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CITY OF DIAMOND BAR
-�---� --� DEPARTIv�NT OF COMMUNITY&DEVELOPMENT SERVICES
2182SE.Copley Drive
'�'"� (909)860-3195 Fax(909)861-3117 PRESS
'`-��� BUILDING PERMIT APPLICATION FIRMLY
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� ISSUE TYPE OCC
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o ADDRESS i��t.r M eG .� , �,� ZONING SETBACKS
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p� OWNER-BUILDER DECLARATION
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p I HEREBV AFFIfiM UNDER PENALTV OF PERIURV THAT I AM E%EMP7 FROM THE CONTRAC70R5 LI� G8109B/CBfpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCI7VOR (n
U COUNT'WHICHREOUIRESAPEAMITTOCANSTRUCT,ALTER.IMPROVE,DEMOLISH,OR{lEPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
� STATEMENT 7HAT HE OR SHE IS LICENSED PUFi5UAN7 70 THE PROVISIONS OF 7HE CON7RACTORS LI- LL
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVSPB y
0 FESSIONSCODE)OHTHATHEORSHEISEXEMP7THEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- �'(!� ��
V TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT T0 Re-Roof �
A CIVIL 7ENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).):
� OI,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Epry�me�Cle� -
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRAC70R5 LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPERTY YrtiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OF HERSELF OR
� THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
Q OFFEFE�FORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE- �
Z 710N,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEI(CLUSIVELYCON7RACTINGWITHLICENSEDCONTRAC70RS
� TO CANSTFUCT TFIE PROJEC7(SEC.70�4,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� Velue�i0f1 � ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPR0.1EC7SWI7HACONTHAC70R(S)LICENSEDPUHSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
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0 , ❑I M1 EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q �
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENqNG WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z i
X MV UCENSE IS IN FULL FORCE AND E�CT.
� LICENSE CLASS � LIC.NO. �O �'� j
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DATE CONTRACTOF d
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� WORKERS'COMPENSATION DECLARATION a
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF 7HE FOLLOWING DECLARA710NS: Z
Z _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
a CAMPENSA710N,AS PROVIDED BY SECTION 37000F THE IABOR CODE.FOR THE PERFORMANCE W
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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Qw _I MAVEAND WILL MAINTAIN WOHKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SECTION
3700 OF THE LABOR CqDE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 4
¢ ISSUED.MY WORKERS'COMPENS 'INSUR ARR��POLICY NUMBER ARE: CONSTRUCTION �
] CARRIER PLAN REVIEW
� POLICY NUMBER ELECTRIC
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� (fHISSECiIONNE�NOTBEOJMREfEDOFTHEPEMNTISFORONEHUPDREDDOLLPAS(f100)ORLESS� PLUMBING
Z I CERTIFV THAT IN THE PEHFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(3 SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AG THAT IF I SHOULD BECAME INSPECTION FEE
� SU&IECT TO THE WORKERS'COMPENSATION PROVISION O SECTION 3700 OF THE LABOR ,
� CADE,ISHALLFORTHWITHCOMPLVWI7HTHOSEPROVI io . • ISSU,4NCE � ._
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p DATE: ���PLICANL S � � �'_�-== ^.'�\` ��� 1 )�
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J WARNING:FAILURETO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL.AND SHALLBE ENERGY P/C �'� ^
LL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSAND EN ERMIT 1 R A 1 ! 7 1 1 I 1/
DOLURS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE IABOR CODE,INTEREST,AND ATTORNEY'S FEES. ETENTION FEE: �� � J�I tl J ' `
a CONSTRUCTION LENDING AGENCY PRE- �
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� I NEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUC710N IENDING AGENCV �'-�ubT' _ __�,�-----'=�
FOR THE PERFORMANCE OFTHE WORK FOR WHICN THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). �......-
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� LENDER'S NAME .
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H LENDER'SADDRESS
� TOTAL F S '
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
w I AGREE TO COMPLV WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIO D PROPERTV FOR IN PECTION PURPOSES. COMMENTS
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= RECP.N0. I PAID BY VALIDATION I
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FTGSlFORMSlSTEEL ; ` FHA REQMTS __
ELECTRIC GROUND � __~ UNDER FLOOR DUCT � —� _
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GROUND PLUMBING __ ; UNDER FLOOR CU�!DUIT � '
SLAB GRADE FIREPLACE FOUNDATION � __
TEMP POWER i _._ _� FIREPLACE BOND BEAM
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WATER SERVICE � � MID HT. BOND BEAM
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ROOF SHEATHI(VG - �� �� � ; 8�T.BOND BEAM '
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FRAMIfJGNENTIL(ATIOfJ � FlNAL BOND BEAM i
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ROOF COVER - --• PRE-GRAt71NG ,_. �— � —.__._.__.__.._
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ROUGH HEATING BENCHING
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ROUGH ELECTRIC r�OUGH GRA�JING
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ROUGH PLUMBING I � FINISI-i GF�ADING �
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SHOWER/TUB 7EST � � I POOL ELEC�rHIC
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� � POOL FENCING
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EXT. LATH/SIDING �
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WALL INSULATION �� POOL FINAL �
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CEILING INSULATI�N i OFF SITE IMPS. ;
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DRYWALL NAILI�lG � DEDICATIOf�S ___ _ _
SEWER FINAL ENG.
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SEPTIC TAI�tK � LANDSCAPE/IRRIG. i _
SEEP PIT/L.L. --!- ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. ' FIRE DEPT. FINAL
FIN,4L HEATING ! �HEALTH DEPT. FINAL
FINAL ELECTRIC � �DEV. FEES PAID �
FINAL PLUMBING � ! � NE ERGY
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