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_ _��_ CTI'Y OF DIAMOND BAR \��- ' 1 \\r 0
DEPARTIvIENT OF COMMUNITY&DEVELOPMENT SERVICES 1 1����
21825 E.Copley Drive
I �- (909)860-3195 Fax(909)861-3117 / �/ PRESS
�'%���,W BUILDING PE TT APPLICATION G�' FIRMLY
y JOBSITE L� APPLICATION PERMIT L P/C
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� ISSUE TYPE OCC
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� CITY �612h r�A ZI TEL. PROPOSED USE
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLAAATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM E%EMPT FROM THE CONTMCTORS LI- G8f8QB/CBfPOfI �
W CENSEUWFORTHEFOLIOWINOREA50N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n
C-� COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRMIVSTRUC� w
w 7URE.PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w P8�10/DBCK . �
� STATEMENT THAT HE OF SHE IS LICENSEO PURSUANT TO hIE PROVISIONS OF THE CONTRACTORS LI� �
� CENSE UW(CHAPTEfl e(CAMMENCINO WITH SECTION 7000)OF DIVISbN 3 OF THE BUSINESS AND PRO- POOUSP2
O FESSIONS COD�OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEOED E%EMP- (!3
U TION.ANV VIOUTION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof
A GVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(SSaO�.):
� ❑I,ASONRJEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrt1rtlBfCiBI
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI- J �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CL THROUCLI HIS OR HER ONM EMPIOVEES,7ROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
� OFFEREOFORSPLE.IF,HOWEVERTMEBUILDIN�ORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE�
Z TION,THE OWNERAUILDER WILL HAVE THE BUHDEN OF PROVING THAT HE OH SHE DID NOT BUILO OR
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w ❑I,AS OWNER OF THE PROPER7V,AM EXCIUSIVELV CANTRACTINO MTTH UCENSED CONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7WI,BUSINESS AND PROFESSIONS CODE:iHE CONTRACTORS�I- V91U81i011 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWFlOBUILDSORIMPROVESTHEREON,AND
� WFIOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�UCENSEDPURSUANTTOTHECONTMC- QU TITY DESCRIPTION FEE
Y TOqS LICENSE LAW.).
� ❑I AA1 EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON ����
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� LICENSED CONTRACTORS DECLARATION �
� I HEREBY AFFIRM UNOER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� D(COMMENCINO WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAND PROFESSIONS CADE,AND Z
��� MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE� v � LIC.NO. O d .`f� �
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� WORKERS'COMPENSATION DEC
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECURATqNS:
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0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WORKERS'
Q COMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE.
OF THE WORK FOR WHICM THIS PERMIT IS ISSUED.
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BV SECTqN
Q ��700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WOR)(FOR WHICH THIS PERMIT IS
/ ISSUED.MY WORKERS'COMPENSATION INSURANCE CAARIER AND POLICY NUMBER ARE CONSTRUCTION
jCARRIER �"'l"� �� �j PLAN REVIEW
Z POLICV NUMBER��r�� I ��S I �'�C� ELECTRIC
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Z I CERTIFY THAT W THE PERFORMAIJCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 MECHANICAL 1 �F--Jl/%' � I ��`�
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE ' 1
(/� WORKEflS' MPENSATqNLAWSOFCAIIFORNIAANDAGREETHATIFISHWLDBECOME INSPECTIONFEE
= 5 ECTT E WOR)(ERS'CAMPENSATION PROVISIONS OF SECTqN OF THE UBOR � j q
DE,I SH FORTHWITH COMPLV WITH THOSE PRO ISSUANCE ` [U O I
p DATE:� E APPLIC SMIP I
J WARNING FAILURE TO SECURE WO o e 5 UNLAWFUL,AND SHALL BE ENERGY P/C I t.D�f,T.
�y SU&IECTANEMPIOYERTOCRIMINALPE ANDCIVILFINESUP NEHUNDREDTHWSANO �?.`-�---� ____
DOLLAFiS(t1oo.000),IN ADDITIONTOTHE W , AMAOES AS PROVIDED FOR IN ENERGY PERMIT - -
J SECTION 37ae OF iHE LABOR CODE.INTEREST,AND ATTOFNEV'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AOENCV
� FOR THE PERFORMANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUED(SEC.3ae7,CIV.C.).
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� LENDER'S NAME
1— LENDER'SADDRE55
w I CERTIFY THAT I HAVE READ THIS APPUCATIDN AND STATE THAT TME ABOVE W FORMATION IS CORRECT. TOTAL FE ES 4'� �✓
� I AOREE TO COMPLV WITH ALL CITY AND COUN7V ORDINANCES AND STATE UWS RELATINO TO BUILDING /
� CONSTRUCTION,AND HEREBV AU'fHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONEO PpOFERTY FO INSPECTION PURPOSES. COMMENTS
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SIG D E
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~ WHITE—Departmant Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SET BACK � � FLOOR JOIST; •
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SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND,B'E�AM' ' ' ' '
ROOF SHEA7HING 8 F?. BOND.B�AM~ �i � ' .
FRAMING/VENTILIATION FINAL BOtVD BEAM � �
ROOF COVER PRE-GRADlNG
ROUGH HEATING BENCHlNG
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION ^ POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL hlAILING DEDIC,4TIONS
SEWER FINAL ENG.
SEPTIC TANK �ANDSCAPE/IRRIG.
SEEP PIT/�.L. ON SITE IMPS:
GAS AIR TEST , FINAL ZONING �
FINAL CONST. � ' ' ' �IRE DEPT. FINAL �
FINAL HEATING ' � • ' HEALTN DEPT. FINAL
FINAL ELECTRIC DE-V. FEES PAID ��
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