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CITY OF DIAMOND BAR '
DEPARTMENT OF.COMMUNITY & DEVELOPMENT SERVICES
c
21660E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117.
BUILDING PERMIT APPLICATION
JOBSITE
A DRESS IISLS`/�JII1o,J(�_(jAR �Ln Sv1TF
PN LOT TRACT
OWNER
ADDRESS
CITY DI/}MpNL�(J 136Q ZlPg�, TE
PPLICANT TEL
CONTRACTOR E L E G • s.
ADDRESS .A N E Q/ O RI7
crry r-rau A c -AM ZIP 9/7� 2TEI(�z� 33/ 3539
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
- 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LH
CENSE UW FORTHE FOLLOWNG REASON (SEC. 7671 A BUSINESS AND PROFESSIONS CODE ANYCRYOR
COUNTY WHICH REOUIRESAPERMITTO CONSTRUCT.ALTER IMPROVE, DEMOUSKOR REPAIRANY STRUG
TURF, PRIOR TO ITS ISSUANCE, ALSO REOUWES THE APPLICANT FOR SUCH PERMIT TO FILE SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE UW (CHAPTER 6 ICOMMENC NO WITH SECTION TWO) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEM PT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.AN7 VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW":
O L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION
WILL K, AND ,
LL DO THE WORD THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7644, SUSI-
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFFERED FOR SALE. F. HDWEW F47HE SU .DNGOIt IMPROVEMENT IS SOLD WrrHN ONEYEAR OFCOMPLE-
' TION, THE CWNCR-0UILDER WALL HAVE THE BURDEN OF PROVNG THAT HE OR SHE DIO NOT BUILD OR
IMPROVE FORTH: PURPOSE OF SALE}
0 LAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CO TRACTNO WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CDC E: THE CONTRACTORS U.
CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITIACONTRACTOR(S( LICENSED PURSUANT TO THE CONTRAr-
RS
TOLICENSE LAW.).
01AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFOW ANDER PENALTY OF PERJURY THAT I AM LICENSED LENDER PROVISIONS OF CHAPTER
P (COLILIENCWG WI1NSECTION 76661 Of DIVISION SOF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT /yam
LJCENSECLASS aC-02-O UC.NO.
DATE 02 -�p • ��/ CONTRACTOR
/O//���n�h�
VRKERS' COMPENSATION DE�lARG7((V
..'
1 HEREBY AFFIRMUNDER PENALTY OFPERPERJURYONE OF THE FOLLOWING DECLARA1ION52-2Ni
I HAVE AND WILL MAINTAIN A CERTIFNCATE OF CONSENT TO SELF-NSURE FOR WORKERS'
COMPENSATION, AS PROVIOCD BY 5ECTION3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THC WORK FOR WHICH THIS PERMIT IS ISSUED,
1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS PEOUIRED BY SECTION
3700 OF THE LABOR COOL FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
M0SECTION NEED NOT BECDM. LrTEDOFTHEPERMITSFORCNEHNDREDOCL1/RS(SI0»ORLESS1
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER $O AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA NO AGREE THAT F I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPCNSATKNP ISKNS OF SECTIDNO THE BOR
CODE. I SHALL FORTHWITH COMPLY WITH ROV1 IONS.
DATE: S 3 9� APPLICANT. y �y
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAW S BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED T
DOLLARS (i 100,060), N ADDITION TOTHE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3703 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007• CIV O).
LENDERS NAME
LENDERS ADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
I
PERMITTE WE
' 9
7 S.GNjUy_CV6RAn9E DATE
EXPIRED
MAR 2 0 2002 PRESS
.FIRMLY
APPLICATION
PERM RI
P/C
DATE
NUMBS
tt
ISSUE
TYPE
. OCC
DATE
CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
❑
SIDE/SIDESTREET
RW
❑
SIDE
❑
PROPOSED USE MAI A)
i4gab N tr�ST
S�S7~FiYj
"D h76<Z
ILP%
NO. DWEL. NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF
ADJ. AREANALUATION
SFFVADDIREM
0
Garage/Carport
WPatio/Deck
UL
PO0vSpa
Z
Re -Roof
OJ
Commercial
m
Valuation
ADJ.AREA
QUANTITY j,9sqiPnw
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FEE
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CONSTRUGd
LAN REVIEW
ELECTRIC
PLUMBIN
ftfi' k
INSPECTION FEE
ISSUANCE
SMTP 'UT),
, A .:
ENERGY P/C ILi)rnir
�, t,TT1 :` • T-Y-ry
t
.
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES''
COMMENTS
RECPT. NO. - PAID BY -
I VALIDATION
WHI mBn[ Copy, YELLOW—Finance Copy. PINK—Assessor Copy. GOLDENHOD—File CA". GREEN—AppliCanr6 GOpy
• ,. .,.. . _,:,
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CITY OF DIAMOND,BAR
,;
03FIRX
.: r:.IRISPECTION'RECORD ,', 1. .
SET BACK Ti_:.
FLOOR.IOIST . -
IFTGS/FORMS/STEEL' - - _ .;_,
-
FHA REQMTS: -_ .:J _.. - ._-- .- .. - --•_. _-- _
ELECTRIC'GROUND----
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CUh's(1UIT, -
:SLAB GRAD E- __ __ ., . --- -- ---- - - -
FIREPL'ACEF N ATIPN �, :'- c fl Gt�'•.fa:•, '
R �-
'
---
TEMP POWER - --, _ - - -
-_•-:; :.
FIREPLACE -BOND BEAM - -
WATER SERVICE _ _.. _ __ _ --
- .- --
MID HT, B6ND'BEAh' V,' r, _,ti
I YO0IF, :S'HEATH iNG' '� `.i ,fir- �` ,\,
_;� �� ,, '.��r. c-.
-8FT. BO b' E -
(FRAMING./VLNTfL1 TIO0 t� .:, • :.r
:1'.�'. �; 1:�
FINAL BOND BEAM
( ROOF COVER
PRE -GRADING ... _.. — --
ROUGH HEATING" --
: - .... _ . _.
BENCHING
!ROUGH ELECTRIC.— _ __ :�r`>' .
;. - '; !_' :
ROUGH GRADING
ROUGH PLUMBING--;----
-FINISH GRADING �
SHOWER/TUBTEST
POOL!ELECTRIC
!.EXT.
LATH/SIDING
POOL'FENCING
WALL- INSULATION -
POOL FINAL
CEILING-IN'SULATION'-1-_-._- _...
_ __ _ .______ ..___ -- -
OFF SITE,IMPS.
I
DRl'tiVALC NAILING-- - _
- - -
DEDICATIONS
SEWER
FINAL ENG.
SEPT lCTANK
�.�
LANDSCAPE/IRRIG.
i- SEER P!T/L.L.- - .
-, -
ONSITE IMPS.
t A� AIR TEST L 1 _
FINAL ZON NG
FIRE DEPT. FINAL
# li`•' (EATING `_ - ��'> �_.:\i .`, �.".': i�\' 4 .- \
HEALTH DEPT. FINAL -
�>
r .'. 1- - -
,.
DEV. FEES PAID ._ .
:.. PLUMBING - - -
\ . i .,
ENERGY
Szy.D•.aci,
'Ii- MMENTS
t
SEPTIC TANK SIZE
SEEP PIT/U SIZE -
,