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J� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117 PRESS
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BUILDING PERMIT APPLICATION FIRMLY
JOBSITEj
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APN LOT - TRACT
OWNER 6PC"(<0 nr' y j41'j
ADDRESS -r:jA I E
CITY ZIP TEL. _ Tom_
APPLICANT TEL
CONTRACTOR r isi
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CITY ZIP TEL.7 j0,'S•`L� -
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DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.6 BUSINESS AND PROFESSIONS CODE: ANY CITYOR
COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT•ALTER IMPROVE. DEMOLISH, OR REPAIR ANY STRUC-
TURE. PRIOR TO ITS LSSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LH
CENSE UW (CHAPTER 0 (COMMENCING WITH SECTION 70001
OF DNISKN 3 OF ME BUSINESS AND PRO-
FESSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE OASIS FOR THE ALLEGED EXEMP-
TION.
XEMP.
TINO . ANY VIOLATION OF SECTION 7071.6 BY ANYAPPLICANT FORA PERMIT SUBJECTS THEAPPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SM4
17 LAS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WILL DO THE WORK AND THE STRUCTURE IS NOT (MENDED OR OFFERED FOR SALE (SEC. 7044. BUSI-
NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUXDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH MPROVEMENTSARE NOT INTENDED OR
OFFERED FOR SALE IF.HHOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WDHINONEYEAR OFOOMPLE-
TION• THE OWNERBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
MPROVEFOR THE PURPOSE OF SALE}
O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U -
CENSE UW DOES NOTAPPLY TO AN OWNER OF APROPERIY WHO BUADS OR IMPROVES THEREON. AND
WIND CONTRACTS FOR SUCH PROJECTS W1THA CONTRACTORS) LICENSED PURSUANT TOTHE CDNTRAr,
TORS LICENSE LAW).
D IAM EXEMPT UNDER SEC. 0. L P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
(COMMENCING WITH SECTION 7000) OF DIVISION OF THE BUSINESS AND PROFESSIONS CCOE.AND
MY LICENSE IS IN FULL FORCEAND EFFECT. q
LICENSE CLASS ` I UC, ND. 4'""'' Z
DATE�� CONTRALTO `ti�'u'JJ+!'V
WORKERS' COMPENSATION DECLARATION
I HEREBYAFFRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -
—1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. r
_I "IWILL MAINTAINWORKERS' OOMPENSAT)ON INSURANCE, AS FECUIRED BY SECTION
3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
IMED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE--
CARRIER
RECARRIER
POLICY NUMBER
(THIS SCCTIGNNEEDNOTM OMMILUEDOFTRE PERMIT S FORONE HI,0AEDDOLLARS (L100)ORLES4
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED.(
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER $O AS TO BECOME SUBJECT TO THE
WORKERS COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LIBOR
COO I SHALL FORTHWITH COMPLNWPT
E P VISIONS.
DATE: r APPLICAN_
WARNING: A0.LIRE TO SECURE WOR(ERSCOVERAGE IS UNLAWFUL. AND SHALLBE
SUBJECTAN EMPLOYER TOCRMINAL PENLFWESUPTOONEHNDREDTHOUSAND
DOLLARS (SMOM). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
I SECTION 370H OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
I CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CN. O).
I
LENDERS NAME
LENDERS ADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO DOM PLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS MATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
PERMITTEENAME IP -
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7 OIG E rtTEE _;.r.t - DATE
APPL
PERMIT /Z P/C
DATENUMBERICATIO
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#
TYPE OCC
DATE
CONST. GROUP
ZONING SETBACKS
FRONT
RW ❑
REAR
❑
SIDE/SIDESTREET
RW O
SIDE
❑
PROPOSED USE r G I t�W L'� ki r_0 S41I
NO. DWEL. NO.
-
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
W
Garage/Carport
WPatto/Deck
'
PDOVSPa
Re -Tool
J
CommBrclal
-
CIO
Valuation I—J-
ADJ.AREA
QUANTITY DESCRIPTION
FEE
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PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
co
. SNIP_ _
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ENERGY P/C
I
•�}J�%
'ENERGY PERMIT
RETENTION FEE:
PRE-ALTFEE:
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY VALIDATION t
1
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CITY OF DIAMOND BAR
INSPECTION RECORD
SET BACK \ __ .-
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y . t .
FLOOR JOIST,,,,
FTGS/FORMS/STEEL
, , ; .. ;. _
FHA REQMTS
ELECTRIC GROUND _-
-: _ ':_ '-
- ' ' .::
UNDER FLOOR DUCT
r
GROUND PLUMBING
UNDER FLOOR CONDUIT
SLAB GRADE _ .__ .
-_-.-- -
: ; . ; '
FIREPLACE FOUNDATION
TEMP POWER- --
-
;; :.
FIREPLACE BOND B'EAM.......
--'
WATER SERVICE ..:-
-
- _
MID HT.,BOND BEAM
ROOF'SHEATHING
8 FT. BOND BEAM t
FRAMING/VENTILIATION :._ , ..
-
FINAL BOND BEAM
ROOF COVER `'
= ' "
PRE -GRADING
ROUGH HEATING- -
-- "
BENCHING
ROUGH ELECTRIC -',
=``
ROUGH GRADING
ROUGH PLUMBING ; -
-
FINISH GRADING ;:• .
;
SHOWERITUB TEST!—' __
._
_..
POOL ELECTRIC ;
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
+-,
POOL FINAL.
CEILING INSULATION
'OFF SITE IMPS.
='
DRYWALL NAILING I
DEDICATIONS
SEWER- . - . _ _
_ ._ _
FINAL ENG.
SEPTIC TANK . _ _..._ .. __
___
.. _. , _ .
LANDSCAPE/IRRIG.
SEEP P1TlL.L. - -_
_.' . =-
J'
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
COMMENTS_------_--_-_
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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