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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE
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APNT T ACT
OWNER
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APPLICANT
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ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U•
CENSE LAW FOR THE FOLLOWNO REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY V"CHI REOUIRESAPERMRTO CONSTRUCT. ALTER IMPROVE. DEMOLISH, OR REPAIRANYSTRUC-
TURF, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FRE A SIGNED
STATEMENT THAT HE OR SHE S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF
CENSE LAW ICHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FORTHE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS 111600).1:
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL 00 THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUST•
NESS AND PROFESSIONS CODE: THE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUIDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROLX7H MS OR ITER OWN EMPLOYEES.
PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FORSALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFOOMPLE
TION. THE OANERFBIBLOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DIE) NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE}
O LAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS L6
CENSE UW DOES NOTAPPLYTO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(5) LICENSED PURSUANTTDTHE CONTRAC-
TORS LICENSE LAW }
wXL- EXEMPT UNDER SEC B. I P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBYAFFI M UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
6 (COMMENCING WITH SECTION 7000) OF DMSION 3 O THE BUSINESS
BBUSINESS AND PROFESSIONS CODE. AND
ULICENSE S N 2!1`Oq�F�TIO EFFECT. UC NO " — 9"
DA�/���c�J�/G'' CONTRA
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PER.URY ONE OF THE FOLLOWING DECLARATIONS:
__I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT S ISSUED.
i
—I HAVE AM WILL MAINTAN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION
3700 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:
I
CARRIER
POLICY NUMBER
i (DS SECTION NEED NOT BE COMPLETED OF THE KRMITSFDA ONE HUNDRED DOLLARS R+m1DRL6.s}
I CERTIFY THAT N THE PERFORMANCE OF THE WORK F HI THIS P . IS IS ED.1
1 SMALL NOT EMPLOY ANY PERSON IN ANY MANNER TOB EJECT HE
j WORKERS COMPENSATION LAWS OF CAUFORNI*. DAGRE HA IF BECOME
SUBJECT TO THE WORKERS! COMPENSATION P. VISION 37000E THE LABOR
TiTIINRiII
nDF SHAIl�i� COMPLY WITH ION
G n�
1 DA LTT APPLIQANr
' WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE ISAND SHALL13E
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ON UNOR AN
THOUSD
DOLLARS (81 D0.000). N ADDITION TO THE COST OF COMPENSATION, pAMAOE AS PRO EO FOR N
i SECTION 37060E THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
I CONSTRUCTION LENDING AGENCY
i
FOR THE AFFIRMUNDER PENALTYOFPEONRYTHATTHEREMACONSUED(S C. 097, CIO AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3037, CIV. Q).
3
" LENDER'S NAME
LENDERS ADDRESS
3 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT,
I AGREE TO COMPLY WITH ALL CIT/ AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION• AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNT.V70 EWEA VPON THE
ENTIONED PROPERTY FOR INSPE S.
� PERMIrrE wNn J
r7 SIGNATURE ERI DATE
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EXPIRED
JUN 19 2002PRESS
FIRMLY
APPLIDATE2 �/ n t 5040 PIC
NUMBEPERMI
DATE 7"� NUMBEFI ,/�� 0
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDESTREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ.AREANALUATION
SFR/ADD/REM
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QUANTITY DESCRIPTION FEE
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CONSTRUCTION
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ELECTRIC
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ENERGYP/C r,.__ t' ND BAR
�LIMAXNU AND SAFETY
ENERGYPERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEESC� v
COMMENTS
VALIDATION
RECPTRECP . NO. BY VALIDATION
riment Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOI.DLNHOo--rue L:opy, UKhhr—npp1icanrs L;4W
CITY OF DIAMOND BAR
INSPECTION RECORD '
SET BACK
FLOOR JOIST
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FTGS/FORMS/STEEL
FHA REQMTS
-
ELECTRIC GROUND �
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UNDER FLOOR DUCT
'
GROUND PLUMBING
UNDER FLOOR CONDUIT-.
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SLAB GRADE -
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FIREPLACE FOUNDATION
TEMP POWER
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FIREPLACE BOND BEAM'
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WATER SERVICE - -
- -
MID HT. BOND BEAM
ROOF SHEATHING
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FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER ":
PRE -GRADING
-ROUGH HEATING — --
-
BENCHING -
ROUGH ELECTRIC -
- _
ROUGH GRADING
ROUGH PLUMBING j
- - - -
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..;: - _-
-
ON SITE IMPS.
GAS AIR TEST. - -
FINAL ZONING
FINAL CONST.
FIRE DEPT. FINAL'
-FINAL HEATING
HEALTH DEPT. FINAL
a _• e
FJNAL ELECTRIC -
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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