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CITY OF DIAMOND BAR ''
� --JF� --- DEPARTMENT OF COMMUNTfY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRESS
�`'%9��� BUILDINGPERMITAPPLICATION FIRMLY
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p I HEREBV AFFIRM UNDER PENALTY OF PERNRV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8QB/C81pOfI
W CENSE LAW FOR THE FOILOWINO REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CITV Oq (n
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w NRE.VRIOH TO ITS ISSUANCE,ALSO REOUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
� STA7EMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE COMRACTORS LI-
� CENSE LAW(pUPTER�(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � Pool/Spa ��
� FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLE6EDE%EMP� �
TION.ANY VqLAT10N OF SECTION 7031.6 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLAqS(5500).):
� ❑I,ASONMEROFTHEPROPER7Y,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfi1RI0fCl01 �
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701l,BU51- _J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUqi WORN HIMSELF OR HERSELF OR
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Q OFFEREDFORSPLEIF,HOWEVER71'�EBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNEREUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVEFORTHEPURP0.5EOFSALE). -��
w OI,ASONMEROFTHEPROPEHTY,AME%CLUSIVELYCOATRACTINOWRHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.70at,BUSINE55 AND PROFESSIONS CADE:hIE CONiRACTORS LI- V81U8I1011 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWFqBUILD50RIMPROVESTHEREON,AND
� WFIOCANTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCFIPTION FEE
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISKKJS OF CHAPTER �
� e(COMMENCINO WfTH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�� MV LICENSE IS IN FULL FORCE AND EFFECT. m
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� WORKERS'COMPENSATION DECLARATION � a �
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOILOWING DECLARATIONS: Z .
�Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WORNERS' a �
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COMPENSATION,AS PROVIDED BV SECTION 37000F THE IABOfl CODE,f-0R THE PERFORMANCE U
Q OF h1E WORK FOR WHICH THIS PERMIT I5 155UED. �
w _I HAVE AND WIIL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION ///��� r �/�
Q 3700 OF THE LABOR CADE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �y7�•�, `
ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION L C/ V
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Z I CERTIFV THAT W THE PERFORMANCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
L} SHALL NOT EMPLOV ANY PEFSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO THE
(n WOH7(ERS'COMPENSATIONlAW50FCALIFOFNI0.ANDAdREETHATIFISHWLDBECOME INSPECTIONFEE
SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTKKJ 37000F THE LABOR
S CODE,I SH�LL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
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J WARNIN6:FAIIURE TO SEWRE WORKERS'COMPENSATqN COVERAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C
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� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTFKKISAND ENERGYPERMIT
DOLLAfiS(f10o.o00�,IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIOED FOR IN
J SECTION 3708OFTHE LABOR COOE,INTEREST,ANDATTORNEYS FEES.
¢ RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFIHM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDINO AOENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEfiM1T IS ISSUED(SEC.3087,CIV.CJ.
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� LENDER'S NAME
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w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTMEABOVEINFORMATIONISCORRECT. TOTALFEES /_`��5 � �'O• V
� I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATINC TO BUILDING �' .
� CANSTqUCTIQN,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE-MEN ED PROPERTY FOR INSPECTION PURPOSES. COM ENTS
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� . RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy �
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SLAB GRADE FIREPLJ4C� FO�UNDATION
TEMP POWER FIREPLAGE BUND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING ' 8 FT. BONQ BEAM
FRAMifVG/VEfVTILiATiORI FINAL BORtD BEAM
ROOF COVER PAE-GRADING' r, -
ROUGH HE,4TfNG BENCH,I ;,�� ° �
ROUGH ELECTRIC ROUGH GRADING
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SHOWER/TUB TEST POQL ELECTRIC
EXT. IJ�TH/SIDING POOL FENCiNG
WALL INSULATIOfV POOL FINAL
CEII.ING INSULATION OFF SITE IMPS.
DRYWALI.NAIUNG DEDICATIONS
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SEPTIC TANK r� ��, LANDSCAPE/INRIC.
SEEP PIT/LL. � � ` T ON SiTE IMPS.
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