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CITY OF DIAMOND BAR EXPIRED
--� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
: �, Zi�oE.c�iey�;�es��i90 APR 25 2003
(909)86a3195 Fax(909)861-3117 PRE$$
�'^�' BUILDING PERMIT APPLICATION , FIRMLY`
� JOBSITE C � S , APPLICATION / PERMIT P/C
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� SSUE ' �-,� I TYPE ER # OCC
� APN LOT TRACT G VV
p OWNER l /�� r DATE CONST. GROUP
o ADDRESS � ZONING SETBACKS
� CITY, .d.✓U ZIP / TEL. a � REART RW ❑
APPLICANT . TEL. SIDE/SIQE STREET RW ❑
� CONTRACTOR SIDE ❑ _
� ADDRESS PROPOSED USE
CITY ZIP TEL �
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
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v� DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION'
p� OWNER-BUILDER DECLARATION SFR/ApD/REM �
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p I HEREBY AFFlRM UNDER VENALTY OF VERIURV TFIAT I AM EXEMP7 FROM THE CONTRACTORS L4 Gflf6 6/C8 fi
C1J CENSEUWFORTHEFOLLOWMOREASON�SEC.7031.6BUSWESSANDPROFESSqNSCODEM1VqTYOR (n B �
C7 COUNTYNRIICHREWWESAPERMRTOCONS7AUCT.ALTERIMPROVE.DEMOLISH.ORREPAIRANYSTAUG w
�Z 7URE,PRqR TO ITS 19SUANCE,IL90 REOUIRES TME APPLICMIT FOR SUCH VERMIT 70 FILE A SI6NED w PatiO/DBCI(
� STATEAIENT THAT HE OR SHE IS LICENSED PURSUMlT TO 7HE PROVISIONS OF THE CONTMCTORS LI- � �
� CENSE UW(pUPTER Y(COMMENCWO WITH SECTION 7000)OF DMSION 3 0F THE BUSINESS AND PR0- PoaUSpe
FESSIONS CODE)OR 7TUT HE OR SHE IS D(EMPT hiEREFROM AND 7HE BASIS FOR THEALLEOED E7�MP- (�
TION.ANV VIOlAT10N OF SECTIOH 7031.6 BV AHV MPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Rooi
�, ACML CENALT/OF NOT MORE h1AN FIVE HUNDRED DOLURS(iboo).):
� ❑I,ASONRIEROFTHEPROPEHTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATqN, � COffImBfCl81 �
W61 DO 7HE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,BUSI� J
N NE59 Alm PROFESSIONS CODE:THE COHTMCTOHS LIC£NSE UW DOES NOT APPLV TO AN OWNER OF �
PROPEAfY M?IO BULOS Ofi MPROVES THEREON,AND WHO DOE9 SUCH MIORK HIMSELF OR HERSELF OR '
2 iHROUGH HI9 OR HER OWN EMPLOYEES,PROVIDW THAT SUCM WPROVEAIENTS ARE NO7 WTENDFA OR m
0 ,OFFERmFORSALEIF,{qWEVEq7HEBUILDINOORIMPROVEMENTIS50LDWfTMNONEVEAROFCOMPLE-
Z 'T10H,iHE OWNE1i�UILDER WILL HAVE THE BURDEN OF PROVINO TMAT HE OR SHE DID NO7 BUItD OR
� IMPROVE FOR 7HE PURP0.SE OF SALE).
w ❑I,ASOYMEROFTHEPROPEHTI',AMD(CLUSIVELYCONTMCfWUWI7HUCENSEDCONTRACTOR3 .
Q TO CONSTRUCT THE PRO.IECT(SEC.)WI,BUSINESS AND PROFESSIONS CODE:THE OONTMCTORS L4 VelUB�IOf1 ADJ.AREA �
W CENSEIAWppESNOTAPPLYTOANOWNEROFAPROPERTVWFqBURD50RIMPROVE$TIEREOH,AND
� wHocorrtrucrswasucHraaEcrswm��oorrrw�croa�s�ucENseoauruu�wrroniEcorrrw�o pUANTITY DESCRIPTION
Y toas ucExsE uw.�. FEE .
0 ❑I MI D(EAIPT UNDER SEC. B.6 V.C.FOR THIS REASON �
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� DA7E OWNER ��- L� �� - U
� � W
.F6 LICENSED CONTRACTORS DECLARATION w
2 �
1 HEREBY AFFIRAI UNDER PENAITY OF PERJURV 7NAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMNENC4q WITN SECTION 7000)OF DMSION J OF THE BUSINESS AND PROFESSKKJS CODE,AND Z — '
MY LICENSE IS Pl FUl FORCE AND EFFEC7. m
� LJCENSE CIASS LIC.NQ � � j . .
