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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
' BUQ.DING PERMIT APPLICATION
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OWNER -BUILDER DECLARATION
I HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF
CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CTYOR
COUNTY WHICH REOUIRE3APERMTT70 CONSTRUCT,ALTER IMPROVE, DEMOLISH. ORREPAIRANY 3TRUG
TURL 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 LF
CENSE LAW (CHAPTER a (COMMENCING WITH SECTION ?W0) 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-
ION
T. ANY VKXATION OF SECTION 7051.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED COLLARS (11500).1:
OL AS OW7NEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WOFK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR BALE (SEC. 70U. BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR W PROVESTHEMON, ADD WHO DOES SUCH WON( HIMSELFOR HERSELF OR
THRO K64 MS OA HER OWN EMPLOYEES, PROVIDED THAT SUCH MPROVEMElTS APE NOT INTENDED OR
OFFERED FOR SALES.. HOVEVEILTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION. THE OWNER-BURDER WILL KAYE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALEL
O L ASOMNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONrFLACTOR3
TO CONSTRUCT THE PROJECT (SEC. 701.1. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LF
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BULBS OR IMPROVES THEREON, AND
WHO CONTMCTSFOR SUCH PROJECTS WITH ACONTMCTOR(5) LICENSED PURSUANT TOTHE COMRAG
TORS LICENSE LAW.).
O I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
P (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
YY LICENSE IS N FULL FORCE RVA EFFECT. /
LICENSE CLASS `' AO 'LIC. NO. fQA�L
DATE 12-3)-7-606 CONTRACTOR T cEj
c
WORKERS' COMPENSATION DECLARATI CM
I HEREBY AFFIRM UNDER PENALTY OF PERRIRY ONE OF THE FOLLOW NO
WILL
-I HAVE AND LL MAINTAIN A CERTIFICATE OF CONSENT TO S FMNSU WURK�RS' ✓
COMPENSATION. AS PROVIDED BY SECTION 7700 OF THE R CODE. FOR THE PERFORMANC
OF THE WORK FORWNFICH THIS PERMIT ISISSUED.
I HAVE AND WILL MAPTAIN WORKERT COMPENSATION INSLI REWIRED
3700 OF THE LABOR COOL FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE TIER AND POLICY NUMBER ARE
CARRIER
POLICY NUMBER
).THESE M NNEEDNOTSECOLLETEDCFTGEPENLREFCRONEHUDCMED
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI IS ISSUE
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECDAAE SUBJE OTHE
WORKERY COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT I'I SHOULD COME
6UBJECTTOTHEWORKERS'COMPENSATI=,. SO�370ROF�E R
COOL I SNAIL FORMWRH COMPLY W11H TNO 15 1 ..
DATE: APPLICANT:
WARNING: FAILURE TO SECURE W OWERS' COMPENSATION COVERAGE IS UNLAWFU. AND SHALL SE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND
DOLLARS (6100,000). 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 AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 3007. CIV. C.I.
LENDERS NAME
LENDER'SADORESS
I 1CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT.
1 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-MENT)ONED PROPERTY FOR INSPECTION EURPOSES.
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1 PERMITTEE ( WIlT)
SIG PE EE DATE
PRESS
FIRMLY
APPLICATION
PERMIT P/C
P/C
DATE
NUMBER ✓
R
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
0—
SIDE/SIDESTREET RW
SIDE/SIDE STREET
L-1
❑
SIDE
❑
PROPOSED USE
NO. DWEL
NO.
NO.
UNITS
STORIES -
BEDROOMS
DESCRIPTION
SO- FT. ! FACTOR'PSF
ADJ. AREA/VALUATION
SFRIADDIREM
C0
Garage/Carport
W
Patio/Dock
LL
PooUSpa
0
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Re -Root
0
Commercial
Valuation
ADJ.AREA
QUANTITY
DESCRIPTION
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ENERGY PIC
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ENERGY PERMIT
RETENTION FEE:
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PRE -ALT FEE:
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TOTAL FEESri
COMMENTS
RECPT. NO.
PAID BY
VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD— ile COW GREEN—Applicant-3 Copy V
CITY OF DIAMOND,BAll
INSPECTIOWRECORD
SETBACK
t'FLOOR JCIST(j., 1, v
TCS/FORMS/STEEL`-
HA REQMTS._ 7"
JELECTRIC GROUND__
UNDER FLOOR QUCT-
lGR_5UND PLUMBING
UNDER FLOOR C6MNblt"'
SLAB GRADE-----
FIREPLACE FOUNDATION
TEMP POWER 7
FIREPLACE BOND BEAM'
WATER SERVICE
POOF SHEATHING
10
FT. BOND -7 1 1.8 -BEAM
FRAMINGrVENTILIATION
I FINAL E�orb BEAM,
[5�0brCbVEFI
PRE -GRADING - j
I 1 ROUGH HEATING
,
f3OUGH'ELECTRIE77-
KI
ROUGH PLUMBING -- !
20UGWdAADING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC -
I EXT. LATH/SIDING
POOL FENCING'
1 WALL- INSULATION -
POOL FINAL
CEILING -INSULATION
OFF SITE IMPS.
DRYWALUNAiLING
DEDICATIONS
'SEWER
FINAL ENG.
SEPTIC TANK, i,
LANDSCAPE/IR91G.
SEEP-PIT/L.L.-.-.
ON SITE IMPS.
G__ASAIR TEST
FINAL ZONING
FINAL,CONST._,� jA(1 FIRE DEPT. FINAL-,
FINAL -HEATING
_Z HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID -
Fi-NAL- PLUMBING
j-1 ENERGY
'%Z'0 M V1 E N T S
4: 3
SEPTIC TANK SIZE
SEEP PITIU SIZE
7
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