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_��_ CITY OF DIAMOND BAR _ /
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ;�' ) ��
21810 Copley Drive,Diamond Bar,CA 91765 -��
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS
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v� DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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p , I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM EXEMPT FROM 7HE CONTRACTORS LI- GHfBCJB/CelpOA.
W CENSEUWFORTHEFOLLOWINOREASON(SECJ031.SBUSINESSANDPROFESSIONSCOOE:ANYCITYOR � (n
V COUNfYNMICHREOU�flESAPERMITTOCONSTAUCT,ALTEP,IMPROVE,OEMOLISH,ORREPAIRANYSTRUG
w TURE,PRIOR TO'RS ISSUANCE,ALSO REWIRES THE APPLiCANT FOR SUCH PERMIT TO FILE A SIONED W PatidDeck
� STATEMEHT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE CONTMCTORS ll- LL � ..
� LENSE UW(CHAPTER B(COMMENCINO VATH SECTION 70D0)OF DIVISION 3 OF THE BUSINESS ANO PRO- POOVSPe
, 0 FESSIONSCOD�OqTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� ,
V TION.ANVVIOUTIONOFSECTION7o37.5BYANVAPVLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO . Z Re-Roof
ACML 7ENALTY OF NOT MORE THANFIVE HUNOAED DOLUIRS(iSOD).):
0 ❑I,ASOWNEROFhiEPROPERTY,ORMYEMPLOVEESWIiH1NAGESASTHEIRSOLECOMPENSATION, � 0 COffIRlBfClal �
Z N7LL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SECJo4l,BUSb �J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE L4W DOES NOT APPLY 70 AN OWNEfl OF � -�
PROPEHfY NM1iO BU�LOS OR IMPROVES THEREON,AND VAfO OOES SUCH WORK HIMSELF OR HERSELF OR�
Q THROUGHHISOFHEROWNEMGIOYEES,PROVIDEDhiATSUpiIMPROVEMEHTSAHENOTIMENDEDOR m
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Z T�ON.7ME OWNER$UIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BURD OR .
� IMPROVE FOR 7HE PURP0.SE OF SALE). ' �
w ❑I.ASONMEROFTHEPROPERfV,AMEXq.USNELYCONTMCTINOWITHLICENSEDCONTMCTORS
� TO CONSTRUCT THE PpOJECT(SEC.7oN,BU5INESS AND PROFESSIONS CODE:THE CONTPACTORS ll- V81U9fI0f1 A0.1.AREA. '
W CENSELAWDOESNOTAPVLYTOANOWNEROFAVROPERTYWHOBUILDSORIMPROVESTHEREON,AND � �
� WHOCONTMCTSFORSUCHPR0.1ECfSWITHACOMRACTOfi(S)LICENSEDPURSUAHiTOTHECONTRAG pUANTITY DESCRIPTION FEE .
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� O I AM E%EMPT UNDER SEC. B.8 F.C.FOR THIS REASON Q
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DATE OWNER F
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UCENSED CONTRACTORS DECLARATION -�
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I HEREBY AFFIRM UNDER PENALTY OF PERIURY 7HAT IAMlICENSED UNDER PROVISIONS OF CHAPTER Ur R�II./�{ G�. (���s tr Li.(t--
� 9(COMMENCINO WITH SECTION 7000)Of DIVISION�OF THE BUSINESS AND PROFESSIONS CODE,AND Z.
IAY LICENSE IS W FULL FORCE AND EFFECT. ` �
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V DATE - Z �-�7. CONTRACTOR �/�I�-l\J.�Je-v"`-�'� d . ..
