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CTI'Y OF DIAMOND BAR C ` ` �' � Y'�P�
� --���-- DEPARTMENT OF CO�R�UNT�'&DEVELOPIv�NT SERVICES
21825 E.Copley Drive �
'~ (909)8603195 Fax(909)861-3117 PRESS
I `�'%»��W BUILDING PERMIT APPLICATION FIRMLY
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p I HEREBV AFFIRM UNDER PEN�LTV OF PERIURV THAT I MI E%EMPT FqOM THE CONTRACTORS LI� Gef9 B/C8 R
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C..� CAUNTYNMICHREOUIRESAPEflMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPUCANT FOR SUpi PERMIT TO FIIE A SIGNED w P0f10/DBCI(
� STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CANiRACTORS LI-
� CENSE LAW(CHAPTER e(COMMENCINQ WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpe
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V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPUCANT FOR A PERMIT SU&lECTS THE APPLICANT T0 Z Re-Foof
A CML PENALTV OF NOT MOqE TiAN FIVE HUNORED DOLLARS(f5oo).):
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WILL 00 THE WORK,AND 7NE S7RUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�4,BUSI- J COITImefCl81
Z NESS AND PROFESSIONS CODE:THE CONTRACTOfiS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ~
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� DATE OWNER �
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¢ �HEREBV AFFIRM UNDEH PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER -} /��_y
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Z0 _I HAVE AND WILL A/AINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' a
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COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PEflFORM/�NCE U
� OF THE WORK FOR WHICH iHIS PERMIT IS ISSUED. �
� � I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIHED BY SECTION
Q 7700 OF THE LABOR CODE,FOR 7HE PERFORMANCE OF 7HE WORK FOR WFIICH 7HI5 PERMR IS
ISSUED.MY WORKERS'COMPENSATION I�RlWC�,CARRIER AND POLICV NUMBER AHE: CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOFi WHICH THIS PERMIT IS ISSUED,I � MECHANICAL � '
L'} SHAIL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE
(,/) WORKERS'CAMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
SU&IECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370 HE LABOR �-��� �
S CODE,I SH FO TH COMPLV WITH THOSE PROVISIONS. ISSUANCE 1 l f '=1 ,�1 _,� ._ .
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p �ATE: ���" D APPLICANT: SMIP . �
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J WARNINO:FAIIURE TO SECURE WORKERS'COM N CAVERAGE IS UNUWFUL,AND SHALL BE
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� SUBJECTANEMPLOVERTOCRIMINALPENALTIES DCIVILFINESUPTOONEHUNDREDTHWSANO ENERGYPERMIT � 1 �' L
DOLLAAS(floo.o00),IN PDDITION TO THE COST OF CAMPENSATION,DAMAOES AS PROVIDED FOfl IN •
J SECTION 37080FTHE LABOR CODE,INTEREST,ANDATTORNEV'S FEES.
OC RETENTION FEE: 1 .
O ' CONSTRUCTION LENDING AGENCY i:.��__
PREALT FEE: � �
� I HEREBV AFFlRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUC710N LENDING AOENCY �—"
n- FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PERMIT IS ISSUED(SEC.3ae7,CIV.C.�.
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� LENDER'S NAME
� LENDER'SADDRESS
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w ICERTIFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORAIATIONIS�CORRECT. TOTAL FEES . /
� 1 AQqEE TO COMPLV WITH ALL CITY AND COUNTV ORDINA/JCES AND STATE UWS REUTINO TO�BUILDINO ,
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CAUNTV TO ENTER UPON THE '
Z ABOVE�MENTIONED PROPER7Y FOR IN,PECTION PURPOSES. � COMMENTS '
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� SI ANRE ERMITfEE A7E .
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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FTGS/F(7RMS/STEEL FHA REG�MTS
ELECTRIC GROUND UNDER FLOOR DUCT !
GROUND PLUMBING � UNDER FLOOR CUMDUIT
SLAB GRADE ' FIREPLAGE FOUNDATI�N
TEMP POWER FIREPLAGE BOND BEAM -
WATER SERVICE MID HT. BC�ND BEANI �� '
ROOF SHEATHI�JG �'� � 8 FT. BONQ BEAM
FRAMING/VENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADINC,
ROUGH HE,4TING SENCFilNG
ROUGH ELECTRIC ROUGH GRADING .
ROUGH PLUiVIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATIdN POOL FINAL
CEILING INSULATION OFF SITE IMPS. i
DRYWALL NAILifVG DEDICATIDNS
SEWER FINAL ENG.
SEPT(C TANK �ANDSCAPE/IRRIG.
SEEP PtT/LL. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FiPJAL CORIST. FIRE DEPT. FINA�
F1NAL HEATING HEALTH DEPT. FINAL
FiNAL EIECTRIC DEV. FEES PAID
FINAL PLUMBIt�1G ENER�Y
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