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CITY OF DIAMOND BAR ��
`----lF� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-'7027 PRESS
''"�", BUILDING PERMIT APPLICATION FIRMLY
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APPLICATION �7 Q PERMIT p/C
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� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
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0 1 HEREBY AFFlRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM 7HE CONTRACTORS LI- GefB B/C8 O
W CENSEUWFORTHEFOILOWINOREASON(SEC.7031.6BUSMESSANDPROFESSIONSCODE:ANYCITYOR (n g � �
C� COUNTYWHICHREOUIRESAPEfiMITTOCONSTFUCT,ALTERIMGROVE,DEMOLISH,ORREPAIRANVSTRUC- w
w NRE.PRqR TO ITS ISSUANCE./�LSO REOUIRES TlIE APPLICANT FOR SUCH PERMIT TO FIIE A SIONED w P0f10/DBCI(
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTOFS LI-
� CENSE UW(CHAPTER Y(COMMENCWQ WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR6 � POOUSpB
_ Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
V TION.ANV VIOLATION OF SECTION 7037.5 BV ANV APPLICANT FOR A PEFUAIT SU&IECTS THE APPLICANT T0 Z qe-Roof
A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(f500).):
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Z WILL DO THE WORK,AND THE STHUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,BU51- J
� NESS AND VROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF j
PROPERTV WFq BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q 7HROU(3H HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVER71/EBUILDIN�ORIMPROVEMENTISSOLDWfTHINONEVEAROFCOMPIE.
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
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w ❑I.AS OWNER OF iHE PROPERTV,AM E%CLUSNELV CANTRACTIN�WfTH LICENSED CONTRACTORS
� TO CONSTRUCT TME PRQIECT(SEC.7W1,BUSINE55 AND PROFESSIONS CODE:THE CON7MCTORS Ll- V0IU0llOfl A0.1.AREA
W CENSE LAW DOES NOTAPPLV TOAN OWNER OFA PROPERTV WHO BUILDS Oq IMPROVES THEREON,AND
� W11000NTMCTSFORSUCHPRQlECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
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� LICENSED CONTRACTORS DECLARATION w
� I HEPEBYAFFIRM UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
��� MY UCENSE IS IN GULL FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION �
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N I HEREBYAFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWING DECLARATKKJS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' _
Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMMICE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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Qw _I HAVE AND WILL A/AINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTqN
3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jCARRIER � PLAN REVIEW c /J
QPOUCY NUMBER ELECTRIC I� �G �Ci � �
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Z �CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHIC}7 THIS PERMIT IS ISSUED,I MECHANICAL
C3 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
(n WORKEFS'COMPENSATIONLAWSOFCALIFORNIA,MIDAOREETHATIFISHOULDBECOME INSPECTIONFEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
~j CODE.1 SHALL FORTHWITH COA/PLY WITH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: SMIP
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� WARNING FAILURE TO SECURE WORNERS'COMPENSATION CAVERAOE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
� SU&IECTAN EMPIOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(5100.000).IN/�DDITION TO THE COST OF CAMPENSATKKJ,DAMAQES AS PROVIOED FOR IN
J SECTION 3�ae OF THE LABOR COOE,INTEREST,AND ATTORNEV'S FEES. �
[C RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-AI.T FEE:
� 1 HEREBV AFFIRM UNDER PENALN OF PERJURV THAT THERE IS ACONSTRUCTION LENDINO AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED(SEC.30G7,CIV.C.�.
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� LENDER'S NAME
� LENOEH'SADDRE55
w I CERTIFV THAT I HAVE HEAD THIS APPLICAT D STATE TIiAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES ��� �
� I AGREE TO COMPIY WITH ALL CITV AND NT ORDINANCES AND STATE UWS REUTIN(i TO BULLDINO
� CONSTRUCTION,AND HEREBV AUTHOR E REP SENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONEO PROPERTV FOR IN PURPOSES. COMMENTS '
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m PERMI77EE NAME(PRIPfT) .
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� SIONATUHEOFPERMITTEE DATE
� �'� RECPT.NO. PAID BY VALIDATION
WH E—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENAOD—Flte Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REOMTS
ELECTRIC GROUND UNDER FLOOR DUCT -
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOtJD BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � ' FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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