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J�� CITY OF DIAMOND BAR � '
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
_ 21810 Copley Drive,Diamond Bar,CA 91765 RESS
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-?027
�<o���W BUILDING PERMIT APPLICATION FIRMLY
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� OWNER-BUIIDER DECLARATION � SFR/ADD/REM
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I HEREBV AFFIRM W�DER PENALiV OF PERAIRV THAT I AM EXEMVT FROM THE CANTRACiORS LI� GA�9���h
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� 3TATEMENT THAT HE ON SNE IS IICENSED PURSUANT TO TNE PROVISIONS�OF THE-CONiRACTORB U� � POOUS 0
� CEN8E UW(L1/APTER Y(COMMEIICW�WITN SECTION 7006)Of DMSION 7 OF 7NE BUSINE55 AND VRO � P ,
FESS�ONS CODE7 OR THAT HE OR SHE IS E%EMPT T7EREFHOM AND THE BASIS FOR 7HE ALLEOED EXEMP•
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Z WILL DO THE WORK AND 1HE 97RUCTURE IS NOT tNiEHDED OR OFFERED FOR 9ALE(SEC.7oai,BU54 J .
� NESS AND 7MFESS�ONS CODE:TME CONiRACTOR3{.10ENSE LAW DOES NOT M�LV TO AN OWNER OF � .
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❑1,AS OWNER OF TME PROPERTY,'NA EXClU57VELV CONTMCTW O WfTH UCENSEfI CONTMCTORS
� 7p Cp/tSTRiJCT THE VRQIECT(SEC.7oaa.OUSINE59 M!O PROFESSIONS COOE:'�HE CONTMCTOR9 LI• V0IU91{OTI ADJ.AREA.
� CENSE IAW DOES NOTAPVLV TO AN ONMER OFA PROPER7Y WHO BUR0.9 OH IMPROVEg TNEREON,AND . . �
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TORS UCENSE LAW.). . �
� O I AY EXEMPT L1NDE SEC. B.a P.C.FOR THIS REASON U
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� LICENSED CONTRACTORS DECLAflATION -�
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1 HEREBY AFFlRN UNDER PENALTY OF PE0.1U�7Y TNAT I AM LICENSED UNDER DROVISIONS OF GFIAPTER �
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� WORKERS'COMPENSATION DECLARATION
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� 1 HEREBY AFFIiUi UNDEfl PENALN Of VERIURY ONE Of THE FQLLOW WG OECLAMTIONS: ZQ
Q _IHAVE�MIDWILLMAINTAINACERTIFlCATEOFCONSEMT03ELF�INSUREFOFlWORICERS' T
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OF THE WORK FOR WHICFI THIS PERMI7 13,ISSUED. �
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W _1 HAVE AND WILL MAIHT/UN WORKER9'�COMPENSA710N MSUiiANCE.AS REWIRED BY SECTION
Q ]7000F THE L�BOR COOE,FOfl THE PERFORMANCE OF THE WORK FOR WHipi iHIS PERMR IS ��g�Q�
� ISSUED.MY WORKEAS'�SA� SURANCE CMRIER AND POLICY NUMBER ME: �CONSTRUCTION�
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� (nussecnor+r�raoreEoor.�tt�oFn+EvasRrS�aaor+E�ooau�sK�m)oa�ssl PLUMBING
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Z, 1 CERTIFY THAT IN THE PERFOfUfANCE OF THE W'ORK FOR WMld/TH44 PENAR u^ISSUED,I
L•} 5/41L NO7 EAIPLOYMn PERSON W ANY NANNER 50/5 TO BECOME SU&IECT TO7HE INSPECTION FEE�
� MIORNERS COMPF115A710N LAWS OF CALIfORNIiI AND A6REE THAT IF 1 SHOUIp BECOME .. .. . .
S SUB.IECT TO THE ERS'WM7ENSATION PROVISIONS OF SECTION 7700 OF TNE U�BOR ISSUANCE �
CODE,1 FiN7TH C01ARv WITTt THOSE 7ROVIS10N5.
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pp�yppg(s�p0,ppp),W ADD�TON TO7HE COST OF COM7ENSATqN,DAMAOES AS PROVIDEO FOR W �
J 6ECT10N 37oe OF hIE LABOfi CODE.INTEREST,AND ATTORNE�"S FEEs. - RETENTION FEE: .
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O� , CONSTRUCTION�LENDINGAGENGY � P,p(/E-ALTF . . 1 �
� 1 HEREBV AFFIRM UI�ER PENAL7V OF PERIURV TNAT THERE IS A CONSTRUCTION LENDWO AOENCY /J,�
FOR THE PERFORMANCE OF 7HE WORK FOR WHICN THIS VERMfT IS ISSUEO ISEC.3007,CIV.C.}
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�' LENDEFTS�NAME —_-- . . .
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� w 1 A6REE TO G�OM7lV N7iH ALL CfTYPND COUNTY ORDINMICES AND STATE UN5 PEUTIN6 TO BURD�NO
n'�' COHSTIiUCTION,AND HER�V AIfTHORIZE REPRESENTATIVES OF THIS COUNi1'70 ENTEH UPON 7HE
Z� 11BOVE-MEN714NEOPROPERTYFORWSPECTIONPU s. COMMENTS '
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Uj SIONATURE OF PERM�TTEE DAT RECPT.NO. PAID BY VALIDATION
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_ i FLOORJO(ST
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ELECTRIC GROUND UNDER FLOOR DUCT
GROURO PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOR1D BEAM
WATER SERVICE MID HT.BOfdD BEAM
ROOF SHEATHI�dG �8 FT.BOND BEAM
FRAMING/VENTILATION FI(dAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING I BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING I FINISH GRADING
SHOWER/TUB TE57 POOL ELECTRlC
EX7.LATH/SIDING POOL FENCING
WAIL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILIfdG DEOICATIONS
SEWER FINAL ENG.
SEPTICTANK _ LANDSCAPE/tRRiG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. O fIRE DEPT,FiNAL
fINAL HEATING i HEALTH DEPT.FINAL
FlNAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FINAL ENGINEERING . � o
�OMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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