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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
B" 21660 E. Copley Drive Scute 190
(909) 960-3195 Fax (909) 961-3117 PRESS
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BUILDINGP RMIT APPLI
ISSUETYPE OCC
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OWNE"UILDER DECLARATION
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I HERESY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF
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CENSELAW PORTHE FOLLOWING REASON (SEC. 7031 ABUSINESS AND PROFESSIONS CODE: ANY ODYOR
CDLPM WF41CH REOUSIEBAPLVA TTOOONSTRUCT. ALTER IMPROVE, DEMOt1SH.OR REPMRAW STRUC-
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TURE. PRIORlO ITSISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
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STATEMENT 7TIAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC79M IJ -
CENSE LAW ICHAPTER 9 ICOMMFUNCING WITHSECTION AOD) OF DIVISION 3 O THE BUSINESS AND PRO-
PESSIOHSCODE) OR THAT HE OR SHE IB EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
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TION.ANY VIOLATION OF SECTION 7031.8 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
AOM. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS-
-
O 1,ASOWMEROFTHE PROPERTY,ORMY EMPLOYEES WITHWAOES AS THORSOLE COMPENSATION,
WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BU31-
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"-. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF -
.PROPERTY INHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WOFlK HIMSELF OR HERSELF OR
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ITHROUGH WS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
_ OFFERED FOR SALE IF, NOWEYER,THE BUMINGORIMPROVEMENT 19SOLDWITHINONEYEAROFCOMPLE-
TION, THE OW NEPARA DER WILL HAVE T E BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE). -
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❑ LAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT ISEC. 7044, BUSINESS AND PROFESSIONS COCE: THE CONTRACTORS U-
-
- CENSE UW DOES NOT APPLY TO AN OWNER OF APROPERTY WHO BUMS OR IMPROVES THEREON, AND
WHOOOMTRAOTS FOR SUCH PROJECTS WITHACONTRACTONS) LICENSED PURSUANT TOTHE CONTRAO
Tari LICENSE LAW.).
❑ 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON
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OATS OWNER -
RETENTION FEE:
LICENSED CONTRACTORS DECLARATION
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(HERESY AFFRiM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
e (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESSANDPROFESSIONS CODE, AND
MY LICENSE Is. N FULL FORCE AND EFFECT.
TOTAL FEES (
to -06 4- a�2 4/1d
LICENSE -- LIC. No.
RECPT, NO. PAID BY VALIDATION
DATE - CONTRACTOR lor
WORKERS' COMPENSATION DEC N ^ _
IIfl:REBY AFFIRM UNDER PENALTY O'PERJURY ONE OF THE WING OECU r/`7i/vl�)
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$ems -I AND WILLMANTAN ACERTIFICATE OF CON NT TO mvF 4 SURE mom RS'
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PENISATION. AS PROVIDED BY SECTION 37011 F THE LABOR CODE, FOR THE PER�11KANCE
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TIE WORK FOR WHICH THIS PERMIT IS ISSUE -I
HAVE AND WILL MAINTAIN WORKERS'COMPENSATION WIREDBY3700
OF 71E LABOR CODE, WRTHE PERFORMANCE OF THE WORK FOR WHKN_T IB
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ISSUED. MYVpRILFA50OJPFJNSATION INSURAN,( CARg1ER AND POLICYNUMBERA
CARRIER .LLS Sti 1
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MC SECTION NEED NOT BECONFLOWOFTHE PEW 6FOR ONE HUNDRMDOLLARS (MDD)OR ES%
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I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR N PERMIT IS ISSUED.I
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SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOE ECT TOTHEN
WDRKERS'COMPENSATION LAWS DF CALIFORNMAN7OULD BECOME
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SUBJECT TO THE WORKERS' COMPENSATION PROVIS b DgD0 OF THE LABOR
COD 1 SHALL TN COMPLY P
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DATE: -APPLICANT:
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WARNING: FAILURE TO SECURE WORKERS? COMPENSATION COVEFIQ IS UNLAWFUL, AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
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DOLLARS 18100,00D� IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 77080E THE LABOftROOE: INTERESLANDATTORNEYSFEES.
- '-CONSTRUCTION LENDING AGENCY
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(HEREBY AFFIRM UNDER PENALTY OF PERJIRYTHATTHERE IS A CONSTRUCTION LENDING AGENCY
MR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097, CIV. C-).
LJJERDER'S NAME - - - - -
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I CERTIFY THAT i HAVE READ1H15 APPLICATION MID STATE THAT7HE ABOVE INFORMATION IS CORRECT
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I AGREE 70 COMPLY OATH ALt CfTY ANO COUNTY Offfi]INANCESANO STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HERESY RIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
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ABOVE-MENTIONED PROPE INSPECTKN PURPOSES.
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COMMENTS -- - -
RECPT, NO. PAID BY VALIDATION
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GROUND PLUMBING
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TEMP POWER i
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FIREPLACE BOND BEAM
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FRAMINGNENTILIATION I
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PRE-GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
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FINISH GRADING
SHOWER/TUB TEST 1
POOL ELECTRIC
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OFF SITE IMPS.
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FINAL CONST.
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FINAL PLUMBING I
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SEPTIC TANK SIZE
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