD OR . .
� IMPROVE FOR THE VURPOSE OF SALE}
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� TO CONSTRUCT THE PR0.IECT(SEG 70a1,BUSINE55 AND PROFESSiONS CODE:THE CONTMCTOpS LI- V0111atf0O� ADJ.AREA�
W CENSEUWDOESNOTMVLYTOANOWNEROFA�ROPER7YWHOBUILDSORIMPROVES7HEREON,AND � �
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� O I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON J
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� UCENSED CONTRACTORS DECLARATION W
� 1 HEREBY AFFIIiM UNDER PENALTY OF PERIURY THAT IAMlICENSED UNDER PROVISIONS Of CVIAPTER � � -� -
d, D(COMMENCIMO WITH SECTION 7000)OF DIVISION 7 Of THE BUSINESS M1D PROFESSIONS CODE,AND Z �
X ►N IICENSE IS IN FULL FORCE AND EFFECT, m
� LICENSE CLASS LIC.NO.. j � , �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALiV OF PERIURV ONE Of THE FOLLAWING DECLAMTIONS: Z � � - � � �
� _IHAVEAND.WILLM/UNTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWOR!(ERS' _ �
COMPENSATION,AS PROVIDED BV SECTION 37000F THE UBOR CODE,FOR THE PERFORMANCE W
Q OF TIE WORK FOR NM111CFi TNIS PERMIT IS,ISSUED. � ' ' '
Qw _I HAVE AND WILL MAINTAIN WORKERB'COMPENSATION INSUMNCE,AS REOUIHED BY SECTION � - ./ -
3700 OF-THE UBOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS. � �` ��
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ISSUED.MY WORKERS'COMPENSATION INSURANCE GAHRIER�AND POIICV NUMBER ARE: CONSTRUCTION�� V
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� (INL4SECfqNNE�NOTBEWP.pLEfIDOFTiEPEMf(6PoRONEFRN�DfiED001.U35Kt00)ORLESS} PLUMBING . . . .
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE.WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
L} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
N WORKERS'CAMPENSATION lAWS Oi CAIIFORNIA,AND AGREE THA71F I SHOUCD BECOME INSPECTION FEE
? SU&IECT TO THE V10W(ERS COMVENSATIDN PROVISKKIS OF SECTION 77o00F THE LABOR -� � - , �
CODE,I SHALL FOHTHWI7H COMPLY WITH 7HOSE PROVISIONS. ISSUANCE
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J WARNINO:FAILURE TO SECURE WOHKERS'COMPENSATION COVEMGE IS UNLAWFUL,AND SHALL BE ���ENERGY P/C
� SUBJECTANEMPLOYER70CHIMINALPENAL7IESANOCMLFlNESUPTOONEHUNDREDTHOUSAND �� 'ENERGYPERMIT
DOLLARS(t100,000),IN MDI710N TOTHE COST OF COMPENSATION,DAMAGFS AS PROVIDED FOR IN -
� SECTION 37oe OF hIE LABOR CODE.�NTEREST,ANDATTORNEI"S FEES. � RETENTION FEE: � ' O
OCONSTRUCTION LENDINGAGENGY { PRE-ALT FEE:
� I HEREBY AFFIRM UNDER PENAI.TY OF PERIURY THAT THERE IS ACONSTRUCTION LENDINO AOENCY
FOR THE PERFORMANCE OF THE WORK FOR NTiICH THIS PERMIT IS ISSUED(SEC:30W,CIV.C.).
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� LENDEitS NAA/E
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w I CERTIfY THAT I HAVE READ 7HIS MPL�CATION AND STATE THAT THE ABOVE INFORMATION IS CORRECL TOTA L F E ES � f �' •
� I AGREE 70 CAMPIY N7TH ALL CI7V AND COUHTY ORDINANCES AND STATE UWS RELATING TO BUILDiN6 �
� CANS7RUCTION,AND HEREBV AUTViORIZE REPRESENTATNES OF THIS CWNTY TO ENTER UPON 7HE �
Z ABOVE-MEMqNED PROPERTY FOR INSPECTION 7 Es. COMMENTS "_
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� SIONATURE E DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplfqnYs Copy
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FTGS/FORMS/STEEL FHA REQMTS
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EIKTRIC GROUND �UNDER FLOOR DUCT _
GROU(�D PWMBING 'UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEANI
WATER SERVICE I MID HT.BOND BEAM __
ROOF SHEATHING � i ;8 FT.BOND BEAM
FRAMING/VENTILATION �FINAL BQND BEAM
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ROOF COVER ;���Z PRE-GRADING
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ROUGH HEATING �BENCHING
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ROUGH ELECTRIC i ROUGH GRADING
ROUGH PLUMBING �FINISN GRADING
SHOWER/TUB TEST I POOL ELECTRIC
EXT.LATHlSIDING ;POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION "OFF SITE IMPS.
ORYWALL NAILING /O��J,�-�_ ._ _ �DEDICATIONS
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SEWER 'FINAL ENG.
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SEEP PIT,�L.L 01 N SITE I�,�PS.
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FINAI.CONST. I FIRE DEPT.riNAL
FINAL HEATING � j HEALTH DEPT.FINAL
FINAL ELECTRIC '� �� • ' DEV.FEES.PAID
FINAL PLUMBING � � I ENERGY
FINAL PLANING I
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