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CITY OF DIAMOND BAR I
� , � ---�� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
- 21825 E.Copley Drive
' '� (909)860-3195 F�(909)861-3117 PRESS I
�`'%���� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE � � � .v� APPLICATION� � � PERMIT �I , P/C
ADDRES DATE NUMBER �[i #
� ISSUE (� TYPE OCC
APN LOT TRACT DATE v` CONST. GROUP
°C OWNER /����'"scl
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� CITY �C ZIP�/7� TEL. q PROPOSED USE -
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION '
O OWNER-BUILDER DECLARATION SFR/ADD/REM I
I HEREBY AFFIRM UNOER PENAL7Y OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- GafeJO/C2fPOlt
W CENSE UW FORTHE FOLLOWING REASON(SEC.7o31.5 BUSINESSAND PROFESSIONS CODE:ANV CI7Y OR (n
U COUNTVYrt11CHREQUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTAUC- W P2fi0/DBCk
w 7URE,PRIOR TO ITS ISSUANCE.ALSO RE�UIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED W
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC70RS LI�
� CENSE LAW(CHAPTEP B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPB
� FESSIONSCODEJORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTNEALIEGEDE%EMP- (�
V TION.ANY VIOUTION OF SECTION 7031.5 BV ANV APPUCANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(f500).�:
ZOI,ASONMEROFTHEPROPERN,ORMVEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSA710N, � COmmBfCiel -
WILL DO THE WORK,AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�1,BU51- J
� NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NMO BUILDS OR IMPROVES THEREON,AND VhiO DOES SUCH WORK HIMSELF OR HERSELF OR
� THFiOUGH HIS OR HER OWN EMPLOYEES,PPOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDWRSPLE.IF,HOWEVEFLhIEBUIL�INGORIMPROVEAIENTISSOLDWITHINONEVEAROFCOMPLE�
� TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEROFTHEPROPERTV,AME%CWSIVELYCON7RACTINGWITHLICENSEDCON7RAC70R5
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[[ TO CANSTRUCT THE PROJECT(SEC.7o�d,BUSINESS AND PROFESSIONS CODE:THE CON7RACTORS LI� VfllllBtlOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTFiACT5FOR5UCHPROJEC7SWITHACON7RACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70FiS IICENSE LAW.).
�� �I AM EXEMP7 UNDER SEC. B.6 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENAL7V OF PERJURV THA7 I AM LICENSED UNDER PROVISIONS Of CHAPTER �
� e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AN� Z
�X MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICEN E CLASSG � � LIQ NO. �^ �� j
V DA� � � � CONTRACTO a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTY OF PERJUHv ONE OF THE FOLLOWING DECLARATIONS: Z
0 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' _
� CAMPENSATION,AS PROVIDED BV SECTION 37ooOF 7HE LABOFl CODE,FOR THE PERFORMANCE �U
Q OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FE IRED BV SECTION ��C�111 /�,
Q 3700 OF THE UBOR' ODE�FOR THE. ERFORMANCE OF HE WORK FO ICN THIS PEHMI7 IS �UI�
ISSUED.MV WOR NS AN IER AND PO NUMBER AflE: CONSTRUCTION �, a
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� CARRIE PLAN REVIEW
ZPOLICV NUMBER ' l ELECTRIC
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� (fHISSECfIONNEmNOTBE00MREfEDOFTHEPERA4TISFORONEHUt�DRED00LLARS(5100)ORLESS). PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(.'} SHALL NOT EMPLOY ANY PEflSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ./
= SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHElA80R ��
CADE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �r
� SMIP � '�l�
p DATE: APPLICANT:
J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5700,000�,IN ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. RETENTION FEE: �
d CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS FERMIT IS ISSUED(SEC.3097,CIV.C.�. .
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� LENDER'S NAME
H LENDER'SADDRESS
� TOTAL FEES D
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE WFORMATION IS CORRECT. �
w I AGREE TO COMPLV WITH ALL pTV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
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� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE-MENTIONED PROPEflTY FOfl INSPECTION PURPOSES. COMMENTS
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m PE E NAME(PFINT)
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� GNATUFEOF ITTEE D
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A IicanYs Co
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ELECTR�C UROUNQ � � i UND�R f=LC�OR DUCT �
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GROUND PLUMBING �_ _ _ ___ j UNDER F�OOR CUf�!DUIT _ i
---._.........._..._.
SLAB GRADE FIRERLACE_FdUNDATION __�__
---...._.
TEPViP POWER FIREPLACE BOND BEAM _ � __ __
W,4TER SERVICE fVIID HT. BQND BEAM _ _
ROOF SHEATHING � �� � _I 8 �• 8��� BEAM i ___..__
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FRAMINGNENTILIATION � ___ I. FINAL BOND SEAM _____ _ ___ �
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ROOF COVER � � PRE-GRAC3ING � ----- --
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ROUGH HEATWG� BENGNlN� I
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ROUGH ELECTRIC R�UGH GF3ADING
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ROUGH PLUMBING I � FINISH uRADiNG
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SHOWER/TUB TEST POOL ELECTRIC
EXT. IATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEI�I�lG INBULATIOfV --- -- OFF SITE iMPS. - --------------�-
pRYWALL NAILI�IG �_ � DEDICAT40N5 � � �
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SEWEFI FWAL E�1�=
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SEPTIC TANK LANDSGAPE/iRRIG. I
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SEEP PIT/LL ON SITE iMPS. � �
GAS AIR TEST FINAL ZON(NG �`
FINA�COiVST. , �IRE dEPT. FINAL
FINAL HEATING HEALTH DF_PT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING FNERGY I
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