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DIAMINI) RAA
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)961-3117
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DING PERMIT APPLICATION
ADDRESS JOBSITE
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APN LOT TRA/CJT��L
OWNER l g 1 fi 5 ab
ADDRESS iIJ17-0 to
CITY[) N. TEL - g
APPLICANT J ZIP r TEL M
CONTRACTOR
.ADDRESS
CITY ZIP TEL
ARCK ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE:ANY CRY OR
COUNTY WMICH REWAES A PERMrTTO CONSTRUCT. ALTE R M PROVE, DEMOLISH, DRREPAIR ANYSTRUC-
TURF- PRIOR TO RS ISSUANCE, ALSO REOURES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSE[) PURSUANT TO THE PROVISIONS OF THE CDNTRACIORS U -
CENSE UW (CHAPTER 0 (COMMENCING WITH SECTION ?WC) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS ODDE) OR TRAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
T ANY VIOLATION OF SECTION 7031.6 BYANYAPPLICANT FOR A PERUITSUaJECTS THE APPLICANT TO
NYC PENALTY OF NOT MORE THAN FIVE HUNDRED COLLARS (ISM).j.
AS OWNER OFTHE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
THE WOW, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC- 7044. BLS).
NESS AND PROFESSIONS COOL THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUNDS OR IMPROVES THEREON, AND YWNO DOES SUCH WORK HIMSELFON HERSELF OR
THROUGH HIS OR HER CYN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NTE NDED OR
OFFERED FORSALE F,HOWEVLR THE BUILDINGOR IMPROVEMENT O SOLDVnTHIN ONE YEAR OF O CMPLE-
TION. THE OWNER BUILDER WILL RAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
M PROVE FOR THE PJRPCSE OF SALE).
❑LASOWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING W IH LICENSED CONTRACTORS
TO CONSTRUCT THE, PROJECT (SEC. 70N, BUSINESS AND PROFESSIONS CODE. THE CONTRACTORS U.
CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WIPO BUILDS CR IMPROVES TIEREDN, AND
TWHO CONTRACTS FOR SUCH PROJECTS WTTH ACONTRACTORNS) LICENSED PURSUANTTO THE CONTRAC-
TORSS,UCENSE LAW.}
,Sj I AM EXEMPT UFUER SEC. 1 P C. FOR THIS RFASCW
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AMRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
I
(COMMEND NG NTH SECTION 7000) OF DIVISION a OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE 1S N FULL FORCE AND EFFECT.
LICENSE CU55 LIC. NO,
DATE CONTRACTOR
WORKERS'COMPENSATIONDECLARATION -
I HEREBY AFFIFW UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. y
I
—I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COUPENSATXCN, AS PROVIDED BY SECTION 3700 OF THE LADOR CODE, FOR THE PERFORMANCE
OF TRE WORK FOR WH. TNIS PERMIT 6ISSUED. _
—I HAVE AND WILL MAINTAIN WORKERS' WMPENSATICH INSURANCE. AS PEOUIRED BY SECTION
37W OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE.
CARRIER
POLICY M)MBER
(THIS SECTION NEED NOT BE COMPLETED OF THE PERMT IS FORCINE HU NCIFn CCLLMS R1 001 OR LESS1
I CERTIFY THAT N THE PERFORMANCE OF THE WOFNK FOR WHICH THIS PERMIT IS ISSUED. 1
SHALL NOT EMPLOY ANY PE RSON IN ANY MANNER SO AS TO BE COM E SUBJE CT TO THE
WORKERS COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUDU ECT TO THE WORP.EPS' COAPEHSATKCN PROVISINS OF SECT ON 3700 OF THE LADOR
CODE.I SHALL FORTHWITH COMPLY NTH THOSE PROVISIONS.
DATE: APPLICANT:
WARNING: FAILURE TO SECURE WOFWERS'CCMPENSATKNJ COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECTA.V EMPLOYER TO CRMNAL PENALTIES AND CNIL FINES UP TO ONE HUINDRED THOUSAND
DOLLARS (L .00400), W AODITON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3704 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFNM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDNO AGENCY
FOP. THE PERFCRMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3097, CIV. O),
LENDERS NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COM PLY WITH ALL CITY AND COUNTY CRDNAN CES AND STATE LAWS RELATING TO BULDINO
CONSTRUCTION.AND HLREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE ME
NT)ON ED PROPERTY FOR INSPECTION PURPOSES.
PyMAf7{,E E (PRINT)
SIGN OFPERMITEE V D .E
PRESS
FIRMLY
APPLICATIO I�- PERMIT P/C
DATE NUMBER k
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW D
REAR D
SIDEISIDE STREET RW D
SIDE D
PROPOSED USE M V L r
Ifyiny
M
NO, DWEL. 0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA VALUATION
SFRlADD/REM
En
Garage/Carport
WPallo/DBCk
LL
POCVSPa
ZRe
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Commercial
m
ValDato b ADJAREA
OUANTITY DESCRIPTION FEE
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W
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE ?• % l
ISSUANCE
SMIP
ENERGY P/C
v 1,
ENERGY PERMIT
1
RETENTICN FEC 11 A '" r . •- f�.�l Ll `�
PRE-ALTFEE: 'Q�1I4• I.�.
TOTAL FEES
COMMENTS(
RECPT N0. PAID BY VALIDATION
..A...vw7, ---is— is— wpy, P• K—Assessor Copy, GOLDENROD—Elle Copy, GREEN—Applicant's Copy
CITY OF DIAMOND,BAR .
INSPECTION RECORD
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FTGS/FORMS/STEEL
" . FHA REQMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
'GROUND PLUMBING
UNDER FLOOR CONDUIT
`
SLAB GRADE
FIREPLACE"1=0UNDATION
TEMP POWER
FIREPLACE BOND SEAM
- -
�NATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING" � 1.v� 8 FT. BOND BEAM
FRAMING.NENTILIATIONFINAL: BOND BEAM
;ROOF COVER
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, 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..
.',`- 'f• ON SITE IMPS.
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FIRE DEPT. FINAL
;
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( HEALTH DEPT. -FINAL -, ', , _
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FINAL ELECTRIC
; DEV. FEES PAID
FINAL PLUIIABING
ENERGY
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COMMENTS
'SEPTIC TANK SIZE
SEEP PIT/U SIZE
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