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CITY OF DIAMOND BAR
- --�� ---� DEPARTIvrE?`'T OF COIvA�1UN1'I1'&�DEVELOPMENT SERVICES �
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��'<��� BUILDING PERMIT APPLICATION FI MLY
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¢ DDRESS_ � APPLICATION � � 02 PERMIT �� #/C
o DATE NUMBER
� ISSUE � TYPE OCC
APN LOT TRACT _ DATE CONST. GROUP
p OWNER
o ADDRESS ZONING SETBACKS
Z CITY IP TEL. .- FRONT Ryy ❑
� APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW O
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Q CONTRACTOR SIDE ❑
� ADDRESS PROPOSED USE
o CITY ZIP 9��� TEL. 461�yS
o ARCH/EN /
z DESIGNER
w NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES �_ BEDROOMS
� CITY ZIP TEL.
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMP7 FfiOM THE CONTqACTORS LI- G0fe98/CefP011
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPqOFES5lON5CODE:ANVCITVOR (n
U COUNTVWHICHREOUIRESAPERMITTOCONSTFUCT,ALTER.IMPROVE,DEMOUSH,CRREPAIRANVS7RUC- W Patio/Deck
Z 7URE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FON SUCH PEiiMIT 70 FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � w
� CENSE UW(CHAPIER Y(COMMENCING WITF1 SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� � PooUSpa � �
FESSIONSCADE)ORTHATHEORSHEISEXEMPT7HEREGROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
� TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICAN�FOR A PERMIT SU&lEC(S 7HE APPLICANT T0 Z Re-Roo1 s J� �
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS�5500).�: �
� ❑I,ASOWNEROFTHEPROPERiY,ORMYEMPLOYEESWi7HWAGESA5IHEIR50LECAMPENSATiON, � COmrtl0fCi81 I
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOEO OR OFFERED FOH SALE!SEC.7011,BU51. _1
� � NESS AND PROFESSIONS CODE:THE CANTfiACTORS IICENSE LAW DOES NO'APPLV TO AN OWNER OF � '
7ROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSEIF OR HERSELF OF
Q THROUGH HIS OR HER ON71 EMPLOVEES,7ROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDFOPSILEIF,HOWEVER,7HEBUILDWCORIMPROVEMENTISSOLDWITMINONEYEAROFCOMPIE- ,
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING:HAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PUHPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTY,AME%CLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS
Q TO CANSTRUCT THE PR0.IECT(SEC.70�d,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U- V21U8NOf1 _ � ADJ.AREA �
W CENSE LAW DOES NOTAPPLV TO AN OWNER OF A PROPEHTY WNO dUII.DS OR IMPROVES 7HEREON,AND
� WHOCONTRAC75FORSUCHPROJECTSWITHACON7FAC70H(S)LICENSEDPURSUANT70THECONTRAC� QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� � O I AM EXEM7T UNDER SF_C. B.8 P.C.FOR THIS REASON Q
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� — CC
DATE OWNER _ � '
Z w
� LICENSED CONTFiACTORS DECLARATION W
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCING WITH SECTION 70W)OF DIVISION 3 OF THE BUSINE55 AND PP.OFESSiOnS CODE,AND Z
`X MY LICENSE IS M FULI FORCE AND EFFECT. m
� UCENSE CLASS ��� � LIC.NO. � J j
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U DATE a� /►�^��fG CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION a
� I HEFEBYAFFIRM UNDER PENALTV OF 7ERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
� I MAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENTTO SELF�INSUHE FOR WORKERS' a
Z
a COMPENSA710N,AS PROVIDED BV SECTION 37000F 7HE LABOR CODE,FOR TME PERFORMANCE `U
Q l]G�MIE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w �HAVE AND WILL MAINTAIN WOHKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION /�_ , �
Q 77000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS �7
ISSUED.MY WORKERS' EN ATION�INS>URANCE CAR AND POLICV NUMBER ARE: CONSTRUCTION V
¢ CARRIER � I Y � PLAN REVIEW -
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Z POLICY NUMBEfi������, ELECTRIC
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� (IHISSEC7/�NNE�NDTBEOJMR.E7FDOFTHEPEW./RISFORONEHUPDREDDOLLPAS15700)ORLESS). PLUMBING
W
Z I CERTIFY THAT M THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C} SHALL NOT EMPLOV ANY PERSON IN ANV AIANNER SO AS TO BECAME SUBJECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INS?ECTION FEE
'= SUBJECTTO TME WORKERS'COMPENSATION PROVI ONS OF SECTION 7700 THE LA R ,
CADE,I SHALL FORTHWITH COMPLV WITH THOS OVISIONS. ISSUANCE
� ��C� '` SMIP C�C/
p DATE: �` y ���'APPLICANT. � 1
J WARNING:FAILUHE TO SECUFE WORKE(75'COMPE ION COVERAGE IS UN WFUL,AND SHALL BE ENERGY P/C
� SU&IECTAN EMPLOVER TO CHIMINAL PENALTIES AN�CIVIL FINES UP 1'00 HUNDRED THOUSAND ENERGY PERMiT
DOLLARS(5700.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN
� SEC710N 3708 OF 7HE LABOR CODE,IN7EREST,AND ATfORNEV'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: '
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDWCa AGENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309],pV.C.).
