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CITY OF DIAMOND BAR
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
� '"%�w��� BUILDING PERMIT APPLICATION FIRMLY
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cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
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I HEREBY AFFIRM UNDER PENALTV OF PERIURV THA7 I AM EXEMPT FROM THE CAN7HAC70RS LI- G8f896/C9fpOfl
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVCINOR (n
U COUNTYWHICHRE�UIRESAPERMITTOCANSTRUCT,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANVS7RUC- -
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck �
STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB
FESSIONSCODE)OFiTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLECaEDEXEMP� (�
� TION.ANVVIOIATIONOFSECTION7031.5BYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Aoot
A CIVIL P NALTY OF NOT MORE THAN FIVE HUNDRED DOLLAHS(f50o).):
ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, �
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Z WILL DO THE WORK,AND THE STRUCTURE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.7o4d,BUSI- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OF HERSEIF OR
2 THROUGH HIS OR HER ONRJ EMFLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDFORSALE.IF,HOWEVEf{THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,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,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCON7FAC70RS
� TO CONSTRUCT THE PRQIECT(SEC.701�,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8�10� U ADJ.AREA
W CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPER7V WHO BUILDS OR IMPROVES 7HEREON,AND
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Q O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATtON W ,
� I HEREBY AFFIRM UNDER PENALTY OF CERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER �
� Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLAFATION Q
� I HEREBV AFFI{iM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO SELF�INSURE FOR WORKERS' _
¢ COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PEHFORMANCE W
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS QG �CJ
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION /O
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� CARRIER PLAN REVIEW
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� (1}iISSECiXXJNE�NOTBE00MPLEfEDOFTHEPEW.If�4SFORONEHUI�DREDDOLlA0.S(f100)ORLESS). PLUMBING � ^ � �y l � �~'�
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �
C7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE �) q ^(�nn
� WORKERS'COMPENSA710N1AW50FCAUFORNIA,ANDAGREETHATIF15HOULDBECOME INSPECTIONFEE IS /. � /1lII!
? SUBJECT TO THE WOfiKERS'COMPENSATION PROVISIONS OF SECTION 37oa OF 7HE LABOR I �I • ; /1 • �
CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. �SSUANCE 01
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p DATE: APPLICANT:
J WARNING FAILURE TO SEWRE WOHKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C ���`�'-'—r. __ _.r
LL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(S�OO.OW),IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN `
� SECTION 3708 OF THE LABOR CODE.INTEflEST,AND ATTORNEY'S FEES. RETENTION FEE: /_ ,
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT 7HERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.308�,CIV.C.).
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� LENDER'S NAME
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� ICERTIFV7HATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINfORMATIONISCORRECL TOTAL FEES � l��,�v
w I AGREE TO COMPLY WITH AlL CITY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTNIS COUNTV 70 EN7ER UPON THE
� A80VE�MENTIONED PROPERTV FOR INSPECTION PURPOSES.
Q ��� ������ j_ ,�U��_� COMMENTS
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QPERMITTEE NAME(PRINT) � ��`o�
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� SIGN � EOFPERM E DATE
= RECPT.NO. � PAID BY C VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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ELECTRIC GROUND ' � � UNdER FLOOR DUCT � -• �
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GROUND PLUMBING � UNDER FLOOR CUI�'�UIT ; � _____ _
SLAB GRADE _�_____ FIREPLACE FOUNDATiC}N ' _ _
TEMP POWER . `, �_._- — FIREPLACE BOND BEAM__ i ___ ---_
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WATER SERVICE . ___�� __� MID HT. BOND BEAM
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ROOF SHEATHING � i 8 Ff. B�ND BEAM__ '
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FRAiVIINGNENTILIATiON ___�_ ___ I �INAL BOND BEAt� �
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ROOF COVER � _ PRE-GRAi�ING __ _ ' ,______
ROUGH HEATING BENCHING ____ �I ______
ROUGH ELECTRIC ROUGH GRADING �
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ROUGH PLUNIBING i FINISH uRADING �
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SHOWER/TUB TEST � � POOL ELECTRIG
EXT. IATH/SIDIfVG POOL FENCING I
WALL IfVSULATIOhI POOL FINAL ;
CEILIf�lG IfVjULATiO1V OFF SITE INiPS. �
DRYWAL�iV�ILIi�G DEDICATIONS ; '
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SEWER FINAL ENG. �
SEPTIC 7ANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS. �
GAS AIR TEST � FINA�ZONING
FINAL CONST. ---` � , FlRE DEPT. FlNA� ��-W- v------
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FINAL HEATING �iT HEALTH DEPT. FWA�
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FINAL ELECTRIC ; DEV. FEES PAID
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FINAL PLUMBING ( � I ENERGY ����� �
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