V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
� 1 MEREBV AFFlRM UNDER PENALTV OF 7ERIURY ONE OF 7HE FOLLOWINO DECLARA71DN5: Z
� _I MAVE AND WILL MAINTAIN A CERfIFlCATE OF CONSENTTO SELFINSURE FOR NpRKERS' a � �
COMPENSATION,A9 PROVIDED BV SECTlON 370o OF iHE UBOR CODE.FOR THE PERFOFUTANCE U
Q OF THE WORK FOR YVHICH THIS PERMIT IS ISSUED. . • , _ � .
� _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BY SECTION '
Q 3700 UF iHE LABOR COOE,FOR THE PERWRMANCE OF hiE WORK FOR WHICH 7HI5 PERMIT IS
� �SSUm.IIY WiDRI(ERS'CONPENSA710N INSURANCE CARRIER AND POLICV NUMBER ARE CONSTRUCTION
> cuiPoER � � PLAN REVIEW
Z� ����ER ELECTRIC �
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0 (MSSECf10NNE�NOT6Eao1.PLEfmaF7/EPEfi.ffsFOaoMEtiUiJR�oaiuti(ftm>oqlES�. PLUMBING _ '
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Z I CERTIFY THAT M THE PERFORMANCE OF THE MfORK FOR WHICN 7HI5 PERMR IS ISSUED.I MECHANICAL
(� SHALL NOT EMPLOY ANV PERSON Pl ANY MANNER SO AS TO BECOME SU&IEC7 70 THE
(/) WORKERS COMPENSA7qN UWS OF C/�LIFOFWIA,AND AOREE THAT IF I SNOULD BECOME INSPECTION FEE
S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOH _
cooE,i sw�u wRn�rn coMP�r win�nasE raowsroNs. ISSUANCE
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p DATE: � APPLICANP. �SMIP n�T�TOOO
w ENERGY P/C ��� � y
� WARNINO:FAILURE TO SECURE WORKERS'COAIPENSA710N COVERAGE IS UNLAWFUL,AND SHALL BE
LL SU&IECf AN EMPLOYER TO CRIMINAL PENALTIES AND CML FWES UV TOONE MUNDRED h10USAND ENERGY PERMIT � F D'
DOlLARS(ilo0,o00),IN ADDITON TO THE COST OF COMPENSATION,DAAUOES AS PROVIDED FOR IN �*^.r�
J SECTqN 370L OF T1E IABOR CODE,INTEREST,AND ATTORNEVS FEES. � V t�+^�
Q RETENTION FEE: ���TNG�
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PEN�LTY OF PEiL1UFiV THAT THERE IS A CONSTRUCTION LENDWO AOENCY � ' . ' .
Z FOR THE PERFORAIANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3007,pV.C.�.
W . �
� LENDERSNAME � . , � .
� LENDER'S ADORESS
w I CEHTIFV iHAT I HAVE READ THIS MPIICATqN AND STATE THAT THE ABOVE INFORMA7qN IS CORRECT. TOTAL FE ES . , . , e
� I AOREE TO COMVLV VATH ALL CfTV AND COUNTV ORDINMICES AND STATE UWS REUTINO TO BUtlDINO . , . . .
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEMATNES OF THIS WUN7V TO ENTER UPON THE ' - . � � '
Z ABOVE� ED PROPER7Y FOq I�SqEC710N PURPOSES. ; .
o �G�� �,/ COMMENTS '
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m PEAMfTTEE NAME(PR1NT) . . - .. � ' .
Q
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N SqNATURE OF PE . E ' DATE RECPT.NO. PPJD BY � VAUDATION
� WHITE-0epertment Copy,YELLOW�inence Copy,PINK—Asaesaor Copy,GOLDENRO�FlIe Copy,GREEN—Applicant's Copy
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SET BACK . . FLOOR JOIST ,
FTGS/FORMS/STEEL � ' - FHA REQMTS
ELECTRIC GROUND ' � UNDER FLOOR DUCT
GRtJUND P�UMBWG UNDER FLOOR CUMDUIT
SLAB GRADE FIREPLACE FO.UNDATION �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
RQOF SHEATH(NG 8 FT. BOND BEAM
FRAMINGNENTILIATION ' - - FINAL BONQ BEAM
ROOF COVER PRE-GRADING
ROUGH HEATlNG BENCHIfVG -
ROUGH ELECTRIC FtOUGH GRADING
RC]UGH PLUNIBINC, FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. I.ATH/SIDING POOL FENCING '
WALL INSULATION POOL FINAL �
CEILING INSULATION QFF SITE IMPS.
DRYWALL NAILING DEDICATIUNS _
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. �
SEEP PiT/LL. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CUNST. FIRE DEPT. FINAL ��
FIIvAL NEATING HEALTH DEPT. FINAL •
FIPJAL ELECTRIC DEV. FEES PAID
�INAL PLUMBING ENERGY
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