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CITY OF DIAMOND BAbt I
' ����� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES�
'� � 21660 E.Copley Drive Suite 190
(909)86Q3195 Faz(909)861-3117 �RESS
��'��^ BUILDING PERMIT APPLICATION FIRMLY
Q DDRIESS � �3D � Go•���n APPLICATION �y�y� .�,1 PERMIT P/C �-•
p DATE L U� NUMBER #
� APN�� LOT TRACT ISSUE TYPE OCC
DATE � CONST. GROUP
p OWNER � M CJ S
" ADDRESS �A� ZONING SETBACKS
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APPLICANT TEL. SIDE/SIDE STREET RW ❑
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� DESIGNER J• �o��✓� NO.DWEL. NO. NO.
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y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADDlREM
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I HEREBY AFFlRAI UNDER PENALTV OF PERIURY THAT I MI E%EMPT FROM THE CONTMCTORS LI- Gel096/COfPOft
W CENSELAWFOR7HEFOlLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANVCITVOR (n �
C� COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOIISH,ORREPAIRANVSTRUC• W P8t�0/DBCk
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH 7ERMIT TO FILE A SIGNED
W STATEMEHf 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- w
� CENSE UW(CHAPTER i(COMMENCIN4 WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSqNSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMMIDTHEBASISFORTHEALLEGEDEXEMP- (!f
TION.ANVVIOLATIONOFSECTION70.71.5BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z qe-Roof
� A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f500).):
� ❑I,ASOMMEROFTHEPROPER7Y,ORMVEMPLOYEESWITHWAGESASTHEIHSOLECAMPENSATION, O COfflrtlBfClel � s
NALL DO THE WORK,AND THE STRUCTURE IS NOT IHTENDED OR OFFERED FOR SALE(SEC.7011,BUSI• J
� NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � p
PROyEHfYNT10BU1LDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR L
Q i11FLOUl3H HIS OR�HER OMM EMPLOYEES,7ROVIDED 7HAT SUCH IMPROVEMENTS ARE NO71N7ENDED OR m -
O ,OFFEHEDFORSALEIF,FIOWEVERTMEBUIIDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z 'TION.THE OWNEREUILDER WILL HAVE 7HE BURDEN Of PROVING THAT HE OR SHE DID NOT BU�ID OR
= IMPROVE FOfl THE PURPOSE OF SALEJ.
�y ❑I,tiS OVMER OF TiE PROPERTY,AM EXCLUSIVELY COMMCTING WfTH LICENSED CONTMCTORS
(t TO CONSTRUCT THE PRQIECT(SEC.7oN,BUSINESS AND PROFESSIONS COOE:THE CONTMCTORS ll- VelllfltlOfl ADJ.AREA
W CENSE LAW DOES NOTAPPLY TO AN ONMER OFA PROPERTV MM1iO BUILDS OR IMPROVES THEREON,AND
� WliOCONTRACTSFORSUCHPR0.1ECT5WIhiACONTMCTOR(S)LICENSEDPURSUANTTOTiECONTMG pUANTITY DESCRIPTION FEE �
� TORS UCENSE LAW.).
O I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON J
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DATE OWNER V
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F fr LICENSED CONTRACTORS DECLARATION w
� I 1 HEREBY AFFIRM UNDER PENAL7Y OF PER1UFtY THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER � ,
� �G(COMMEHCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE,AND Z
�W UCENSE IS IN fULL FOHCE ANO EFFECT.
� LICENSE CLASS �_I� LIC.NO. 5��� I CIJ-�� ,/� .. j
V DATE I I ' �O� CONTRACTOR n I�1/+Gt✓C�T I!2 a
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� WORKERS'COMPENSATION DECLARATION �
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� 1 HEREBY AFFIRM UNDER PENPLTV OF PERIURV ONE OF THE FOLLOWING DECURATIONS: �
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� I HAVE MID WILL AWNTNH A CEFTIFICATE OF CONSEN7 TO SELF-INSURE FOR WORKERS' 2
� COMPENSATION,AS PROVIDED BV SEC710N 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE w
�` OF TIE WORK FOH NMICH THIS PERMIT IS ISSUED. �
� ��
W _I HAVE AND WILL MAINTAIN WOfiKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION ' '
Q970o OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PEHMIT IS . � �`
�,/ ISSUED.MY WORKERS'COMPENSAT NSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION '. ,..�
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� CARRIER �- T SI�+N'�L�CQ.� ' PLANREVIEW ( (�
� POLICV NUMBER v� �+�C C`�X�'7lir[n 3-CY3 —� • ELECTRIC �'�L��_�I l� �
� (iH6SECf10NNE�NOT8E00MR.EfIDOF7F�PEPoMEfi�RONEHUIiNim00L1�(5100)ORLESS} PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL .. n
� SHAI.L NOT EMPLOY ANY PERSON IN M!Y MANNER SOAS TO BECOME SUBJECT TO THE {- LUU 0
� WORKERS'CAMPENSATION UWS OF C�LIFORNIA,AND AGFEE THAT IF I SHOULD BECOME INSPECTION FEE 1 � "`�
SU&IECi TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION]7o00F THE IABOP ^�/�p��y]
s CADE,I SHALL FOiRHW17N COMPLV N77H THOSE PROVISIONS. �SSUANCE �iTQ7�/1,L'i�I A NIY 1I�1 V Da
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DATE: APPLICANT: .�. ��� e
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J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE
LL SUBJECTANEMPLOVERTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOIURS(f100,000),IN PDDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � f�,(�
� SECTION 370E OF THE LABOR CODE,INTERE57,AND A7TORNEI"S FEES. � RETENTION FEE: I�C/��
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFIRM UNDER PENALTV OF PERIURV 7HAT THEHE IS ACONSTRUC710N LENDING AGENCV
FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME �
� � LENDER'SADDRE55
� ICERTIFYTHATIHAVEREADTHISAPPLICA710NANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES �
W 1 AGREE TO COMPLV N7TH ALL CI7V AND COUNTY ORDINANCES AND STATE LAWS REU7ING TO BUIL�ING � � -
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE � �
Z �BOVE- ENTIONED PROPERTY FOH INSPEC710N PURPOSES. COMMENTS �
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� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—Applicant's Copy
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SLAB GRADE FIREPLACE FQUNDATION � ___ __ _ _
TEMP POWER FiREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM,. • , ' �
ROOF SHEATHING 8 FT'. BOND BEAM ' ' `
FRAMINGNENTILIATION FINA�BOND BEAM
ROOF COVFR PRE-GRADING " �
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING. � FINISH GRADING
SHOWER/TUB TEST r'OOL ELECTRIC
EXT. LATH/SIDING i POOL FENCING
WALL lNSULATION � POOL FINAL
CEILING INSULATION � OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. '
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L � ON SITG IMP�. �
�GAS AIR TEST F{NAL ZONING � '
FINAL GONST. FlRE DEPT. FINAL
FlNAL H�ATING HEALTH QEPT. FINAL
FiNA�ELECTRIC � ' DEV. FEES FAiD
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