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I CITY OF DIAMOND BAR �
�"--�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-31,17 Building Inspection Hotline(909)839-7027 PRE$$ ,
,�''"'. BULLDING PERMIT APPLICATION FIRMLY ,
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CONST. (L GROUP
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� CITY ZIP TEL.
� DESCRIPTION S�.FT, FACTOR PSF ADJ.AREANALUATION
O OWNER-BUILDER DECLARATION SFR/ADD/REM
p I HEREBV AFFIqM IAlDER PENALT/OF PERJUpy 7}uT t AM E%EM7T FROM THE CONTRACTORS L4 G8f8 0/C9
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C� COUNiYWHICMREWIRESAPERMR7000NSTAUCT,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W pafl0/DBLI(
< NRE,PRIOR 70 RS 159UANCE,/�LSO REOUIqES THE APPLICAN�FOR SUCH PERMIT TO FILE A SIONED w
�� STATEMEHf THAT ME OR SNE IS LICENSED PURSUANT TO THE PROVISIONS�OF THE'CONTMCTOR3 L4 .
` CENSE UW(CHAVTER Y(CAMMENCWO Wlhl SECTION 7oD0)OF DMSION 3 OF THE BUSINE59 M1D PRO� � PooUSpa
vFESSIONS CODE)OR THAT HE OR SlfE IS IXEMPTTiEREFROM AND 7HE BASIS FOR THEALLEOED E%EMP- (�
T�ON.ANVVIOLATIONOFSECTION7031.6BVANYMPLICANTFORAPERMI7SUBJECT3THEAPPLICANTTO . Z R�R001
� A CML PENALT'OF NpT A/ORE THAN.FlVE HUNDRED DOLLARS(i5oD1J: ..
Q ❑I,ASOWNEROFTHEPROPERTY,OR/AVEMPLOVEE9WITHIWGES.LSTHEIRSOLECOMPENSATION, � COfI1R18fC18I
Z WILL DO THE WORI(AND THE STRUCTURE 19 NOT INTFTlDED OR OFFERED FOR 9/�LE(SEC.70s1,BU51� J "
N NESS AND FROFESSIONS COOE THE CON7RACiOR4 LICENSE UW DOES NOT A7PlY TO AN OWNEH OF j
PROPERTY WHO BU0.0.4 OR IMPROVES THEREON,AND WHO DOES SUp/K�ORK WMSELF OR HERSELF OR
� THROUO/iW50RHEROWNEMPLOVEES,PROVIDEDTHATSUOiIMPROVEMENTSARENOTINTENDEDOR . m - � .
0 OFFERIDPDRSALEfF,HOWEVER,7HE8lNLDW�ORWPROVEMENTISSOLDWITMNONEVEAROFCAMPLE-
Z TK)N..THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVBia THAT HE OR SHE DID NOT BUILD OR
� DAPROVE FOR THE WRP0.5E OF SALE} � .
w ❑I,ASOWNEROF.THEPROPEHTY,AMEXQUSIVELVCANTMCTWOWRHLICENSEDCONTRAGTORS
Q TO COMSTRUCT THE P(1Q1ECT(SEC.)ON,�BUSINE53 AND PROFESSIONS CODE THE CONTMCTORS LI- V01Ufl1I011 AD,�.AREA. '
L11 CENSE LAW DOES NOTMPLV TOAN OWNER OFA PROPERTY WHO BUILDS OR W 7ROVES THEREON,AND ' � �
h WHDCOMRACT6iOR3UCHPR0.1ECT5W17HACONTRACTOR(5)UCENSEDPURSUAHfTOTHECONfRAG p�qNT�Ty DESCRIPl10N �E .
� TORS LICENSE UW.).
� O I AM EXEMPT UNDER SEC. B.8 P.G FOR TWS REASON Q
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� DATE OWNER f-
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� UCENSED CONTRACTORS DECLARATION W
� I HEREBYAFFlNA/UNDER PENALTY OF PERJUM iHAT I AM�LICENSED UNDER PqOVISIONS OF GIAPTER � -- - �
� 9(COMMENGNO WI7M SECTION 7000)OF DrvI510N 70F THE BUSINESS AND PROFE5510N5 ODDE,AND Z �
��� MY LICEN9E IS W FULL fORCE AND EFFECT.
� UCENSE CLASS C '�_ UC.NO. �� ` � -
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� � � WORKERS'COMPENSATIONDEC ION �� - � � � -
� 1 HEAEBV AFFUiN UNDER PENALTY OF PEiiIUM ONE OF THE FOLLOW W O DECURATIONS: U .
