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CITY OF DIAMOND BAR
--��`-- DEPARTMENT OF CONIMUMTI'&DEVELOPMENT SERVICES
21825 E.Copley Drive PRESS
"'- (909)860.3195 Fa�c(909)861-3117
"`:9�'� BUILDING PERMIT APPLICATION FIRMLY
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� I HEREBV AFFIRM UNDER PENAL7Y OF PERJUFV THAT I AM EXEMPT FROM THE CONTRACTORS LI� Gefe(J6/C8fP0�
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W TURE,PRIOR TO ITS ISSUANCE.�LSO FEOUIRES THE APPLICANT FOR SUCH PEF7MIT TO FILE A SIGNED W
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� CENSE LAW(CMAPTER Y(CAMMENCINO WITH SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � POOVSPe
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7I�EBASISFORTHEALLEOEDE%EMP�
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r A CIV�ENALTV OF NOT MORE TNAN FIVE HUNDRED DOLLARS(f5o0).):
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Z WIIL THE M�ORK.M1D THE STRUCNRE IS NOT INTENDED OF OFFERED FOR SALE(SEC.70�1,BU51� J
N NESS AND PROFESSIONS CODE'THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO Ml OWNER OF �
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Z TION,1HE ONMER�BUIIDER YALL HAVE 711E BURDEN OF PROVINO 7HAT ME OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
�1,AS OWNER OF TNE PROPERTY,AM ExCLUSNELY CANTRACTING WfTH UCENSED CONTRACTORS
� TO CONSTRUCT TME PRQIECT(SEC.70U,BUSINESS AND PROFESSIONS CODE:THE CANTAACTORS LI� VelUO�lOf1 ADJ.AREA
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� LICENSED CONTRACTORS DECLARATION �j S�(/I C
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� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ' / � / Q�/N U
� G(COMMENCINO WITH SECTION 7000)OF DIVISION J OF THE BUSINESS ANO PROFESSIONS CADE.AND Z L
X MY UCENSE IS IN FULL fOFiCE AND EFFECT. m
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� � WORKERS'COMPENSATION DECLARATION � �'A�
N I HEREBV AFFIRM UNDER PENALTY OF PER1l1RV ONE OF THE F-0LLOWING DECIARATIONS:
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� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' 2
� CAMPENSATION,AS PROVIDED BV SECTION 3�OOOF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WMICH THIS PEHM7T IS ISSUED. �
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w _I HAVE ANO WILL�1AIMAIN WOR)(EFlS'COMPENSATION INSURANCE,AS RE�UIflED BV SECTION
Q 3700 OF THE LABOR CODE,FOR TME PERFORMANCE OF THE WORN FOR WHIp1 THIS PERMIT IS
0 ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER ANO POLICY NUMBER ARE: CONSTRUCTION /a ��
� CAARIER PLAN REVIEW �v
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W MECHANICAL �I� O
Z I CEPTIFV TH�T IN THE PERFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED.I
(,�} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE ^
� WORI(ERS'COMPENSATIONLAWSOFCAIIFORNIANdDAGREETHATIFISHOULDBECAME INSPEC710NFEE Tr ��� ��)
� SU&IECT TO THE WORKERS'COMPENSATION PfiOVI510N50F SECTION 9�000F THE LABOR J�•��"( � �-"'�C'��" /OD.
� CODE,I SHALL FORTIiWIiH COMPLV WITH THOSE PROVISIONS. ISSUANCE
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� DATE: APPLICANT: . � .
J ENERGY P/C
J WAANING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNIAWFUL,AND SHALL BE I
�—y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANOCNIIFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT
DOLURS(f 10o.000I.IN ADDITION TO 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN . � A
J SECTION37D8OFTHELABORGODE,INTEREST,MIDATTORNEr'SFEES. RETENTIONFEE:
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w CONSTRUCTIOtJ LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRAI UNDEi7 PENALTY OF PERIURV THAT THERE�5 A CONSTRUCTION LENDINO AGENCY _
d FOR iNE PEFFORMANCE OF TNE WORK FOF WHICH THIS PERMIT IS ISSUED(SEC.JOB7,CIV.C.).
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� LENDER'S NN.if
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� I CERTIFY THAT I HAVE REAO THIS APPLICATION AND STATE TMAT THE ABOVE INFORMATKKJ IS CARRECT. TOTAL F E ES �Z • � ���
w I AOREE TO COMPL�WfTH ALL CITV AND COUN7Y ORDINANCES AND STATE LAN/5 RELATINO TO BUILDINO
� CONSTRUC110N,AND HEREBV AUT7-IORIZE REPRESENTATNES OF 7HIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PftOPERTY FOR INSPECTION PURPOSES. �
COMMENTS
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� WHITE--0epariment Copy,YELLOW—Fi�ance Copy.PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanPs Copy
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GROUND PLUMBING UNDER FLOOR CUt�1DUIT
SLAB GRNDE FIREPLACE FOUNDATION `
TEMP POWER ' FIftEPLACE BOND BEAM
W,4TER SERVICE MID HT. B�NQ B�AM
ROOF SHEATHItVG 8 FT. BONQ BEAM
FRAMINGNENT(UATION FINAL BOND BEAM i
ROOF COVER PRE-GRADING
ROUGH HE,4TING BENCHING
ROUGH ELECTRIC ROUGH GRAbING
R(�UGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELEGTRIC
EX7. LATH/SIDING P�OL FENCING
WALL IPVSULATIOIV PO�L FINAL
CEILIiVG IN�ULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAIVK LAtVDSCAPE/IRRIG.
SEEP PtT/LL. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAl.COf�ST. , FlRE DEPT. FWAL ��
FINAL HEATING HEAL7H DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINA�PLUMBING ENERGY
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