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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE ...
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OWNER-BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI.
CENSE LAW FORME FOLLOWING REASON (SEC. 7531.5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR
ODUNTYWHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER.IMPROVE. DEMOLISH,OR REPAIR ANY STRUC-
TURE. PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER e(COMMENCING WITH SECTlON Tow)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)ORTHAT HE OR SHE is EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
APPLICANT TO
7044,BUSI-
AN OWNER OF
(ION.ANY VIOLATION OF SECTION 7031,9 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE HERSELF OR
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).). INTENDED OR
CII,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, orCOMPLE-
WIU. DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. NOT BUILD OR
NESS AND PROFESSIONS coDE.:THE CONTRACTORS UcENSE LAW DOES NOT APPLY To CONTRACTORS
PROPERTY WHO BUILDS OR ImpROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR LI-
THEREON.AND
THE CONTRAC-
THIS REASON
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT
. OFFERED FoR SALE IF,HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHN oNE YEAR
lOK,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID
IMPROVE FOR THE PURPOSE OF sALEL
CI L As OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED
To CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES
%VW/CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO
TORS LICENSE LAW.).
0 I AM EXEMPT UNDER SEC. 8 .4 P.0 FOR
ATE OWNER
LICENSED CONTRACTORS DECLARATION
, I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
, B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
; MY LICENSE IS IN FULL FORCE AND EFFECT.
i
',. LICENSE CLASS6 LIC. N0, (49 4 1 0 t-
., DATE ((7 2..1 ot CONTRACTOR (1.A, DA SriQ ki
, -- i PERFORMANCE
WORKERS'COMPENSATION DECLARATION BY SECTION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS THIS PERMIT IS
I HAVE AND WILL MAINTAIN A CERNRCATE OF CONSENT TO SELF-INSURE FOR WORKERS' ARE
COMPENSATION,AS PROVIDED BY SECTlON swo OF THE LABOR CODE, FOR THE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
J I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED
C 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH
ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER
CARRIER
- tL6 t7t1
POUCY NUMBER 7a4 Irl7
(MO)OR LESS)-
ISSUED. i
gIeSSC-CTKINNEED NOT SECCUpLEIED OFTHEPERAT IS FOR oNEHLAIXIIEDOCUARS TO THE
) BECOME
J THE LABOR
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT is
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT
) WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD
- SUBJECT To THE WORKERS COMPENSATION PROVISION OF SECTION 3700 OF
COD,I SHALL FORTHWITH COMPLY WITH THOSE PR IONS,
7 -..,
DATE: ( ) APPLICANT. t
3 WARNING FAILURE TO SECURE WORKERS'COMPENsAN N -Kid YSINLAWFUL,AND SHALL BE
L. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIA I SLIP TO ONE HUNDRED THOUSAND
- DOLLARS(0100,000),IN ADDITION TO THE COST OF COmPENSAT1oN, DAMAGES AS PROVIDED FOR IN
sEcnoN 3700 oF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES
U
L CONSTRUCTlON LENDING AGENCY
)
C !HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
k- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CiV C.).
p,.
Li
E LENDER'S NAME,
LENDER'S ADDRESS
9
r I CERTIFY THAT I HAVE READ THIS APPIJCATION AND STATE THAT THE ABOVE INFORMATION IS CONNECT
u
,... I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
,.., CONSTRUCT/ON AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
•-•- ABOVE MENTIONED PROPERTY FOR INSPECT/ON PURPOSES.
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ihst. A
7:1 PEFBAITTEE NAME(PRINT)
•:C i.
:0 SIGNATURE OF PERMITTEE DATE
PRESS FIRMLY
APPLICATI06 ••^ •
DATE fi 6
111 PERMIT j..---._. P/C
i,
NUMBER
ISSUE
DATE
. D A TYPE
� .-I. ONST.
GROUP
OCC
FRONT
ZONING REAR
SIDE/SIDE SETBACKS
SIDE • RW 0
' D
STREEf RW 0
CI
PROPOSED
N0. DWEL. USE (146-4; rAmar
UNITS
N0. N0.
I STORIES 7-- BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION
? i
SFR/ADD/REM '',f 1 IainaRaffita
lowitimorm
u) Garage/Carport ,
ill Ratio/Deck r .i'---
LL Pool/Spa
0
z
i�
-J Re-Roof
D
m
Commercial E
I I
OA 0 W
Valuation * ADJ.AREA
QUANTITY DESCRIPTION FEE
I
<
0
Fr
I-
0
tu
-J
IL
CD
Z
2
D
_I •,1
a
..)
.5
. i . .
I
I
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE q IZL\. D.
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE6geti3,
3 5 411"---7 C—?-.---g:Cr--
C 00- 1:11)
����p
c.. -lA.)
c C1.0'9C)--
4ix,21115'
131
Pt-e-314 6'..?
VC--
TOTAL FEES ..6: Li/05 6 ti LI 91 1 (7-
COMMENTS f z
VAUDATION *-7..til_,..
FIECPT. N0. PAID BY./401.0
WHITE-Department Copy,YELLOW-Finance Copy, ssessorCopy. op].T5NEEN-Applicanrs Copy,
CITY OF DIAMOND BAR INSPECVON RECORD
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I: "f: e„�•�..
.11
• • • a
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r-L.,....._,N„Jup., 1 ..;
.../,..
"GS/FORMS/STEEL • FHA REQMTS, -
ECTRIC GROUND UNDER FLOOR DU•CT
ROUND PLUMBING UNDER FLOOR CONDUIT,'
-AB GRADE (641-43( 21::3""'*.-- FIREPLACE FOUNDATION ;" - ;:.
,:i
FIREPLACE BOND BEAM
EMP POWER
�15-'02—. MID HT. BOND BEAW; -: ', '. ' t 0 7 ,
fII
ATER SERVICE ' ,fg. - SP-IYO' I 8 FT. BOND BEAM
s,',, lii „ ,. •
ANAL BOND BEAM
OOF SHEATHING •
RAMINGNENTILIAT N . ? -..-..-...
OOF COVER PRE GRADING
OUGH HEATING 41 Aggib BENCHING
OUGH ELECTRIC I-OUGH GRADING
OUGH PLUMBING FINISH GRADING
HOWEFI/TUB TEST ' liff7 AM, POOL ELECTRIC
r
XT. LATH/SIDING POOL FENCING .
c/ALL INSULATION
POOL FINAL
EILNG INSULATION . OFF SITE IMPS.
-tt.-01. ref
)RYWALL NAILING DEDICATIONS
1 FINAL ENG.
EWER
iEPTIO TANK LANDSCAPE/IRRIG.
;t-ip PIT/L.L. I ON SITE IMPS.
rett FINAL ZONING
'AS AIR TEST .. . oc-
'NAL CONST. I FIRE DEPT. FINAL
:NAL HEATING ..---.) HEALTH DEPT. FINAL
:NAL ELECTRIC 0 -- lila DEV. FEES PAID
:INAL PLUMBING ENERGY ..
�
g,,,,,/,,. ..
a.OMMEr\ITS -.-- .....
rib*a og, % estAt /306/e, . . j MIMI' '
/-2-Ot oic To 6A-ck r li err 1(..w 4 A=O:I
O1C,0 ,A 4.4,..,_ -02/41M'Or
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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