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CITY OF DIAMOND BAbt �^P�RED
--��� DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES
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(909)860-3195 Faz(909)861-3117
���m" BUII.DING PERMTl';aIPPLICATION FIR LY
� JOBSITE APPLICATION � PERMIT
� ADDRESS ��� DE���LL R� DATE � NUMBER #/C
� ISSUE TYPE OCC
� APN LOT TRACT DATE - CONST. GROUP
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� DESIGNER NO.DWEL. NO. NO.
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�n _ DESCRIPTION SQ.Ff: FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLAfiATION .
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� TURE,PRIOR TO ITS ISSUMIC�AL50 REW IRES THE APPIICANT FOR SUCH PERMR TO FILE A SIONED w
! S7ATEMENT THAT HE OR 9ME IS UCENSED PUHSUANT TO THE PROVISIONS OF 7HE CONTMC70RS U� �
CENSE UW(CiIAPTER 0(COMMENqNO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND Pq0. PooUSpa
¢ FESSIONS CODE)OR 7HA7 HE OR SHE IS EXEMPT 7HEREFROM AND THE BASIS FOfI7HE ALLEOEO EXEMP- C7
�� TION.ANYVIOLATIONOFSECTION7031.6BVANYAPPLICA!lTFOHAPERMITSU&IECTSTHEMPLICANTTO Z Re-Roaf
� A GVIL VENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5a0).):
O ❑4�OM7�EROFTHEPROPERTY,ORMVEMPLOYEESWI7HWAOESASTHEIRSOLECOMPENSA7pN, 0 COfTm6fCl8� � � '
Z MALL 00 THE WORK M1D THE STRUC7URE IS NOT I/fTENOED OR OFFERED FOR S�LE(SEC.7oa�,BU54 J
N NESS AHD PROFESSIONS CODE TME CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPEHfY V/Fq BUILDS OR IMPROVES i7/EREON,M1D WHO DOES SUp/WORN HIMSELF OR HERSELF OR
� THROUl3M HI9 OR HER OWH EMPLOVEES,PROVIDED THAT SUG/IMPROVEMENTS ARE NOT INTENDED OR m
OFFERED FOR SALE IF,HOWEVER 1ME BUIIDW OOR IMPROVEAIBfT 19"M.1 WfTW N ONE VEAR OF COMPI.E-
Z 'TION,THE OWNER-BUILDER WILL HAVE TME BURDEN OF PROVPIO THAT HE OR SHE DID NOT BUILD OR
� WPROVE FOR 7NE PURPOSE OF SALEI.
w ❑I,ASOWNEHOF7HEPROPEHf'/,AMD(CLUSIVELVCONTMCTPIOWITHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.)04/,BUSINESS AND PqOFESSIONS CODE THE CONTRACTORS U- VBIUBfIOf1 ADJ.AREA
CEHSE UW DOES NOTAPPLY TOAN OMMER OFA PROPERTY WFq BUILDS OR IMPROVES 7HEREON,AND
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LICENSED CONTRACTORS DECLARATION -�
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1 HEREBVAFFIqM UNDEH PENAL7Y OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CViAPTER �
� Y(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OG THE BUSINESS AND PROFESSIONS CODE,AND Z � -
MY LICENSE IS IN FULL FOFCE AND EFFEC7. m
� LICENSE CLASS LIC.NO. j
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� WOFKERS'COMPENSATION DECIAAATION Q .
� 1 HEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF 7HE FOLLOWINO DECLApA710NS: Z �
� _I NAVE AND WILL MAINTAIN A CERfIFlCATE OF CONSENT TO SELF-INSURE FOR WOqI(ERS' a
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Q COMPENSATION,AS PROVIDED BV SECTION J700 OF T1E LABOR CODE,FOR TME PERFORMMICE U
Q OF THE WORK fOR N711CH THIS PERMIT IS ISSUED. �
� _I HAVE AND YYILL MAfNiAM W WMER5 CAMPENSATION INSURANCE,AS REWIRED BV SECTION - - ' ' ^ •
Q 970o OF THE UBOR CODE,FOR THE PERFORMANCE OF 1HE WORK FOR WHICN THIS PERMR IS
� ISSUED.MY WORKERS'COMPEHSATqN INSURANCE CARHIER AND PO�ICV NUMBER ARE: CONS RUCTI�A R '
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Z I CEHTIFY 7}UT W h1E PERFORMANCE OF THE WORK FOR WHIC}i THIS PERMR IS ISSUED,I MECHANICAL
SMALL NOT EMPLOY ANV PERSON W ANY MAtJNER SOAS TO BECOME SU&1ECT TO THE
(n WORKERS'COMPENSATION UWS OF GLIFORNIA,AN�AOREE TMAT IF I SHOULA BECOME INSPECTION FEE
SUBJECT TO THE WORKERS'COAI7ENSATqN PROVISIONS OF SECTqN��OOOF THE IABOH
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p DATE: � APRICANT: �SMIP
w ENERGY P/C �
� WMNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,MID SMALL BE
�y SUBJECT M!EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLAHS(i100.000�.W ADDITION TO THE COST OF COMPENSATpN,DMIAGES AS PROVIDED FOR IN
J SECTION 370!OF THE UBOR COOE,INTEREST,AND ATTOANEY'S FEES. � '
p� RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER VENALTV OF PERIUHV THAT THERE IS A CONSTRUCTION LENDINO AOENCY - � .
Z FOR THE PERFORMANCE OF THE WORK FOR WHICH TMIS PERMR IS ISSUED(SEC.�OW,CIV.C.�. .
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� IENDER'S NAME � . � � �
� LENDER'SADDRESS
W t CERTIFV THA7 I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOHIAATION IS CORRECi TOTAL FE ES � ' ��'
� 1 AOREE TO COMPLV VJITH ALL CfTV M1D COUNTV ORDINANCES AND STATE UWS RELATINO TO BU0.DINO ��•-
� CONSTRUC710N,AND MEREBv AUTFIOR2E REPRESENTATNES OF 7H1S COUN7Y TO ENTER UPON iHE � � � . ,
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PUPPOSES. _ .
COMMENTS '
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� RECPT.NO. PAID BY � VALIDATION
I WHITE—Department Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—ApplicanYs Copy
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ELECTRIC GROUND . ' , ;�.� UNDER FLOOR DUCT
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GROUND PLUMBING UNDER FLOOR CUMDUIT .� -� • , ,.. . . ,: -. , ,,
SLAB GRADE FIREPL`�GE F t,l TION . ., ;;`� :: •._; �-.,�, ;•',.+.
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
RDOF SHEATHlN�-, ;',,� ;��.' ,,-' `��;,�1`�'+ . '•:� 8 FT. BOND BEAM
FRAMINGNENTfL{ATiON FINAL 80ND BEAM
ROOF COVFR PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
RQUGH F'LUMB�NG FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING '
WALL IIdSULATION POOL FINAI.
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. � � �
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PtT/L.L ON SITE lMPS.
GAS AIR TEST FINAL ZONING �
FlPJAL C�?NST. FiRE DEPT. FINAL
FlNAL HEATING FiEALTH'DEPj. FINf� ;:. ������:�
FINAL ELEC7RIC DEV. FEES PAID � '�-` "
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