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�� CITY OF DIAMOND BAR � ( �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��
21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 � PRESS
'°"', BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE ZZ� ����.r. �y /�,, APPLICATION PERMIT (��,p/C /�
o ADDRESS Z 3 l=�`�vldU V►c DATE 4 Z�C� �/ NUMBER/I� �` �# -� 7 3�
� ISSUE TYPE OCC
APN LOT� TRACT -3I�G Z DATE CONST. �� GROUP
p OWNER ����"J�-[�_ I
o ADDRESS y � U ZONING SETBACKS
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFlRAI UNDEH PENAL7Y OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8le0B/COfPOft
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.5BU5WESSANDPFOFE5510NSCODE:ANYCITYOH (f�
U COUNTVWF{�p{REOUIRESAPEfiMITTOCON3TFUCT,ALTER1MPqOVE!DEMOUSH,ORFEPAIRANYSTRUC- w
W TURE,PRIOR TO RS ISSUANCE,/�LSO,REOUIRES THE APPITCANT f�R SUp1'PERMIT TO FILE A SIONED w Petlo/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTOqS LI- � O
� CENSE UW(CHAPTER e(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND Pq0- � PooUSpa
FESSIONSCODE)ORhIATHEORSHEISE%EMPTTHEREFROMMID7NEBASISFORTHEALlEOEDEXEMP� (!�
TION.ANY VIOLATION OF SECTION 7a31.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z qe-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNORED DOLLARS(f5ao).):
� ❑4��M�NEROFTHEPROPERTY,OHMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 COrtIrtIBfCI01 �
Z WILL DO THE WOHI(,AND 7HE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7011,BU51� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NhiO BUILDS OH IMPROVES TMEREON,AND NMO OOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,7ROVIDED THAT SUCH IMPROVEMEMS ARE NOT WTENDFD OR m
Q OFFEREDFORSILEIF,FIOWEVER711EBUILDWOORIMPROVEMEMISSOLDWI7HINONEYFAAOFCAM%.E-
Z TIDN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINQ THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR TIE PURPOSE OF SALE).
w ❑I,AS ONMER OF THE PROPEHTV,AM E%CIUSIVELV CAMMCTIN(i WfTH LICENSED COMTMC70RS �7 �
Q TO CONSTRUCT THE PRQIECT(SEC.70.�,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8110f1 47 QD O qp,J,qpEq
W CENSEUWDOESNOTAPPLVTOANONRJEROFAPROPERTVWHOBUILDSORIMPROVESTHERE-0N,AND
� NM1IOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION " � '�
TORS LICENSE LAWJ. FEE
� O I AM EXEMPT UNDER SEC. B,8 P.C.FOR THIS REASON Q
2� U "
LL DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� 1 HEREBY AFFIRAI UNOER PENALTV OF PERJURV THAT I AA/LICENSED UNDER PROVISIONS OF CHA7TER �
� D(COMMENCIN(i WfTH SECTION 7000)OF DIVISION�OF THE BUSINESS PND PROFESSIONS CADE,AND Z
�� A/Y LICENSE IS M FULL FOpCE M1D EFFECT. ; � m 1
� LICENSE CLA S �IC.NO. � S �
U DATE � CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION � •
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N I HEREBYAFFIRM UNDER PENALTY OF PERIURV ONE OFTHE FOLLOWING DECLARATKKJS: Z
� _I HAVE MJD WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOFlNERS' _ �
� COMPENSATION,AS PROVIDED BV SECTION 37o00FTHE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. �
� _1 HAVE AND WILL MlJNTAIN WOR)(ERS'CqMPENSATION INSURANCE,AS HE�UIqED BV SECTION
Q 3�00 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WOPK FOR WHICH THIS PEqM1T IS ��'���
ISSUED.MY MfOR10ER5'COMPENSATION INSURANCE CAiiRIER AND POLtCV NUMBER ARE: CONSTRUCTION �7
jCARRIER PLANREVIEW �lYlX .Y �
Z� POLICY NUMBER ELECTRIC
Q
� (1FLLSSECiK71N�NO7BENAAPLFfmOFTHEPERMTiSFOqONEFR�DREDDOLlARS(ft00)ORLE55} PLUMBING _
W •
Z I CERTIFV hiAT IN THE PERFORMANCE OF THE WORK FOR WHlqi THIS PERMIT IS ISSUED.I MECHANICAL
GS SHALL NOT EMPLOV ANY PERSON IN ANY MANN 50 AS TO BECOME SU&IECT TO THE
N WORKERS'COMPENSATION UWS OF CALIFO I AND AGREE THAT IF I SHOULO BECOME INSPECTION FEE
SUBJECT TO h1E WORKERS'COMPENSATIO 7R ISIONS OF SECTION�700 0F THE LABOR
O CODE,I HALL F RTHWITH COMPLY WITH 5 PROV ISSUANCE �+ Z
p DATE: �� �'sl APPLICANT: . SMIP
w ENERGY P/C
� WAHNING:,AILURE O SECUFE WORKERS'COM AT N RA UNUWFUL,AND SHALL BE�
� SU&IECTAtJEMPLOVERTOCRIMINALPEW�LTIESANDCMLFINESUP OONEHUNDREDTHCNISAND ENERGYPERMIT
DOLURS(f tao.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMA�ES AS PROVIDEO FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEqEST,AND ATTORNEVS FEES. RETENTION FEE: �O O
OCONSTqUCTION LENDING AGENCY PRE-ALT FEE: dS. _ _
� I HEREBV AFFIRM UNDER PENALTV OF PEFJURY THATTHERE IS A CONSTRUCTION LENOINO A6ENCV
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.'CJ.'
Z
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� LENDER'S NAME
F— LENDER5ADORESS �-�f
w I CERTIFV TMAT I HAVE READ THIS APPLICATION AND STATE TIiAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES 3� � �/ � 3y •t(/�
� I AOREE TO CAMPLV WITH AlL CITY AND COUNTV ORDINANCES AND STATE LAWS REUTW6 TO BUILDINO C
� CONSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATIVES OF THIS CWNTV TO ENTER UVON THE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPoSES. COMMENTS �
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� SIONATUREOFPERM ATE
� � �� RECPT.NO. PAID B VALIDATION
WHITE—DepeAment Copy,YELL W�Inence Copy,PINK—Assessar Copy,GOLDENROo--File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBIPIG UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMING/VENTILATION 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 �) _l�'��� -
WALL INSULATION POOL FINAL _•
CEILING INSULATION OFF SITE IMPS. ��� �
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/1RRIG.
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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