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FACTOR PSF ADJ.AREANALUATION � � OWNER-BL'ILDERDECLARATION • SFR/ADD�'REM O ' p 1 MEREBY AFFIRM UNDER PENALTY OF PERJl1RY THAT 1 AM E%EMPT FROM iHE CO4TRACTORS LI� G3f0gelCeryOr1 � W CENSEUwFORTNEFOILOw!NCREASON(SEC.7o�t.58U51NE55ANDPROLE55lON5CA0E-MlYCITYOR (n � CpUNTYWHICHREWIRESAPERMITTOCONSTPUCT,ALTER.MPROV[,Df1AOLISH,ORREVAIRANVSTRUG� W NRE,PRAR N ITS ISSUANCE,ALSO R'cOUIfiES THE APPLiCA4T FOR SVCH PEfiMIT TO FILE A SICNED W Patio/Bevk 4�/fx ' W STATEMENT TMAT NE OR SME IS LIGENSEO PUIiSUANT TO 7ME PNOVISIONS OF iHE CONTMCTORS Lb . S CENSE UW(CHAPTER Y(COMMENCWG WITH SECTqN 7000�OF DM5qN30F 7H[B:JSiNE55AND PRO� � POOVSPB � FESSIONSCODEIORTHA7HEORSHEISEXEMATTHEREFROMANDTHEBASISFOR7MEALlEGEDE%EMP• V TION.ANYVi0U7qNOFSECTION7o]I.58YANYAPPLILAMFO�7APERMITSU&IECTSTHE�FPI�CANTTb Z Rp-ROpf . � A CML OfNALTY OF NOT 40Rf THAN iNE HUNORED DOLLARS(5500),I: . � OI,�SOWNEROFTHEPROPERTv.ORMVE�oLOYfESwITNWACESA5T41EiR50LECO�PENS�7i0N, O COmmOrti�1 Z YlILL DD TM[WORK,ANO iM[STRUCTURE IS NOT INTENDED OR OFFEREU FOR SPLE(SEC.7W�,BUSI� J NESS AND PROFESSIONS COOE.THE OONTPACTORS ULENSE UW DOES NOT APPLV TO AN OWNER CF �J� N PROPERTYMh108U:1D50RIMPROVESTHEREON,ANDWHODOESSUCHWO�iKH�MSELFORHERSFLFOq � �(.G� � 2'�� � THROUGHHISORXEROwYEMPLOYEES,DROVIDEOiHATSUCHIMPROYEMENTSARENOTWTEN�EDOR m QOFFEREDFORSALE.IF,IqWEVE0.1HE8UILDINGORIMPROVEMENT1550lDWITHPJONEYEAROF�OMFIE� ' Z TION,THG OVfNER BU4DER WILL NAVE THE BUROEN OF VROVI�G THAT NE OR SHE DI'J NOT EURD OR = IMPROVEFORTMEPURPOSEOFSALE). � w OI,ASOYR:EROFiHEPROPERTY.AME%0.USIVELYLOMMCTWCYf•iHLICENSEDCONTMCTOFS _ (L TO CANSiRUCT THE PROJEGT(SEC.7a�,BUS�N[SS/�ND VROFESSiONS CODE THE CONTMCTOfiS LI• V�lu3tiOn ADJ.AREA W CENSEUWDOESNOTAPP�YTOANOWNEROFJIPRWEFTYW110BUILDSOHIMPROY[STHERCON,AND � YAiOCONTFACTSfORSUCHPROJECTSWITMACONTMCTOR(S)LILENSEDPURSUMfTTO7HECON7MG OUANTITV �CSCRIPSIO�J � � � FEE . TORSLICENSELAW�. QO��u EXEIAPTUNDER SEC. B.d P.C.FOR 7HIS REASON U I� �� � Q LL" �ATE OwN[R � . � � W � LICENSED CONTRACTORS DECLARATION W ��� � IMEREOY/�FFIRMUNDERPENALTYOFPEHJURYTNATIAMLICENSEDUNDERPROVISqNSOFLHAPTER � . p„ q(�pMM[NCINGWRNSECTION7000)OFDMS�OY]OFTHEBUS:NESSANDFROFESSKKISCODCtiYD ' Z X ►IYLICENSEISINFULLFORCEMI7EFFECT. �A : m � LICENSE CLA55��l��.—UC.NO. J Ol y��_�.( j � V DATE_3.�1!�� � �L��!1 a CONTRAGiOR W ��' � WORKERS'COMPENSATION DEC 'a�IG'�l � � a � 3� IHEREBVAFFIRMUNDERFENAL7YOFPERIURVON[OFTIEFOUOW:NGDECLAMTpNS:�, � Z Q O _INAYEANDW�LLMAINTAI4ACEHTIFICATEOFCONSENTTOSELF�IhSUREFOf1NORNER.