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CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
�.-C 21660 E.Copley Dme Suite 190 , ' . PRESS
(909)860-3195 Fa�c(909)861-3117 - •
�"'"" BUILDING PERMIT APPLICATION FIRMLY
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� DESCRIPTION SQ.Ff. F CT PSF ADJ.AREANALUATiON
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.p I HEREBV AFFlRM UNDER PENAL7Y OF PERIURY 7HAT 1 AM E7(EMVT FROM 7HE CON7RACTORS LI. ' Ge� �
W CENSEUWFORTHEFOU.OWWOREASdJ(SEC.7a77.6BUSWES5MIDPROFESSqNgCppEANVGTYOR (n � ��
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W NRE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE APPLICANT FOR SUd1 PERAIIT TO FILE A SI(iNED w
STATEMENT THAT HE OR SFIE IS LICENSED PURSUNJT 70 THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER G(COMMENCWO WI7H SEC710N 7000)OF DIVISpN J OF 7HE BUSINESS AND PRO- � POOU$(J8 �
� FESSIONSCOOE�ORTHATHEORSHEISEXEMPT7HEREFROMMIDTHEBASISFOR7HEALLEOEDEXEAIP- (�
TION.ANYVIOLATIONOFBECT10N7W7.60VANVMPLICANTFORAPERMITSU&IECTSTHEMPLICANTTp Z Re-Roof
� A CNIL'VENALTY OF NOT MORE 7T4W FIVE HUNDRED DOLLARS(i6a0).�:
� ❑I,ASONRJEROFTHEPHOPER7V,ORMVEMPLOVEESWI7HWAOESASTHEIRSOLECOA1pEN5A7qN, � (`,pmTBfCl91
Z WILL DO THE WOHI(AND THE S7RUCTURE IS NOT INTENDED OR OFFERED FOR S�LE(SEC.70/�,BU56 _J
N NESS M!D PROFESSIONS COOE THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF j
PROVEPiY NTfO BU0.D5 OR IMPROVES TiEREON,ANO NM110 ppES SUp/MqHK H W SELF OR HERSELF OR
`2 THROUGH HIS OR HER ONR!EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENT6 ARE NOT WTENDED Oq m
0. OFFERED FOR S�LE IF.HOWEYER 71rE BULOWOOR IMPROVEAIENT IS SOLD WI7MN ONE VEAR OFCOAIPLE- .
Z TION,iHE OWNER-BUItDER MALL MAVE THE BURDEN OF PROVWO THAT HE OR SHE DID�NOT BUILD pq
� IMPROVE fOR THE PURPOSE OF SALEI. .
❑4��WNER OF THE PROPEHfV.AM EXCLUSIVELV CAMRACTW(i WfTH LICENSED CONTqACTpq3
� TO CONSTFIUCT 7HE PROJECT(SEC.7011,BUSINESS AND PROFESSION9 CODE THE CONTRACTOqg LI- V91U9IIOf1 ADJ.AREA
� CENSE UW OOES NOTAPPLV TOAN OWNER OF A PROPERTV W//O BUttDS OR IMPROVES 7HEREON,AND �
WHOCONTRACTSFORSUCFIPRO,)ECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECOHT{UP QUANTITY DESCRIP7"ION �.