C� Z
� _I HAVE AND WlLL MAINT/UN A CERTIFICA7E OF CONSENf TO SELF-INSURE FOR WOAKERS' �
COMPENSATION,AS VROVIDED BY SECTION 3700'OF 7HE LABOR COpE,FOR THE PEqFOM1AF7CE W�
OF THE WOqK FOR N711CH THIS PERMIT IS ISSUED. �
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� �MAVE AND WILL I.WMAW WOPo(ER$'COMPENSATqN INSUfW�CE,A$REOUIRED BY SECTION . . .
Q �7000E-THE LABOR CODE,FOR THE PERFORMMICE OF THE WORK PoF WHlpi 7HI5 PERNIT i3
ISSUEA.MV WOPoCEAS�CyOAIPET15A7ION INSUFiANCE CARRIER�AND.POIICY NUMBER ARE CONSTRUCTION.
> ��� N,��u��r� PLAN REVIEW
� POLICY�NUMBER �— . . . .. .
ELECTRIC
o (nussEcr�r� eE ocn�aar.ir5waa+E�noauar�s�siaoloa�ssl PLUMBING �� Z
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Z 1 CERTIFY THAT W iHE PERFORMANCE OF THE WOPK FOfl WHiq1 THI$PERMIT IS ISSUED.1 MECHANICAL�
CS� SFIALL NOT EMGLOY ANY 7ERSON W ANV MANNER SOA3 T ECOME SUBJECT 70 THE � � -
(n WORKERS'CAMPENSA710N LAWS OF CALIFORNIh�ND EE THA71F I SHOULO BECOME INSPECTION FEE
SU&IECT TO THE WOPo(ERS'COMPENSATION PRO S OF SECTION 3700 OF THE LABOR � - ' � .�
o cao.i swiu Foar�mnn�couv�v vnrH rHo o�sior�s. ISSUANCE
p DATE�� APPLICANT. �SMIP
� WARNMO:�FAIWPETOSECUREWORKERS' SATqNCOVERAGEISUNLAWFU�,�WpSHALLBE ENERGYP/C
�y SUBJEC7 AN EMPIOYER TO CRIMINAL P ES M1D GVIL FlNES UP TOONE HUNDHEO TFqUSANp ENERGY�PERMIT
DOU_AHS.(f10o,o00),W ApplTpp TO THE T OF COMPENSATION,DAMAGES AS PROVIDEp Fpq W r�
� 6ECTION 370!OF hIE LABOR CODE,IMEREST,AND ATfORNEV'S FEES. ' RETENTION FEE: `�
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFlRM UNDER PENALTV OF PEAIURy THAT THERE IS ACONSTRUCTION�El1pWp AOENCY
�' FOR h7E PERFORMANCE OF 7HE WOPo(FOR WHICH T}�IS PERAIR IS ISSUED�SEC.30V7,CIV,C,�
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�, LENDERBNAME . .. . .
�"-' LENDER'SADDRE55 � � � -
W� ^�/�
'�CEAT�FY THAT�HAVE READ 7HI9 MPLICATION,WD STATE 71iAT7HEABOVE INFOqMATqN 19 COMECT. TOTAL FEES \ � <X
p 1 A6REE 70 COMPLv WITH ALL q7V AND COUNTy OqppUJ.�CE3 AND STA7E UWS fiEUTING TO BU0.DIN0 J(�
_� CONSTRUCTION,AND HEREBV AUTHORI2E REPRESEN7ATIVES OF 7HIS COUNTY TO ENTER UPON iHE �
Z ABDVE-MEMIOIJED PROPERTY FOR INSPECTION VUqPOSES.
p COMMENTS '
� P -�
'Q PERMITTEE NAME(PiUNn .
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�/j SIONATUREOFPERMffTEE DATE
� RECPT.NO. PAID BY VALIDATIO .
ITE—Departrnent Copy,YELLOW—Flnance Copy,P�NK—Assessor Copy,GOLDENRO�File Copy,GREEt� ' '
Applicant's Copy
CITY 4F DI/lMOtVD BAR
INSPECTtON RECORD
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SET BACI< FLOOR JOIST
FTGSlFORMS/STEEL FHA REQMTS
ELKTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER F100R CONDUlT
SLAB GRADE . FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM '
ROOF SHEATHIRlG' 8 FT.BOND BEAM
FRAMING/VENTILATION FIPIAL BOND BEAM
ROOF COVER PRE-GRAOING
ROUGH HEA7ING BENCHItdG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBWG FW(SH GRAOWG
SHOWER/TUB TEST PpOL ELE�TRIC
FXT.LATH/SIDlNG POOL FENCING
WALI INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS. -
GAS AIRTEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING EIJERGY
FINAL PLANING
FINAL ENGIfVEERIN� p
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COMMENTS ��'� !�� l�Z-�
SEPTICTANK SIZE
SEEP PIT/U SIZE �
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