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CITY OF DIAMOND BAR
DEPARTMENT OF -COMMUNITY & DEVELOPMENT SERVICES
21660 E. Cop1Cy Ddve Suite 190 PRESS
(909) 860-3195 Fax (909) 861-3117
h BUILDING PERMIT APPLICATION FIRMLY
JOBS
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APN LOT — TRACT
OWNER
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APPLICANT TEL
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DESIGNER
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CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4
'CENSE UW FCR THE FOLLOWING REASON (SEG 7031.5 BUSINESS AND PROFESSIONS CODE: ANYCRYOR
COINTY WHICHRECUIRESA PERMRTO CONSTRUCT, ALTER IMPROVE. DEMOLISH, OR REPAIRANY STRUC-
TURE. PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 700?) OFDIVISION S OF THE BUSINESSAND PRO-
FESSICNSCODE) OR THATHE OR SHE 13 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TON. ANY VIOLATION OF SECTION 7031.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CNC PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (L50ol.)*.
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYE E5 WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE [SEC. 7044. BUSP
FESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOTAPPLY TO AN OWNER OF
PROPERTY WHO BOLDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SLX7/ IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FORSALE If.POWEVERTHE BUILDING ORIMPROVEMENTISSOLDWRHNONEYEAR OFCOUPLE'
' TON. THE OWNER 1UILDER WALL HAVE THE BURDEN OF PROVNQ THAT HE OR SHE DO NOT BUILD OR
IMPROVE FORTE PURPOSE OF SALEI
O L AS OWNER OF THE PROPERTY, ILIA EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 704. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U -
CENSE UW DOES NOTMPLY TO AN OWNER Of A PROPERYYYY/IO BUILDS OR IMPROVES THEREON. AND
WHO
CONTRACTS FOR SUCH PAGIECTS VATHACON7RACTOR(S) LICENSED PURSUANT TO THE CONTRAG
TORS IUCENSE LAW).
O 1 AM EXEMPT UNDER SEG B. S P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 FIEREBYAFFBM O
UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PiONSNS OF CHAPTER
WITH, 0 tCOMMENCNO SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODEAND
MY LICENSE 6 N FULL FORCE AND EFFECT.
LICENSE CLASS r-;-- ! UC. NO. S� Z(0
DATE �.� I�� CONTRACTOR _.fj -r-141
� 1 -"
y WORKIERT COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PRWOED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
-I HAVE AND WILLMANTAM WORKERTOOMIPENSATION INSURANCE, AS REOJIRED BY SECTION
7700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER .
POUCYNUMBER
(RTS SECROI NEED NOT IIE OOMPLETEDDFTE PERM IS FOR ONE HUEXYDDCLLARS (910D)OR LESS)
1 CERTIFY THAT N THE PERFORAIINCE OF THE WORK FOR WHICH THIS PERMIT O ISSUED. I
I SHALLN07 EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
j WORKERS• COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBUECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
i CCOE 1�7M COMPLY WITH THOSE PROVISIONS.
I DATE: APiT.ICANI:
1
I WARNING:FAILURE TO NEMPOYER T URI ANAL PENALTIES
ENSATION COVERAGE ONEHLVFTA.A D $HALL BE
THOUSAND
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (f 100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
t SECTION 7705 Of THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. -
L CONSTRUCTION LENDING AGENCY
i
FOR THE PERFORMANCE
UNDER PENALTY OFPERNRYTHAT THERE OACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERYR IS ISSUEDISEG 3007, CIV. G).
1
LENDERS NAME
LENDER'SADORESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AID STATE THATTHEABOVE INFORMATION I5 CORAECT.
I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUC'TION• AND HEREBY AUR�DRGE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
AB OVE-MENTONED PROPERTY FOR INSPECTION PURPOSES.
PEWRTTEE NAMEIPRI
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O SKLNATURE OF PERMITTEE -TUATE
APPLICATION PERMIT t
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.DATE l(lNUMBER Ot[f—J�
ISSUE ASI / �ejs�33TYPE OCC
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DATE' 1? CONST. GROUP
ZONING SETBACKS
FRONT - RW ❑
REAR ❑
SIDE/SIOESTREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
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ENERGY P/C
ENERGY PERMIT
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RETENTION FEE:
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COMMENTS -2
RECPT. NO. .. PAID BY VALIDATION
WHITE-0eDaMnent Copy, YELLOW--Fimanos COPY. PINK—Assessor DOPY, UULIJLNHiVu—rue L:CPy, ummm—Apprcam s L•Gpy - -- • -
CITY OF DIAMOND. BAR
''""INSPECTION RECORD'
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SETBACK �1;�� `�
DATE _'INSPECTOR
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INSPECTION DATE�
'F.LOOR,PIST �a„•1 N I. !.!i'
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FTGSlFORMSlSTEEL
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'FHA REOMTS- - - -- - :.._ .._
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ELECTRIC GROUND __ ._. _
.. _..... .. .r _. _ ....
UNDER FLOOR DUCT
GROUND PLUMBING
SLAB GRADE - -
— _
FIREPLACE FOUNDATION
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TEMP POWER - `'
.: :.'::. ,...: ;
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND.BEAM.. ` F ..
:.. '.. - I
ROOF SHEATHING
8FT,BO
FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER .`.
PRE -GRADING .. _........ --........
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ROUGH HEATING -
-
BENCHING
ROUGH ELECTRIC -',
-`
ROUGH GRADING
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ROUGH PLUMBING -
_ -
FINISH GRADING
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'SHOWER/TUB TEST
-._ . ...._ ...
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL .'
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
j
SEWER --.._.._.._._..: ._
_ .
FINAL ENG.:
SEPTIC TANK _....1 .__
_.._ _. ....
LANDSCAPEIIRRIG.
SEEP PIT/L.L.-- - - - - -
-= _.. '_:. - _ . \.__
ON SITE IMPS.
GAS AIR TEST -i
FINAL=CONST.-; - ---'
FINAL -HEATING -
Z -
I -
FINAL ZONING
FIRE DEPT. FINAL
HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
-
FINAL PLUMBING
ENERGY
COMMENTS .... -
t
SERI C TANK SIZE
SEEP PIT/U SIZE'
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