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C1TY OF DIAMOND BAR
^----���--- DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 PRESS
��'%»��" BUILDING PERMIT APPLICATION FIRMLY
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o ADDRESS 11 6�'i ZONING SETBACKS
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� I HEREBV AFFIRM UNDER PEWLLTV OF PERIURV THAT 1 MI E%EMPT FROM THE CONTRACTORS LI- G8(8JB/C9fpOR
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w NRE,VR10R TO RS ISSUANCE.AL50 RE�UIflES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT hiAT HE OR SHE IS LICENSED PUFSUMIT TO THE PROVISIONS OF hIE CONTMCTORS LI�
CENSE UW(CHAPTER B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � PooUSpa
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V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPUCANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CML PENALTV OF NOT MORE THMI FIVE HUNDRED DOLLAAS(f500).�:
� OI,ASOWNEROFTHEPROPERTY,ORMVEMPIOVEESWITHWAC,ESASTHE1R50LECAMPENSATbN, � COR1RIBfCIaI
Z WILL�O THE WORK,AND iHE S7RUCNRE IS NO7 IMENDED OR OFFERED FOfl SALE(SEC.70�a,BUSI- J �
N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WFIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH UAPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERTNEBUILDINOORIMPROVEMENTISSOLDWITHINONEYE/�ROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SNE DID NOT BUIID OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCOMRACTIN�WITHLICENSEDCONTRACTORS
� TO CANSTRUCT THE PROJECT(SEC.7oN,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8�lOf1 ADJ.AREA
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QO I AM EXEMPT UNDER SEC. B.8 P.C.F-0R THIS REASON Q
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PFOVISIONS OF CHAPTER �
� o(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CADE,AND Z
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V DATE CONTRACTOR M 1�-O�YS' IA ��� a
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� WORKEFS'COMPENSATION DECLARATION Q
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N I HEREBY AFFIRM UNDER PEN�LTV OF PERIURV ONE OF THE FOLLOWING DECLAAATqNS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
COMPENSATION,AS PROVIDED BV SECTION J�00 OF TME LABOR COOE.FOR THE PERFORMANCE U
Q OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED. �
Qw _�G I HAVE M!D WILL MAINTAIN WOR)(ERS'COMPENSATION INSURANCE,AS RE�UIRED 8V SECTION �O
3700 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HI5 PERMIT IS ^
� ISSUED.MY WOFiKE(i5'COMPENSATI�INSURFACE Gf_RRIER D POLICV NUMBERARE: CONSTRUCTION pr
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� (iHLSSECTIONN�NOT8E001.�LEfmOFhEPERA4iISFOqONEViIN�DFEDDq1/�A5(t�oo�OqLESS} PLUMBING
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Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOH WHICH THIS PE ISSUED,I MECHANICAL
CJ SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU E TO THE
. (/� WORKERS'CAMPENSATIONLAWSOFCALIFOR ANDAGREETHATIF H LDBECOME INSPECTIONFEE /�
= SUBJECT TO THE WORKERS'CAMPENSATION OVIS S OF SE T 3� OF THE UBOR
CODE,I SHALL FORTHWITH COMPLV W SE I ISSUANCE �
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� p �ATE:� APPLICANT: SMIP 1
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J WARNIN�:FAIIURE TO SECURE MIORKERS'COM ENSATION CAVER E IS UNUWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTAN EMPLOYER TO CRIMINAL PENlLLTIES AND CML FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(f100.000).W ApDIT10N TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN M
J SECTION 37oe OF THE LABOR CODE.INTEREST,AND ATTOfUIEV'S FEES. �W
w RETENTION FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AOENCV
FORTHE PERFqRMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�.
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� LENDER'S NAME
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� w A/
w ICERTIFVTHATIHAVEFEADiHISAPPLICATIONANDSTATETHATTHEABOVEINFORMAT10NI5CqRRECT. TOTAL FEES ��//_ , 7d
� I AOREE TO COMPLV WITH ALL qTY AND COUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDINO ^\Q
� CONSTRl1CTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z ABOVE-MEMIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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� SI RE OF PERMITT DATE �
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK FLOQR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION �
TEPdIP POWER FIREPLACE BONQ BEAM
WATER SERVICE MID HT. B�ND BEAM �
ROOF SHEATHIPIG 8 F?. BOND BEAM V i
FRAMfNGNENTILIATION F►NAL BUND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING B�NCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUIVIBItVG FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATHlSIDING � POOL FENCING
WAL�IMSULATION POOL FINAL
CEILING IN�ULATIaN QFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEW�R FINAL ENG. �
SEPTIC TANK . LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE iMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. F!RE DEPT. FINAL
FINAL HEATING HEALTH DEPT. F1NAL
FINAL ELECTRIC DEV. FEES PAlD
FINAL PLUMBING ENERGY
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SEPTIC TAfVK SIZE
SEEP PIT/U SIZE
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