Z
W
S LENDER'S NAME
�
F— LENDER'SADDRESS
� TOTAL FEES � GJ�� �D
� I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT TME ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALl CITY AND COUNTV ORDINANCES ANO STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AN HEREBY AUTHORIZE FEPRESENTATNES OF THIS COUNTV TO ENTER UPUN TNE
Z ABOVE�MENTION OPERTV FOR INSPECTION P OSES.
Q ( � COMMENTS ,
� 7� �� �
m PERMITTE (PRINT)
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N SIGNATUREOFPERMITTEE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—De artment Co YELI.OW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A canYs Co
P PY, PY, PY. PY. PP PY
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_._ .__ ; --- _._-_ --- -----_ --= . I------ -_.._--
FTGS/FORMS/STEEL ; � I FNA REQMTS
- ,_---- -- --- ----.._ ------_-- -...--
--- - -- -
ELEGTRIC GROUND � UNDER FLOOR DUCT I ___
- - -- -- --------� ---- -...- ---------
GROUNQ PLUMBING , UND[R FLOC?R CUt��DU�T _ ' • � _
--- ---�- ---- _ _
S�AB GRADE ' � f-(f�FPLACE F�UNbATICON i (
____. �_ l 1._ _ � � � .._.______-__ r -i _- --
TEMP POWER --- � ' __ __ 1 F�iREPLA�E BdNC} BEAM
- --
WATER S.ERVICE j , ; Mid NT E30ND BEAM ' �_ _
-- -- _._.---- _ _...... __._... -- -�-- --------- ' .
ROOF SHEATHING 7j;�%fo:. �, �� _�_y_8 FT. BOND BEAM , . , ;
._ -- ----
FRAMINGNENTILIATION � � � ` FiNA�E30ND BEAM �
--- ----- ---...__._...,----- -._..._... ---.._...__...__--------- ,
_.._.....-----
ROOF COVER _ � , PRE-GRAQING
- -- - ---------------...._.....- --;_...._----- � -----....
ROUGH HEATiNG _ __..__ __� � ����%��N� ;
_ --.. __... - -- _...�___._.__
ROUGH EIECTRIC I RC�t.JGH �RADING � �
__ _ -------...__. _. _._--.� _ _......_ ..._._....---- -- ..._._
ROUGH PLUMBING I FINlSH uRADING __ _ _
-- -�- ------- ------- -- - -----
SHOWER/TUB TEST _�___ ; PO�L ELECTRIG __
EXT. LATH/SIQING _� ___ j POOL FENCING �
� -- -- _
WALL INSULATION � POt3L FINAL �
------ -- ----- -... -----._--- �
-- ....-----
CEILING IN�U�AT10N � '� �?FF SITE IMPS. �
_ __.._ _.__ __.._ _ __...... ._. .- --- ----_ ._._....--'--
�_.
- -
QRYWAL�NAILING � _ , ` DEDiCATIQNS
------- --------- !---- --._._� ---- -----.....-------- --
SEVNER �_FINAL ENG.
- --- - -- ------- --
SEPTIC TANK �i LANDSCAPE/IRRIG_ _ __�
---- -
SEEP PIT/LL I � GN 51TE IMPS:
_ - �. ................--- ------------- -
GAS AIR TEST ; FiNA�ZONING
____�___. ___._.-----.....
- ______ ----------
FINAL CONST. -----� ___.._.._�_ _ ; �iRE C�EPT. FINAL
-- __ :-�----------------. � ----- _.------ - -----
FINAL HEATING ' HEALTH DEP f FINAL
--�--- --�-------- -- - -- ---
FiNAL ELECTRIC I ; � DEV. FEES PAID _ l __
-----
FINAL PLUMBING ! i ENERGY �
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SEPTIC TA�IK SIZE
SEER PIT/U SIZE -- --- --�— — —
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