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1�„!_ CITY OF DIAMOND BAR /�� � (�
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES Cn`� /
21825 Copley Drive,Diamond Bar,CA 91765
' (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027, PRESS
�"��' BUILDING PERMIT APPLICATION FIRMLY
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I HEREBY AFFIRM UNDER PENALTY OF PERNRV THAT I AM E%EMP7 FROM THE CANTRACTORS LI- G0fe9B/CefPOff
W CENSEUWFOR7HEFOLLOWINGREASON(SEC.703t.58USINESSANDPROFESSIONSCODE:ANVCITYOq (n
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT hiAT HE OR SHE IS�ICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- �
� CENSE LAW(CHAPTER 8(COMMENCINO WI7H SECTION 700a)OF DIVISION 3 OF THE BUSINE55 AND PRO� POOUSP2
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A qVIL VENALTY OF NOT MOHE THAN FIVE HUNDRED DOLURS(f500).):
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WILL DO THE WORK,AND THE STHUC7URE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.701�,BUSI- J
N NESS AND PROFESSIONS CODE:THE CANTRACTORS IICENSE LAW DOES NOT qPPLV 70 AN OWNER OF �
7ROPERTY WHO BUILOS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CC THROUGHHISORHERON?JEMPLOVEES,GROVIDEDTHA75UCHIMPROVEMENTSARENO71N7ENDEDOR m
0 OFFEREDFORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
Z TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING 7HA7 HE OR SHE DID NO7 BUILA OR
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w ❑I,AS ONTJER OF THE PROPERTV,AM EXCLUSIVELY CON7RACTING WITH LICENSED CAMRAC70RS
Q TO CANSTRUCT THE PR0.1EC7(SEC.70�4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U3�1On ADJ.AREA
W CENSE LAW DOES NOTAPPLY TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
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� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER �
� e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBV AfFIflM UNDER PENALTY OF PERJURY ONE OFTHE�FOLLOWING DECLARATIONS: Z
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOH CODE,FOR THE PERFORMANCE U
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SECTION �� �
Q 3700 OF THE LABOF}CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
. ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: ONSTRUCTIO 3 3i�
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Z I CERTIFY THAT IN THE PERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � /
(3 SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
y WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD ME FEE
� SUBJECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SE TION 3700 OF H UBOR ��'
� CODE.I S ALL FO HWITH COMPLV WIT�THOSE PRO ISIONS. -
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J WARNING FAIL RE 70 S CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE E
� SU&1ECTANEMPLOYER OCFIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTMOUSAND ENEFGYPERMIT _ �
DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN /�
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE' ✓O
OCONSTRUCTION LENDING AGENCY P FE • //+
� I HEREBV AFFIRAI UNDEii FENALTV OF ERJUR HAT THERE IS A CONSTRUCTION LENDING AGENCY � V D
FOR THE PERFORMANCE OF E WO FOR ICH 7HIS FERMIT IS ISSUED(SEC.3087,CIV.4�.
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� LENDER'S NAME
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,� TOTAL FEES '�3�' q �j��, �
� I CER7IFV THA7 I HAVE READ THIS APPIICATION AND STATE THAT 7HE ABOVE INFORMATION IS CORRECT.
� I AGREE TO CAMPLV WITH ALL CITY AND COUNTV ORDINANCES ANO STATE LAWS REU7ING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HIS COUN7V 70 ENTER UPON THE 9 ////�� /•�,y�J/.�
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FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BQND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING ,
WALL INSULATION POOL FINAL �
CEILING INSULATION � OFF SITE IMPS.
DRYWALL NAILING 1 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
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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