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CITY OF DIAMOND BAR ;
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21825 E.Copley Drive � �`�1�00�
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w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' POOUSPB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDExEMP- (�
� TION.ANY VIOLA710N OF SECTION 7031.5 BY ANV APPLICAN7 FOR A PERMIT SUBJECTS THE APPLICAN770 Z R2-ROOi
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(f5o0).):
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WILL DO 7HE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704I,BUSI- J
� NESS AND PROFESSIONS CADE:THE CONTRACTOHS LICENSE LAW DOES NOT APPLV TO AN OWNER OF =
PROPER7V WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CC THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER�BUIL�EFi WILL HAVE THE BUHDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
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Y 70R5 LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON J
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PER1U(iV THAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTER �
� d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION a
� 1 HEREBY AFFIRM UNDER PENALTV OF PERIUPV ONE OF THE FOLLOWWG DECURATIONS: Z
� I HAVE AND WI�L MAIN7AIN A CER7IFICA7E OF CONSENT TO SELF-INSURE FOR WORKERS' 2
¢ CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMANCE W
Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. �
w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 37oa OF THE LABOR CODE,FOR THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORK�a S CO PENSAT NSURAN E CARRIER AND POLICV NUMBER ARE: CONSTRUCTION '�� �_
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C�J SH/LLL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BE CT TO THE ' " � �_�':� � � s�
� WORKERS'COMPENSATIONLAW RNIA,ANDAC,RE HATI SH ULDBECOME INSPECTIONFEE�/ '
� SUBJECTTOTHEWORKERS'C PENSTION OVISI NS SECTI0137000FTHELABOR ���`
CODE,I SHALL FORTHWITH COM LV WI H THOS PRO I51 5. ISSU 1NCE �1(1 n'I
p DATE:I� 3 0l APPLICANT: � SMIP� QC� �� c�Cl
J WARNING:FAILURE TO SECURE WORKERS'CA ATION COVE AGE IS U WF L,AN ALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTI DCIVILFINES HUNDRE� SAND ENERGY�PERMIT ----��
DOILARS(floo.oa0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIO OR IN ��.,`
� SECTION 3708 OF THE LABOF CADE.INTEREST,ANDATTORNEV'S FEES. RETENTION'FEE:� - �
a CONSTRUCT�ON LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). .
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� LENDER'S NAME
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� I CERTIFV iHAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INfORMATION IS CARRECT. TOTAL FE ES � ��
� I AGFEE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING �
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z A VE-MENTIONED PROPEF;jY FOR INSPECTI auaPosEs. COMMENTS
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= 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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GROUND PLUMBING ; UNDER FLOQFi CU�IDUIT ;
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SLAB GRADE � FIREPLAGE FOUNDATION ' � " ' ' �
TEMP POWER � I FIREPLAGE BOND BEAM �
WATER SERVICE __j______ i _MID HT. BOND BEAM ' __ __ __ _ _
ROOFSHEATHING �j��� j ; 8 Fi'. BOND.'BEQM ' �^
FRAMING/VENTILIATION � � FINAL BOND BEAM �
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ROOF COVER PRE-GRADING
ROUGH HEATING , BENCHING
ROUGH ELECTRIC ROUGH GRADING` � � �
ROUGH PLUMBING ; ; FINISH GRADING
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SHOWER/TUB TEST I POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
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CEILING IfVSULATION i OFF SITE lMPS.
DRYVUALL NAILI(VG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAf�K LANDSCAPE/IRRIG.
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GAS AIR TEST FINAL ZONING
FINAL COIVST. �IRE DEPT. FINAL
FINAL HEATING HEALTH DEPT.fINAL
FINAL ELECTRIC DEV. FEES PAID
FIPVAL PLUMBIMG ENERGY
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