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CITY OF DIAMOND BAR
i
DEPARTMENT OF COMMUNITY & Dpw
21660 E. Copley Drive Suite 190
(909) 860.3195 Fax (909) 861-3117
' BUILDING PERMIT APPLICATION
JOBSITE 33� �WAD V\a fir
ADDRESS
APN LOT TRACT
OWNER
ADDRESS
CITY ZIP TEL.
APPLICANT 1 _Y11GS TEL.1�-7^
CONTRACTOR
ADDRESS
CITY ZIPgbC1 TELi�0J42�Y{ZQ3
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS T. -
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031-5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REOUIRESA PERMRTO CONSTRUCT,ALTER IMPROVE, DEMOUSK OR REPAIRANY STRUC- -
TURE PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE 18 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U -
DENSE LAW (CHAPTER S (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.8 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS Woo) I,
O LAS OWNEROF THE PROPERTY, OR MY EMPLOYEES W TH WAGES AS THEIR SOLE COMPENSATION.
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WINO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCHWJRK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT $UCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE W.
HOWEVERTHE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OFCOMPLE-
TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BURR OR
IMPROVE FOR THE PURPOSE OF SALEM
O L AS OWNER OF THE PROPERTY.AM "CLUSNELY CONTRACTING WTTN UCENSED LYk7TRACTORS
TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U -
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAG
TOILS LICENSE LAW.).
O 1 AM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
S (COMMENCING WITH SECTION TOM) OF DIVISION a OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE IS N FULL FFOORC'E AND EFFECT.�%
LICENSE CLASS 0 LIC. NO. `
41 v3=
DATE_' CONTRAC -
WORKERS'COMPENSATIO RATION J1�
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARAT S: I
_ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 37W OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHION THIS PERMIT IS ISSUED.
1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECTION
3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY KERVK V�S^IONfLISURANCE CANW� AND PIUCY NUMBER ARE
CAAW[R LA.AL[— [ilN��1V/rT1N�tY7 e11hr- _
POLICY NUMBER 7 03
(RIS BECTON N'EEONOT BE OGMPETEDOF7NE PERMIT 5 FOR ONE M.R011CD )TIO:' SS)
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1
SHALLNOT EMPLOY ANY PERSON NANY MANNER 50 AS TO BE ESUBJECT TO THE
WORKERS'COIJPENSA710N LAWS OF CALIFORNIA AND ACRE ff18COME
SUBJECT TO THE WORKERS' COUPE TION PROVISONSO SECT OF .LABOR
rCOCE.1 SHALL FORTHWITH
COUPL E 0 ION
DATE: 7��� APPL M. _
WARNING: FAILURE TO SECURE ERS" 5ATON COVE RAGE IS UNLAWFUL AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL ILS AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS t$1010.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRLL LNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 30W, CIV. Q.
LENDERSNAME
LENDER'SADDRESS
ICENTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
IAGRCE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUINORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE•MENTONED PROPERTY FOR INSPECTION PURPOSES.
1 E�MNL
7 NAME (P NT)
8gNATU
PER1,11ITTEE DATE
PRESS
FIRMLY
APPLICATION PERMIT P/C
DATE NUMBER_
ISSUE F _ Q TYPE OCC
DATE ✓ l N T. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR () `1 Z00 ❑
SIDE/SIDE STREET ❑
L-1
SIDE ❑
11�90_POSEDUS359cFrAem- WQ ( Sti`'«
-P3CL�f1 X13-1�f a ixt-mal l:: �Lk:-IArAr1A
-
NO. DWEL. N .
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA (VALUATION
SFRIADDIREM
to
Gamge/Carport
WPatio/Dock_-
LL
Pool/Spa
ZRe
-Roof
0
Commarclal
m
Valuation ADSAREA
OUANTITY DESCRIPTION FEE
J
Q
U
Q
H
U
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J
w
U
Z
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J
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a
U
Z
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U
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE -^
ISSUANCE 00
SMTP
ENERGY P/C ► Anl -
ENERGY PERMIT
RETENTION FEE: (((�����
PRE -ALT FEE:
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T—
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY VALIDATION
WHITE—Department Copy. YELLOW—Finan Copy. PINK—Assessor COPY. GOLDENROD --Fila Copy. GREEN—Applicant's Copy
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S''TIONRECORD
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FLOORsJ(PIST
iFTC, S/FOR AS/ST EEL'
,
FHA em'ATS r- r
ELECTRIC GROUND.._.
- I
UNDER FLOOR DUCT
:GROUND PLUMPING ti.! r„
UNDER FLOOR CONDUIT
SLAE3 GRADE +,:,
FIREP .ACE FOUNDATION
7EF:?P POWER "
FIREPL9,C�-�n'd)Nb E EhM
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f VVATER SERVICE ...... I
MID HT. 13011'J[7 SFy__ mss_.,• !<�<
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FRAMglt_,?VENTII ATIO d ^ � � ''' �e
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( FINAL B WD B"AM
—ROOF COVER ' :
PRE -GRADING
I
:E17UGH HEATING
BENCHING
:DOUGH ELECTRIC.
ROUGH GRADING
-
sZOUGH PLUIM.E31NG
FINISH GRADING
SH0WER.TUBTEST
-
POOLUELECTRIC
i
EXT. LATH/SIDING
POOL:FENCING
X%'ALL-INSULATION
POOL FINAL
CEILING INSULATION. -
OFF SITE IMPS.
DRYVJAL.L NAILING
I DEDICATIONS
SE VER
FINAL -ENG.
SEPTIC TANK
LANDSCAPURRIG.
'
'SEEP PETIL.L.
ON SITE IMPS..
GAS AIR TEST
FINAL ZONING
1 .T,I ,L CONST... _
; FIRE DEPT. FINALI.
j
F; NAL HEATING -...__
.HEALTH DEPT. FINAL
-
F"'AL ELECTRIC I
DEV. FEES PAID I
iFLft PLUMBING I
ENERGY
Tf
SEPTIC TANK, SIZE
— — --
.SEEP PITO SIZE