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CITY OF DIAMOND BAR '
DEPARTMENT OF COMMUNITY & DEVE MEPEM
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE
ADDRESS
APN LO TRACT
OWNER
AD SS
C ZI T
APPLICANT TE .
CONTRACT
ADDRESS
CITY ZIP TE
ARCFVENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE F'OLLOWIN'G REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CDOE: ANY CITY OR
COUNTYMMKCHREOUIRESAPERMrTMOONSTRUCT.ALTER IMPROVE.DEMOLISH.ORREPNRMIYSTRUC• ,
TURF. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLMJNT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U•
CENSE UW (CHAPTER 5 (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 E%EMP•
T10N. ANY VIOLATION OF SECTION 7001.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CTRL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).1:
O L AS OWNER OF THE PROPERTY.OR MY EMPLOYEES WITH 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 WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF CR
THROUGH HAS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVNO THAT HE OR SHE DD NOT BUILD On
IMPROVE FOR THE PURPOSE OF SALEI. '
O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LL
CENSE DOES ES NOT APPLY TO AN OWNER OF A PROPERTY W/O BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC-
TORS UCEHSE LAW }
D 1 AM EXEMPT UNDER SEG B. S P.C. FOR THIS REASCN
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBYAFFM LNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
O ICOMNENCNG WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS INFUO. FF AC'EANDEFFECT.
I-361
LICENSE C S v LIC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:'
_I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
_t HAVE AND WILL MAINTAIN WORKERS*COMPENSATION INSURANCE. AS REQUIRED BY SECTION '
37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS- COMPENSATION INSURANCE CARVER AND POLICY NUMBER ARE,
CARRIER _ _.._ .. ..... .. _
POLICY NUMBER
(DG SECTION NEEDNOTBE OOMPLCTEDOFTIE PERMIT IS PoRONE HUNDRED DOLLARS $100) ORLESS),
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS• COMPENSATION LAWS OF CALIFORNIA. REE THAT IF I SHOULD BECOME
!ffiw
S'COMPENSATIONP SIONS CiION 37000E ELABOR
HCOMPLYES.�DATE: PPLICANT'
IL
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE ISA WM,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 7705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM TINDER 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.).
LENDERS NAME
LENDERSAODRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGRE4 TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREGYAUTHORQE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
10NEDP RTY FORT SPECTION PURPOSES.
V
TME E (PRI �
SKIFUTUFF OIVPERVAI
APPLICATION
-7 q c/ PERMIT P!C
DATE I ` l O NUMBER
U A
ISSUEl �/ TYPE
-17 7 _�
OCC
DATE 11 9 CONST.
GROUP
ZONING SETBACKS
FRONT
❑
REAR
❑
SIDE/SIDESTREET RW
❑
SIDE
p
PROPOSED USE
LUUu
NO. DWEL. NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF
ADJ. AREANALUATION
SFR1ADOIREM
U)
Garage/Carport
LLI
Patio/Deck—
L-
PooVSpa
Z
Re -Roof
Commercial
In
Valuatlo ADJ.AREA
QUANTITY DESCRIPTION
FEE
U
W
-I
W
Z
TO
EL
EL
U
. . ...
Z_.
Q
2
W
ONSTRUCTION
4;2
PLAN REVIEW
- -
—
ELECTRIC
PLUMBING
MECHANICAL'
INSP EE
00
ISSUAN
SMIP
/ U
ENERGY P/C ��D
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE: N O Y
CITY OF DI
BUMDING AND
/
TOTAL FEES
I
u
aaAv
MF�TS
` J
RECPT. NO. PAID BY
VALIDATION
WHITE—Department Copy, YELLOW --Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy . .
• IT OF DIAMOND, BAR ,
o ri f.�.� PECTIONRECOFiD _ .
x
SET BACK
FLOOR JOIST
FTGS/FORMS/STEEL
FHA REQMTS _.... _. ..._.
ELECTRIC GROUND =
-
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CONDUIT .. '' '
SLAB GRAD "� =1'~ i�"t
-'
FIREPLACE FOUNDATION 1
TEMP POWER -- -- '•'"
: ; . - -
FIREPLACE BOND BEAM
WATER SERVI E l'r:f `
u - - _ _ - .. _ .:.._ .
MID HT BOND BEAM,
ROOF SHEATHING - -
8 FT BOND•BEAM
FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER
`" PRE -GRADING
-ROUGH HEATING
_ .- -
BENCHING..
ROUGH ELECTRIC -
ROUGH GRADING
ROUGH PLUMBING i-
..-- -..-
FINISH GRADING
SHOWER/TUB TEST. _..-..
. _.. _. _....:.. I.
POOL ELECTRIC . s;.
EXT LATH/SIDING
POOL FENCING
WALL INSULATION I
POOL FINAL ..
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING I
DEDICATIONS
SEWER -..-.-..FINAL
1 �
ENG. I r'
SEPTIC TANK._
LANDSCAPE/IRRIG. i
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 .' .
COMMENT
I ..
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E,
SEPTIC TANK SIZE
SEEP.PITIU SIZE