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� WORKERS'COMPENSATION DECIARATION Q
� I HEREBV AFFlRM UNDER VENALTV OF PERJUM ONE Oi THE FOLLOWING DEQARA710N5: Z � �
� �1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSEPR TO SELF•INSURE FOR WORI(ERS' _
COMPENSATION,AS PROVIDED BY SECTION 37000F 7HE LABOR CODE,FOR THE PERPDRMANCE W�
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � � �
Qw _1 HAVEAND WIIL MNINTAM�WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION
370D OF THE LABOR CODE,FOR THE PERFORMANCEDF THE WOHK FOR WHltll THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARqIER AND POLICY NUMBER ARE: CONSTRUCTION��
j CARRIER ��6�'�C`�`ti'`� PLAN REVIEW
0 POUCY NUMBER �Z7,lnl�.�� ' _ . ELECTRIC
0 (fH65ECiX7NNEIDNOTBE00APLEfIDOFiHEP£RMf15FOqONE11l.rDFiED00UAR5(510010R1.ES5} PLUMBING � . . . _ � -
Z 1 CERTIFV.THAT IN THE PERFORMANCE OF 7HE WORN FOR WHICii iHIS PERMIT IS ISSUE0,1 MECHANICAL �
C7 SHALL NO7 EM7LOY ANV VERSON IN ANY MANNER 50 AS TO BECOME SU&IEC7 70 THE� �
� WORKERS'CAMPENSATION LAWS OF CKIFORN11 AND AGREE 7HAT IF I SHOU�D BECOME INSPECTION FEE
� SUBIECTTOTHEWOHKERS'COMPENSA710NPROVISIONSOFSECTION77o00FTHEUBDfi ' - � , �
� cADE,I HALL FOi�HWITH COMPLY 5 � vI510N5. ISSUANCE . i
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p DATE: � % _APPLICA � �SMIP
J WARNINQ:FAILUHETOSECUREWOR)(ERS'COMPENSA710NCOVERAGEISUNLAWFUL,ANDSWLLLBE ENERGYP/C
� SU&IECT AN EMPIOYER TO CRIMINAL VENAL7IES AND CML FINES UP TOONE HUNORED TNOUSAND ENERGY PERMIT
DOLURS(5100.0oo),�IN ADDITION TOTHE COST OF COMPENSATION,DMIAGES AS PHOVIDED FOR IN
J SECTION 370E OF hIE LABOR CODE.IN7ERE5T,AND ATfORNE1"5 FEES. � .�
oC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDINO AOENCV
�FOR THE PERFORMANCE OF�THE WORK iOR WHIC/1 THIS VERMIT IS ISSUED(SEC:7oa7,GV.G),
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�, LENDER'SNAME
F— IENDER'SADORESS
w 'ICERTIFYTHATIHAVEREADTHISA7PUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ��,�
� I AGREE TO COMPIY VATH ALL CITV AND CAUN7Y ORDINANCESAND STATE UWS REUTWO TO BUILDINO
� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THiS COUN7Y TO ENTER UPON 1HE '
Z ABOVE-MEHTbNED PROPERTY FOR INSPECTION PUR70SES.
0 A ,I�I / .�,C C,, A�- 1 COMMENTS '
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= RECPT.NO. PAID BY WLLIDATIONi
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pa py, Copy,PINK=Assessor Capy,GOLDENROD--File Copy,GREEN—Applirant's Copy
CITY 4F DId�M�ND B�4R
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SET BACK I FLOORJOIST
FTGS/FORMSISTEEL --- -- ---- --_--- �FHA REQfviTS ---- -----------_---_--- ---------_---
ELECTRIC GROUND �UND[R FLOOR DUCT
GROUNO PWMBING UNDER FLOOR CONQUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP PObVER 'FIREPLACE BOND BEARn
WATER SERVICE I MID HT.BOND BEAM
ROOF SHEATHING j 8 FT.BOND BEAM
FRAMING/VENTILATION j FINAL BOND BEAM
-------._.._..-------.._.__..-----------------------..----------...----._._._.- ;--------------._.__.._..____._._.._____._..------- ..._._.._____..----------------------
ROOF COVER ----— ;PRE-GRADING ---------- -----__ - --
ROUGH HEATING j BENCHING _ ____
ROUGH ELECTRIC ;ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SI-IOWER�TUB TEST �POOL ELECTRIC.
EXf.LATH/SIDING PO�L FENCING
WALL INSULATIQN POOL FINAL
CEILING INSULATION j OFF SITE IMPS.
DRYWALL NAILING i DEDICATIONS
------- ------ --------- ---- -__.------- ._ __-------- _______. ._. F.._
------ -- ._...- -----_ _._...___ ._.___.__ .._._._._ __._._.._ ..._..___ ...__.._
SEWER i FINAL ENG.
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SEPTICTANK LANDSCAPE/IRRIG.
-- --------- �— -------------------- -----------_..--------
SEEP PIT/L.L. �ON SITE IMPS.
GAS AIR TEST �FINAL ZONING
FINAL CONST. �FIRE DEPT.FINAL
FINAL HEATING �HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING I ENERGY
FINAL PLANING I _ __ ______
FINAL ENGINEERING • • A o
COMMENTS � E�� — ------------- --
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