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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)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'°�'� BUILDING PERMIT APPLICATION FIRMLY
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APPLICATION PERMIT ' P/C
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� CITY � V ZIP TEL. 0 q PROPOSED USE � y�� �
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT I AM EXEMPT FHOM THE CONTRACTORS U� G8l8 B/C9 R
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C� CWNTYWHIC}IREOUIRESAPEfUAITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w
W NRE.PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONE� w Patlo/Deck
g STATE�IENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CANTRACTORS LI�
CENSE UW(CHAPTER B(COMMENCWO WITH SECTION]000)OF DIVISION 3 Of THE BUSINESS AND PR0. � POOUSPO
� FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEM7� C7
U TION.ANV VpLAT10N OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(f500).):
0 ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtIf7lBfCi81
Z WILL DO THE WORN,AND THE STRUCTUiiE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Wa,BU51- J
N NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEHTV NRiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
w THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED TFIAT SUCM IMPROVEMEMS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERTFIEBUILDINQORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE W R70SE OF SALE).
_ w ❑I.AS OWNER OF THE PROPEHTV,AM E%CIUSIVELV CAMMCTINO WRH LICENSED CANTRACTORS "
[[ TO CONSTRUCT THE PRQIECT(SEC.7wI,BUSINE55 AND PROFESSIONS CODE:THE CONiMCTOqS LI- V8IU8�lOf1 ADJ.AREA
W CENSE UW DOES NOTAPVLV TO AN OWNER OF A PROPERTV WHO BUILDS OR IMPqOVES THEREON,AND
� WHOCANTRACTSFORSUpiPROJECTSWITHACONTRACTOq(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
Y TORS IJCENSE LAW.). FEE
� O I AM EXEMPT UNDEfi SEC. B.d P.C.FOR THIS REASON �
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� DATE OWNER F-
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� LICENSED CONTRACTORS DECLARATION � w
� I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AA/UCENSED UNDER PROVISIONS OF CHAPTER �
� �(OOMMENCINO WRH SECTION 7000)OF DIVISION J OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS IN FULL FOHCE AND EFFECT. m
� LICENSE CLAS q � ���.Na. `7�5 6 � �
U DATE I��7O j� CONTRACTOF d
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� WORKERS'COMPENSATION DECLARATION Q
� I HERFBV AFFIRM UNDER PENALTY OF PERIURY ONE OF 7HE FOLIOWING DECLARATION$: V
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� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' _
� COMPENSATqN,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE U '
OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. �
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w �I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CADE,FOR THE PERFORAIANCE OF THE WORK f-0R WHICH THIS PERMIT IS (� '�U
ISSUED.MV W}O",�y�KE�RS'Cq-TM�P�EN ATION INSUR1ANCE CAR�R,IEy/AND POLICV NUMBER AAE: CONSTRUCTION �
j CMRIER �WB IA'l� 11Q/'U�MrIA PLANREVIEW
ZPOLICV NUMBER I I Q 7 ELECTRIC
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� (IlUSSEC�qNNE�NOTBEODI.RETmOFiFEPEPo.f�ISFpqpr¢HU.pREpppuqRS(1100)ORLESS} PLUMBING
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Z �CERTIFY THAT IN THE PERFOPMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED.I MECHANICAL
�'} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE '
(/� WORNERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAOREETNATIFISHWLDBECOME INSPECTIONFEE
SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR � �
S CODE,I SHALL FORTHWITN COMPLV WITHJ THOSE PR,�OVIS/�Q�N S. ISSUANCE
p DATE: Z � APPLICANT: �►`'er FJ� PIY�"��� � SMIP ` 2�
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J WARNINO:F/JLURE TO SECURE WOiil(ERS'CqMPENSATION fAVERAGE IS UNUWFUL,AND SHALI BE ENERGY P/C �
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� SU&IECTANEMPLOVERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSMID ENERGYPERMIT
DOLLARS(5100.000�.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE UBOfl CODE,INTEREST,AND ATTORNEV'S FEES.
w RETENTION FEE: Z��U
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� 1 HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDINQ AGENCV �Ji�7� �
FOF THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.7081,CIV.C.).
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� LENDEF'S NM1E
F— LENDEfYSADDRE55
w I CERTIFY THqT I HAVE READ THIS APPLICATION AND STATE THAT 7HE ABOVE INFORMATIOfJ IS CARRECT. TOTAL FE ES �� /U
� I A�REE TO COMPLY WITH ALL CfTV AND CWNTV ORDINANCES ANO STATE LAWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PR07ERTV FOR INSPECTION PURPOSES. COMMENTS '
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� SIGNA E OF ERMfTTE DATE
� RECPT.NO. PAID BY VALIDATION <"
WHITE—DepaAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy �
CITV O� DIAiViOND B�►R
INS�IEC�'o0i� 9�ECORD
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOPJD BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
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 NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
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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SEPTIC TANK SIZE
SEEP PIT/U SIZE ,
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