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CITY OF DIAMOND BAR' " EXPIRED
-- DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. COplcy DEivc Suite 190 MAR 2 0 1001 PRESS
(909) 860.3195 Fax (909) 861-3117 -
BUILDING PERMIT APPLICATION _ , , T FIRMLY
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ADDRESS/ "-730
ADDRE�-/•J -
APO LOT TRACT
OWNER
ADDRESS
CITY ZIP TEL
APPLI A TEL
CONTRACTO —GkZ'F
ADDRE S
CITY' °_ ZIP ) TEL��I� —
ARC NG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U-
DOJSE LAW FORTHE FOLLOWING REASON (SEC 7031.6 BUSINESSAND PROFESSIONS CODE: ANY dTYOR
COUNTYI "OM REOIUW ESAFJTMRTO CONSTRUCTALTER IMPROVE, DEMOUSK OR REPAIR ANY STRUC-
TURE, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL
CENSE LAW ICHAPTER I (COMMENCING WITH SECTION TOW) OF DIVISION 3 O THE BUSINESS AND PRO-
FESSIONS O W EI OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (900).k
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
TWILL 00 THE WORK, AND THE STRICTURE 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 WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER Will EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENT$ ARE NOT INTENDED OR
OFFERED FOR SALE FMCWEVERTME SUIONG OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE
TION, THE OWNER.BULDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DW NOT BUILD OR
IMPROVE FOUTHE PURPOSE OF SALE),
O L AB OWNER OF THE PROPERTY,AM EXCLUSIVELYCONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U•
CENSE LAW DOES NOT APPLY TO AN OWNER OF APROPERTY VMO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS 1MTHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.). .
O IAM EXEMPT UNDER SEC. 8.8 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
P (COMMENCING WITH SECTION TOM)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
W LICENSE IS N FULL FORCE AND EFFECT ACIP::
LICENSE C S UC. NO.
DATE '^ ^ CONTRA
WORKERS' COMPENSATIO
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
i
_I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REWIRED BY SECTION
370o 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:
I
CARRIER
! POLICYNUMBER
((HS SECTION NEM NOT BE COMPLETED CFTHE PERMIT IS FOR ONE H W REODOL ARS ITIOM OR LESS)
I
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
f SHALL NOT EMPLOY ANY PERSON IN ANY 50 AS TO 8ECOME SUBJECT TO THE
j WORKERS' COMPENSATION LAWS OF RNI AND AGREEr IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENS KNP VISIONS9 cit 137000E THE LABOR
F- I SHALL FORTHWITH COMPLY TH P f ONS.
U
T DATE: _ ev APPLIC
i
WARNING: AN
TO EMPLOYER
TO
E 'COARSEN T COVERAGE UPTOSUNIAWFUL,ANHOUSA DE
• SUBJECTAN EMPLO'IER TO CRIY ENALTES IVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (11100,000). N ADDmONT THE COST OF PENSATgN, DAMAGES AS PROVIDED FOR IN
i SECTION 3700 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES,
J CONSTRUCTION LENDING AGENCY
IORTH HEREBY AE UNDER PENALTY LENDING AGENCY
FOR THE PERFOFO CO
RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV. CJ.
J
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT I RAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
3 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
NTIONED PROPERTY INSPECTION PURPOSES.
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APPLICATIONPERMR
P/C
DATE
NUMBER
#
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBACKS
FRONT
RW ❑
REAR
❑
SIDE/SIDE STREET
RW ❑
SIDE
- ❑
PROPOSED USE
NO. DWEL. NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDIREM
N
Garage/Carport
W
PatiolDeck
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Re -Roof
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CITY OF DIAM0ND,BAR . (
INSPECTION RECORD .f
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SEPTIC TANK -SIZE:'"
SEEP PIT/U SIZE
ISET BACK .,, ; S (� ; ;+, -:, •
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FLOOR JOIST 11 V`\ `':, 1:1- ,;- C-. - ;Ti ...
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FTGS/FORMS/ST L-` -- -'- ......:.
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(ELECTRIC GROUND
UNDER FLOOR DUCT - --- - -'
IGROUND PLUMBINGUNDER
FLOOR COP;DUIT r 7
SLAB GRADE - - �" ---
- - -
FIREPLWCE`FOUNDATION ,�.`.
(TEMP POWER - �,, -- - -
-
FIREPLACE BOND•BEAM
;WATER SERVICE------- ---- --•- ---- -
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-- MID'HT. BOND BEAA4- . � :�_ > > �'•= � -�,. � �i �
ROOFSHEATHINGt'-
B F?. BOND BEAM.-<:-. -'•.� .. , . ."' :_ ';.
�FRAMING/VENTILIATION -- - --
-- - -
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'ROOF COVER :"
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PRE -GRADING
!ROUGH HEATING -- -_ __ =
-,,
- __ _ _ - BENCHING
'.ROUGH ELECTRIC—_,___ " , _
ROUGH GRADING -
ROUGH PLUMBING -•-- - ------ --
-- --
----- FINISH GRADING
SHOWrR.rrUB TEST--'- - - -
EXT. LATH/SIDING - - ---- —
-- - - -
-
- POOL ELECTRIC =
- - POOL FENCING
VlALL tNSt1LATION--..— -- _..... -
-
- POOL FINAL
CEILING 117SULATION -_ .---.._- _.
- - ---- OFFSITE -IMPS. , • :;
DRYVVALL NAILING- - -- - -
_._ _--
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? SES/ER - - - - - _
_
FINAL ENG.
SEP T 10 TANK
LANDSCAPE/IRRIG.
SEEP.?IT/L.L -- :. . ,,
__
ON SITE IMPS.
I I.,.t R TEST --
FINAL ZONING
t +1" , ...GTd T- ! . _ '_; _
�' , `• ` '� FIRE DEPT, FINAL
HEALTH DEPT. FINAL - - -
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DEV. FEES PAID - - -- -- ----
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ENERGY
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SEPTIC TANK -SIZE:'"
SEEP PIT/U SIZE
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