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CITY OF DIAMOND BAR
---��-- DEPARTMENT OF COIvIIvIUNITY&.DEVELOPMENT SERVICES �-.�4J '
E 21825 E.Copley Drive PRESS
(909)8603195 Fax(909)861-3117
�°':�:,:�'y BUILDING PERMIT APPLICATION FfRMLY
� JOBSITE APPLICATION��� Q 1 PERMIT 1�` -�1 P/C I
I oADDRESS f DATE P10UMBER�� 1,� #
� ISSUE TYPE OCC
APN OT TRACT DATE CONST. GROUP
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� DESCRIPTION S�.FT. FACTOR PSF ADJ.AAEANALUATION
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z TURE,VRIOR TO ITS ISSUANCE.AL50 REOU�RES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
W STATEMENT THAT HE Of7 SHE IS LICENSED NRSUANT TO THE PRO�SIONS OF THE CONTRACTORS LI-
� CENSE LAW(CIiAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- � POOUSP3
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Z WILL D�7HE WORK,AND THE S7RUC1l1RE IS NOT IMENDED OR OFFERED FOR SALE(SEC.70a�,BU51� J
� NESS M1D PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT A7PLV TO AN OWNER OF �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURY TNAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � i'
d 9(COMMENCW�WRN SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL F RCE AND EFFECT. m
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� WORKERS'COMPENSA710N D Q
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N I HEREBY AFfIRM UNDER PENALTV OF PERIURV ONE OF THE fOLLOWING DECLAPATqNS: Z �
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� _INAVEANDWILLMAMTAWACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' S
COMPENSATqN,AS PROVIDED BV SECTION 370o OF THE V.BOR CODE,FOR THE PERFORMANCE W
—OF WORK FOR WNKX/TH�S FEFtMIT IS�SSUED. �
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W I HAVE AND WILL MAINTAIN WORKERS'COMPENSATqN INSVHANCE,AS RE�UIFED BV SECTION
Q 3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WOR!KERS/'�o M(q��N,SAYION INLs�g�r�CE GAROq�R AND POLICV NUMBEHAAE: CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE�.'ORK FOR WHICH THIS PERMIT t5 ISSUEO,1
(J SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO TNf
� WORKEFS'COMPENSATION LAWS OF CAIIFORN10.�N0 A�REE h/AT IF I SHWLD BEWME INSPECTION FEE
S SUBJECTTOTHEWORKERS'COMPENSATIONPpOVISIONSOFSECTION77000fTHELABOR ISSUANCE
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p DATE: APPLICANT:
J ENERGV P/C
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�y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
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J SECTION 3708 OF THE LABOR CADE.INTEREST,M1D ATTORNEY'S FEES. RETENTION FEE: `�D
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d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDEF PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LEN�INO AGENCY
� FOR THE PERFORMANCE OF THE WORI(FOR N7HICN THIS PERIAIT IS ISSUED(SEC.7097.qV.C.). �
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� LENDER'S NAME
F— LENOEN'SADORESS
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE WFORMATION IS CARRECT. TOTAL FE ES
W I AGREE TO(:OMPLV WITH ALL CITY AND CAUNTV ORDINANCESAND STATE LAWS RELATING TO WILDINO
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ,\D
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N SIGNATU DATE RECPT.NO. PAID BY VALIDATION
� WHITE—Depa ent Copy.YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applicant's Copy
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SLAB GRADE FIREP�AGE FOUfVDATION
TEMP POWER FIREPLAGE BOND BEAM
W,4TER SERVICE . �/IID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMIf�lG/VEfVTILtATION FItVAL BOND BEAM
ROOF COVER PRE-GFiADING
ROUGH HEATING BENCHING
R(JUGH ELECTRIC ROUGH GRADING
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CEILIfVG IMSULATiOiV OFF SITE IMPS.
DRYWALI.NAILIfVG DEDICATIONS
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SEPTIC TANK LANDSGAPE/tRRIG.
SEEP PIT/L.L. ON SITE iMPS.
GAS AIR TEST FINAL ZONING �
FINAL CONST. GIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINA�ELECTRIC DEV. FEES PAID
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