TORS LICENSE LAW.). �E
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THI9 REASp.I � �
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� DATE OWNER ' �
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� LICENSED CONTRACTORS DECLARATION w �
� I HEREBV AFFIRAI UNDER PENALTV OF PEFLIURV THAT I AM LICENSED UNDER VROVISIONS OF CHAVTEq � �
� Y(COYMENGNO WIiH SECTIDN)000)OF DNISION 3 OF THE BUSINESS AND PROFESSpNS COOE,MID Z
��� MV LICENSE IS pl FULL FORCE AND EFFECT. m
� LICENSE CUSS LIC.NO. �
V DATE CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION � / � �S �
� 1 HEREBV AFFIRM UNDER PENAL7V OF PE0.IURY ONE OF TNE iOLLAWINO DEG.ARATIONS: V
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� _I HAVE AND WILL MAINTAW A CERTIFlCATE OF CONSEHT 70 SELFaNSURE FOR NpRI(ER5 � � �
� COMPENSA710N,A3 PROVIDED BV SECTION J7000F THE 1A80R CODE,FOR THE PERFORAIAlICE U
OF THE WORK FOR NM111p1 7HIS PERMIT 19 155UED. W
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Qw _I HAVE AND WILL MAINTAIN WOPo(ER5 COMPENSATION INSURANCE,AS REWIRED 8V SECTK]N
37000F THE LABOR ODDE.FOR THE PERFORMANCE OF THE WORK FOR WHld/THIS PERAUT 19
ISSUED.MY WORKERS'COMPENSATqN INSURANC6 CARRIER AND POLICY NUMBEH ME: CONSTRUCTION
� CARRIER PLAN REVIEW
� POLICV NUMBER � � � '
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0 (nassEcrnr�r�raieeoo�rmaFnEaew,�rsFoaa+Er�iwr�ooauasp+ooloalFCC' PLUMBINO
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Z 1 CERTIFV THAT W THE PERFORMANCE OF THE WORK FOH WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C7 SHALL NOT EMPLOV ANV VERSON IN MIY MANNER SOAS TO BECOME SUBJECT TO THE
f/� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND A(iREE THAT IF I SHOULD BECOME INSPECTION FEE �
SUBJECT TO 7HE WOR1(ERS'COMPENSATION PROVISIONS OF SECTION�70o OF 7HE LABOR
rj CODE,ISHALLFORTHWIT/COMPLVWI7HTHOSEPROVISIONS. ISSU/WCE �
0 �
p DATE: APPLICANT. SMIP
� WARNIN(i:FALURE 70 SECURE WORKERS COMPENSATqN COVERAOE IS UNLAWFIA,AND SHALL BE ENERGY P/C ' �
� SU&IECT AN EMPLOVER TO CRIMWAL PENAL71E5 AND CML FWE3 UP 70 ONE HUNDREO TFqUSANO ENER6Y PERMIT
DOLLARS(t100,000),pJ MDITION 70 THE COS70F COMPENSATION,DAAIA�ES AS PROVIDED FOR IN
� SECTION J70E OF THE UBOR CODE,p/TERE3T,AND ATfORNEY9 FEES. FaE'TENTION FEE: �
OCONSTRUCTION LENDING ACiENCY pqE•ALT FEE:
¢ 1 MEREBV AFFliUI UNDER PENALTV OF pER1UM THAT THERE IS A CONSTRUCTION LENDW(i AOENCY
�Zi FOR THE PERiOHMANCE OF 7HE WORK FOR NR/ICF1 THIS PERAIR IS ISSUED(SEC.wW,qV.C.).
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� LENOfR'9 NMIE
� LENDERSADORE95
� TOTALFEES /
¢ 1 CERTIFV THAT 1 HAVE READ TH�$APP�ICATION AND STATE THAT TME ABOVE WFORMATION IS CORRECT. f
w I AOREE TO COMPLV WITH/�1.L CT'AND COUNTV ORDWANCES MID STATE UWS RELATWO TO BUILDINO J �
� CONSTRUCTION,AND HER�V AUTIKIRIZE REPRESENTATIVES OF THIS CWNTV TO ENTER UPON TME �
� ABOVE-MENTIONEO VROPERTV FOR INSPECTION PURPOSES.
. COMMENTS ��
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� Sq RAUTTEE DATE � • � �� �
� � RECPT.NO. PAID BY,/ VALIDATI�
WHITE—�DepeAment Copy.YELLOW--Finence Copy,PINK—Aasesaor Copy.(iOLDENROD—File Copy.OREEN—Applicant's Copy .
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SET BACK � FLOOR JOIST � � � • - � -
�TGS/FORMS/STEEL FHA REG�MTS
ELECTRIC GROUND UND�R FLOOR DUCT '
GROUND PLUMBING UNDER�.FL'OOR GUhIpUIT .
SL�4B GRADE FIREPLACE FOUNDATIO�t " "
TEflAP POWER FIREPIACE BOND BEAM
VNATER SERVICE � MID HT. BOND BEAM '
ROOF SHEATHIIVG 8 Ff. BOND BEAhh
� FRARAINGNENTILIATIOfV � FINAL BOP1Q BEAM
ROOF COVER PRE-GRADING �
ROUGH HEATING � BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNiBING FINISH GRADING �
SHOWER/TUB TEST POOL ELECTRIC � �
EXT. LATFil�y�Dli�Ca - PO�L FENCING , � '
WALL INS LA710N ,. POOL FINAL
CEILING I SUL.�TfbN OFF SITE IMPS. '
DRYVUALL�NAILING DEDICATIONS ' .
SE�NIER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP P.IT/.L.L. ON SITE IMPS.
GAS AIR TEST • - FtNAL ZONfNG
FINAL CONST. . - FIRE DEPT. FINAL
FIIVAL HEATItVG - HEALTH DEPT. FINAL .
FIhIAL ELECTRIC � DEV. FEES PAID
FIPIAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PITN SIZE ,
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