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CTI'1'OF DIAMOND BAR �
�---��`-- DEPARTMENT OF COMMUNITY&DEVELOPIviENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�<9��� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE APPLICATION� D� PERMIT I`J P/C
ADDRESS � �'1+ ` DATE � NUMBER / Z #
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSKKJSCODE:ANVCITYOR (n
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w NRE.PRIOR TO ITS ISSUANCE,/�150 REQUIRES THE APPUCMIT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Dedc
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CFUPTEH B(COMMENCINQ WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � POOUSPB
O FESSIONSCODE)ORTHATHEOHSHEISEXEMPTTHEREFROMANDiHEBA515FORTHEALlEOEDE%EMP- (�
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Z WILL DO THE WORK,AND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOF SALE(SEC.7a4I,BUSI- J � J �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF ?
PROPER7V NM110 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR �
wTNHOUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVERT}1EBUILDINGORIMPROVEMENTISSOIDWfTHINONEVEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� UAPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASON7JEROF7HEPROPEHTV,AME%CLUSIVELVCAMRACTINOWITHLICENSEDCONTRACTORS
[[ TO CANSTRUCT THE PRQIECT(SEC.704/,BUSINESS AND PROFESSIONS COOE:THE CONTMCTORS LI- V81UefIOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TOMI OWNER OF A PROPERTY WHO BUILAS OP IMPROVES THEREON,NID
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� LICENSED CONTRACTORS DECLAFATION w
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I HEREBYAFFIRM UNDER PEWLLTV OF PERIURV THAT I AM UCENSED UNDER PROVISIONS OF CHAGTER �
� Y(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE,AND Z
LLI MV UCENSE IS W NLL FOFCE M!D EFFECT. m
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� WORKERS'COMPENSATION DECLARATION Q
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� 1 HEREBV AFFIRM UNDER PENALTV OF 7ERJURY ONE OF 7HE FOLLOWINO DECLARATKKJS: Z
� _�MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' = i
� COMPENSATION,AS PqOVtDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE U
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION n
Q 3700 OF THE LABOR CODE,FOR THE 7ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��' �/}/� ����� —A `
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER/WD POLICV NUMBER ARE: CONSTRUCTION (J V
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� (IHISSECTqNN�NOTBENAREfmOFTI-EPERMfTISFORpNEFiIN�OREDDOLil�RS(flao)ORLESS} PLUMBING
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Z 1 CEHTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
CS SHPLL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
(/� WORKERS'COMVENSATIONLAWSOFCALIFORNIA�NDA�REETHATIFISMOULDBECOME INSPECTIONFEE
� SU&IECT TO THE WORKERS'COMVENSATION PROVISIONS OF SECTqN 9700 0F THE LA80R
CODE,I SHALL FORTHWITH COMPLV WIiH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: � SMIP
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J WARNING FMWRE TO SECURE WOFKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(f100,o00),IN ADDITION TO THE CQST OF COMPENSATION,OAMAOES AS PHOVIDED FOR IN
w SECTION 3708 OF THE LABOR CADE,INTEREST,AND ATfORNEV'S FEES. � RETENTION FEE: ' +'_�
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
� I HEF7EBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
FOR 7HE PERFOFMANCE OF7NE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3aB�,CIV.C.�.
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� LENDER'S NAME
1— LENDER'SAD�RESS
w I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT 7HE ABOVE INFORMATION IS CARRECT. TOTAL F E ES ����`��L r��� ��D �
� I AGREE TO CAMPLV WITH ALL CfTY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,ANDHEREBVAUTHORREREPRESENTATIVESOFTHISCWNTVTOENTEiiUPONTHE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES, COMMENTS
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� E ERM DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR File Copy,GREEN—Applicant's Copy �
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5E7 BACK . � • FLOOR JOIST
FTGSlFORMS/S7EEL � ' FHA REGIMTS '
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CUMDUIT '
SLAB GRADE FIREPLACE FOUNDATION ' •
TEMP POWER FIREPLACE,BOND BEAM
WATER SERVICE MID HT, BOND'BE'AM ` •
ROOF SHEATHING, - � 8 FT. BOND BEAM
FRAMINGNENTILIATION � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHlNG �� � `
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUIVIBING FINISH GRADING
SHOWER/TUB TES7 POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WAL�INSULATION POOL FINAL
CEILIfVG INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS �
SEWER FINAL ENG. p 6L
SEPTIC TANK LANDSCAPE/tRRIG. �� `,l�
SEEP PiT/LL. ON SITE IMPS. ��
GAS AIR TEST �INAL ZONING � ����
FINAL COi�lST. `� FIRE DEPT. FINAL �dZ
F1NAL HEATING HEALTH DEPT. FINAL �
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING � _ ENERGY
_. C�G�OG��o _ _.
COMMENTS
SEPTIC TA�VK SIZE
SEEP PIT/U SIZE
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