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t ' 1� CITY OF DIAMOND BAB EXP'IREp
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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(909)860-3195 Fax(909)861-3117 �Uf�I 1 7 ZOOZ PRESS
���'� BUILDING PERMIT APPLICATION FIRMLY
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APN LOT TRA T DATE CONST. GROUP
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" ADDRESS l� ZONING SETBACKS
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cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBY AFFlRN UNDER PENALN OF PERIURV THAT I MI EXEMPT FROM THE CONfMCTORS LI� G8f8 J0/CBIPOft I
W CENSEUWFORTHEFOLLOWINGREASON(SECJo31.5BUSINESSANDPROFES510N5CODE:ANVCI7VOR (n '
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Z NRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
W STATEMEM THAT HE OR SHE IS LICENSED PURSUAHT TO 7HE PROVISIONS OF THE CONTRACTORS LI� w
� CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- LL' PooVSpa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND hIE BASIS FOR THE ALLEGED EXEMP�
TIDN.ANYVIOLATIONOFSECTION70.11.58YANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAHTTO Z Re-Root �
�� A CIVIL VENALTV OF NOT MORE 7HAN FIVE HUNDRED DOLURS(t5oo).):
� �I,ASONMEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSO�ECOMPENSA7qN, � Commercial -
WILL DO THE WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70u,BU51� J
� NESS AND PROFESSIONS ODDE:THE CONTMCTORS LICENSE UW DOES NOT A7PLV TO AN OWNER OF � '
PROPEHfVVh1OBUILDSORIMPROVESTHEREON,ANDWHO00ES5UCHWORKHIMSELFORHERSELFOR m �
� THRODUH HIS OR HER ONRJ EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
Q ,OFFEREDFORSALEIF,HOWEVEFLTHEBUILDINOORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPIE-
Z `TION,THE ONMERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE f-0R THE PURPOSE OF SALE).
w ❑I,AS OVMER OF 7HE PROPEHTV,AM EXCLUSNELY CONTRACTINO WITH LICENSED CONTMCTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7os1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U2110f1 O ADJ.AREA
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DATE OVMER �
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� LICENSED CONTRACTORS DECLARATION W
OC I HEREBY AFFIRM UNDER PENALTY OF PE0.IURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER Ur
� Y(COMMENCIHO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
� UCENSE CLASS l � / LIC.NO. 1 !i� j .
WDATE ���I CONTRACTOR a
� WORKERS'COMPENSATION DE A ON�� C�1 �
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� I HEREBYAFFIRM UNDER PENALTV OF PERIURY ONEOFTHE FOLLOWING DECURATIONS: U
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� _I HAVE AND WILL AWNTAIN A CERTIFICA7E OF CONSENT TO SELF-INSUFE FOR WORKEHS' _
COMPENSATION,AS PROVIDED BV SECTION 37a0 OF 7HE IABOH CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. �
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_I HAVE AND WILL MAINTAW WORKEHS'COMPENSATION INSURANCE,AS REOUIRED eY SECTION �O(� �/t
QQ 3700 OF TiE LABOR OODE,FOq THE PERFORMMlCE OF THE WORK FOH Wh{ICH THIS PERMIT IS �� v
ISSUED.MY WORKERS'COMPENSAT^ION 7IN�"/I RANCE CARRIER�AN-D_PO`L�I Y NUMBER ARE: CONSTRUCTION �
jCAHRIER S�('r 1 G ��v I� PLAN REVIEW
� POLICY NUMBER C�O O I"'j �� ELECTRIC
� (iHSSECfqNNEIDN0T8E001.�LEfIDOFhIEPERMTISFORONEMNDiREDDOLlA0.SR100)ORLESS) PLUMBING .. . ;�^^--:.�'."^'
111 ., �._..
Z I CERTIFV THAT IN THE PERFORMANCE OF THE MIOHK FOR WHICH THIS PERMI715 ISSUED,I MECHANICAL � � '.'=._�.�._
(} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SOAS TO BECQME SU&IECT TO THE
� WORKERS'COMPENSA710N IAWS OF C/�LIfORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR � / {
CODE SH FOR7HWITH COMPLY WIT/7HOSE PROVISION\S. ISSUANCE � � `l� �J I E
p DATE: S I D I APPLICARTW`I/ ��1 D� SMIP
J WARNINO:FARURE TO SECURE M/ORKERS'COMPE SATION COVERAGE IS UNUWNL,AND SHALL BE ENERGY P/C — �
� SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED 7HOUSAND ENERGY PERMIT --'-"� " �
DOLLAHS(f1oo,000).IN ADDITON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SEC710N 37oe OF hiE U�BOR CODE,IN7EHE5T,AND A7TORNEI"5 fEES. � RETENTION FEE:
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d CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� 1 HEREBV AFFIRM UNDER PENALTV OF PERJUHV THAT THERE IS A CONSTRUCTION IENDING AGENCY ;
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.3oYl,CIV.C.). _ ,
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� LENDER'S NAME �
F— LENDER'SADORESS
� 1 CER7IFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA7pN IS CORRECT. TOTAL FE ES �
� 1 AGREE TO CAMPLY N7TH ALL CITV M1D CAUNTY OFDINANCES ANO STATE UWS RELATING TO BUILDING ���
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF 7HI5 COUNTV TO ENTER UPON THE ' '
Z ABOVE-MEMpNED PHOPERTY FOR INSPEC710N PURPOSES. COMMENTS
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N SIONA I E DATE � ,
� RECPT.NO. PAID BY b VALIDATION
WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK � �t � FLOOR JOISI�, ;,�
FTGS/FORMS/STEEL ` FHA RE�MTS �
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT � __
SLAB GRADE FIREPLACE�FOUNDATION _
TEMP POWER FIREPLAC�BOND BEAM
WATER SERVICE MIQ HT. BOND BEAM _
ROOF SHEATHING C? Z5 � 8 Ff. BOND BEAM i_ _
FRAMINGNENTIUATION � FINAL BOND BEAM I
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 i �
WALL INSULATION POOL FINAL �
CEILING INSULATION � OFF SITE IMPS. j v�
DRYWAL.L NAILING DEDICATIONS �—
' SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. � �
SEEP PIT/L.L. ON SITE IMPS.
, GAS AIR TEST FINAL ZONING
FINAI CONST. FIRE QEPT. FINAL
FINAL HEATING i HEALTH DEPT. FINAL
FiNAL ELECTFIIC DEV. FEES PAID
FINAL P�UMBING � ENERGY
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