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CTI'1'OF DIAMOND BAR
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�`'%���� BUILDING PERMIT APPLICATION FIRMLY
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cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBY AFFIRM UNDER PENALTY OF PE0.IURV THA7 I AM EXEMPT FROM THE CONTRAC70R5 LI- Gefe90/CBfPOA
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7037.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n
U COUNTVWHICHRE�UIRESAPERMITTOCONSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC-
w TURE,PFIOR TO I7S ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooUSpa
� FESSIONS CODE)OR THA7 HE OR SHE IS ExEMP77HEREFROM AND THE BASIS FOR THF.ALLEGED E%EMP- (�
V TION.ANV VIOUTION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CIVI�PENALTY OF NO7 MORE 7HAN FIVE HUNDRED DOLLARS(f5oo).):
❑I,ASOWNEROFTHEP{iOPERiY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, 0
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7ot4,BU51- J COmmBfCiel -
� NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPER7Y NMO BUILDS OR IMPROVES THEREON,AN�YAiO DOES SUCH WORK HIMSELF OR HERSELF OR
CC THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDf-0RSALEIF,HOWEVER,hIEBUIL0INGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
� TION,THE OWNEF-BUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,AS OWNER OF THE PROPERTY,AM EXCIUSNELY CONTRACTING WITH LICENSED CONTfiACTORS
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Q TO CANSTRUCT THE PR0.IECT(SEC.7010,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOFIS LI- V8IU2SIOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7HEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORSLICENSEUWJ. .
� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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� DATE y�.3 0� �Z CC
OWNE�T� �1��, U
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRM UNOER PENALTY OF PERJUPY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEfi �
d B(COMMENCING WITH SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
� `X MY LICENSE IS IN FULL FORCE AND EFFECT. m I
� LICENSE CLASS LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTI OF PE0.IURV ONE OFTHE FOLLOWING DECURATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOfiKERS' _
¢ CAMPENSATION,ASPROVIDEDBYSECTION370oOFTMEIABOFCODE,FORTHEPERFORMANCE w
Q OF THE WOFK FOfi WHICH THIS PERMIT IS ISSUED. �
W I HAVE AND WILL MAINTAIN wORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SEC710N �O
Q 3700 OF THE LABOR CODE,FOfl THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLIGY NUMBER ARE: CONSTRUCTION �
Q ,1
� CARRIER PLANREVIEW � 'b��•
Z POLICY NUMBER ELECTRIC I
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� (Ri1SSECTqNNE�NOTBECOMR.EfEDOFhiEPERMffISFORONEFNt�DRED00UAFiS�S10D)ORLESS} P�UMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOfi WHICH THIS PERMIT IS ISSUED.I MECHANICAL
(.r} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGfiEETHATIFISHOULDBECOME INSPECTIONFEE ��
? SUBJECTTOTHEWORNEFiS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR
fADE.1 SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: 1��
J WARNING:FAILURE TO SECURE WOFiKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
. � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,IN7ERES7,AND ATTORNEV'S FEES. RETENTION FEE:
d CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBY AFFIRM UNDER PENALTV OF PEFLIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
� FOR THE 7ERFORMANCE OFTHE WORK FOR WHICH 7HI5 PERMI7IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
F- LENDER'SADDRESS
,� TOTAL FEES y t �
� I CERTIFV iHAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOFiMATION IS CORRECT.
� I AGREE 70 COMPLV WI7H ALL CITY AND COUNTV ORDINANCES AN�S7ATE lAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HIS COUN7V 70 EN7ER UPON THE
Z ABOVE�MENTIONED PROPEFTY FOR INSPECTION PURPOSES. COMMENTS
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m PEHMITTEENAME(PFiINT)
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N SIGNA7UfiE4F�ERMI77EE ^ DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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FfGS/FORMS/STEEL �.t� �- _______ j .FHA REQM i S �
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ELECTRIC GROUND ` , UNDER FLOOR DUCT ;
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GROUND PLUMBING � I � UNQER FL_OOR CU��DUIT
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S�AB GRADE � FIHEPLJ���E �OUNDATION i �
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TEMP POWER --.--. ' ----...._. __,.;._._FIREPL.AGE BONC� BEAM '
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WATER SERVICE � __..._._ I MID {�T ���C3 E��AM ---_._
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ROOF SHEATHI�IG g �. ���� �E�M �
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FRAMIfVGNEIVTILIATION ____; FINAL BOh1D BEAM . ;
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ROOF COVER PRE-GRRDING _ ____
FiOUGH HEATING ' BENCNING
- - --
ROUGH ELECTRIC ROUGH GRADING __
ROUGH PLUIVIBIIVG ; i FINISH uRADING ___
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SID11�lG ; POOL FENCING i
WALL INSULATIOfV I POOL FINAL i
i 0 SITE lMPS.
CEILING INBULATION I
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DRYWALL NAIUNG j DEDICATii7N8 �
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SEWER � FINAL E��.
SEPTICTANK ��--- -- LANDS�,�P�/IRRI�. � ----�_�__ _______ ��
SEEP PIT/LL. � ON Sli"E IMPS.
GAS AIR TEST FINA�ZQN{NG
FINAL CONST. C?�` �SL 4����j i F!RE DEPT. FINAt._ _
FINAL HE,4TING �_ � HEALTFi DEPT. FINAL _
FIfVAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING I i ENERGY
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