`.' _ � COMPENSAnON,ASPROV10EDBVSECTIONa70oOFTHEUDORCOOE.FORTHEPERWRMANCE W OFTHEWOFKFORWHICHRi15PERMITISISSUED. � ., � W IFUVEANDW;ILMAINTAINWORNFRS'CONPENSATIONINSURANCE,ASREW:fiEDBYSECTION Q �]7ooOFTHEU[30RCODE,FORTM[PERFDRAIANCEOFTHEWORRFORWHICHTHISPEAA�ITIS � �/ � ISSUED.MYWOflKERS'COMPENSATIONINSURANCECARRIERANDDOLICYNUAI�3ERARE: CONSTRUCTION �� _� 9�,]_ ¢ _$����..VI� PLANFlEVIEW �_�� > w+nien /� /� /� /� Z GCLICYNUN6ER�l��J�J��—/�!� ELECTRIC V. . . . _��� Q � 7 � � �n+�ss[ctaraN[owrs[oor.stcr[ooFnEOEwwrswnor+E�unPmoatnns�sim�on�i PLUME3ING Z ICERTIFYTMAiMTMEPERFORMPNCEOFTiEWORKFORWHICHTHISPEHMIT15155UED,l MECHANICAL (7 SHALLNOT EMPLOYANV FERSON W ANY M0.YNEfl SOAS TO 9ECOM[SUOJECT TO iME. � N M'OiUCEHS'COA!PENSATIONLAWSOFCALIFORNIA,AN�AGREEIMATIFISFIOULDDECOME INSPECTIONFEE S SUOJECT 10 THE WOFKEiYS'COIV.PENSATI�N PROVISIDNS OF SECTION 7700 OFTNE U!'AR /� CADE,�SNALLFORTTIWITH COMPLY WiMTHOSE VRONSIONS. ISSUANCE � �V� � —3.-�' �1f���—�-�� p DATE: Yy� AFPLICANT: � SMIP W � - J WARNING:FAIWRETOSECUR[WOAKERS'COMOENSATIONfAVERAGEISUNUWNL,AN'JSHALLBE ENERGYPlC � SUfiJEGTAYEMPLOYERTOCflIM:NAIPFNALTIESANDCMLFWESUPTOONEHUNDREDTNOU5AN0 ENC-RGYPEViM1T _p�v•-" ' DOLURS(S7oo.000).1N ADDITION 10 THE COST OF COMPENSATqN,OAMAGES AS PflOViDLD FOH IN � SEGTION�7080FTHEUBORCODE,PllEREST,ANUAT70RNEY5FEE5. RETENTIONFEE: �� a CONSTRUCTION LENDING AGENCY PR[-ALT FEE: O ' � IHEREBYAFFIRMUNOERPENALTYOFVCfiNRYTMATTHLRE15ACON5TRUCTIONLEN0INGAGENCY , � �- FOR TMC PERFORMANCE OF THE WOFK FOR WHICH TMIS PERM:i I5155UEO�SEC.7091,CN.G.�. � I w� �LENDERS NAME�� � ,� , � S �LEnDER'SADDRESS - �� ` � � � `� ! ¢ ICERTIFVTHAiIHAVEREA�THISAPPL�CATIONIIN'JSTATETHATTHE/�BOYEPIFORMATIONISCO�iRECT � TOTAL FEES � w' IACREE TO CCMPLV WITN ALL CIZY/�NO COUNT'(O�DININCES/�ND STATE UWS NELA'IhG TO�UILD:NG� ' � 'CONRRUCTION,MlOHEREBYAUTFIORIZEREPR[SENTATIVCSOfTXISCOVNTVTOENTERUPONTNE'��� ' �, z. 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COMMENTS .o ;;�' � .� �� �� ,� _ J 1 ��� � � � _ � ¢ �PERMI7TEEKAMEI INn ' ` �_`=�- �� � +�// �//f _ ,� lM.�� -:��/-/�✓ . � � SICNA �iL F ERMITTEE '�, DATE � � � - REC��� PAID BY _. _ _VALIDATION _ WHITE—Department Copy.YELLOW—Finence Capy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � ..1 .. . .. . , ..., ..r.:.. . �.r� . ., . . .- .. -['.ti:`� � .;n<. . , ;-<=' • � , . ..,.. ,.. .. . , ' ,. .. .. ...�. ♦ � - • ' . .. .,_ • , '� . � CITY OF DIAMOND BAR „' : , INSPECTION RECORD � ' I� .i ' �7..�.Qi�� e.1� � ' � E� � � .U-�.1� E �-�J.1� � ' I� r'.�e I�� r. � SE :''{CK � ' � I FLO�R JOIS .•, FTG:;FORMSlSTEEL Z � FHA REQMTS �� � • ' ' . ,. r ,. � ELECTRIC GROUND UNDER FLOOR DUCT . _;, ' t� .. :. . • � GROUND PLUMBING UNDER �LOOft COPIQUIT � s"1 . •�' °•it•;`•-' ` SLAB GRADE - � FIREPLACE'FOUNQATION �� ' •� ' �• ' - ' � TEMP POWER � FIREPLAC�E BOND BEAM � ` �� '� �� ' `� • ' �11fA`TER SERVICE� ' '�'�'� `• ��' � ' � • ' MID HT.'•�OND BEAM.� ' � ' •���� 1 ' � ROOF SFiGA�HtNG ` 8 FT'.BOND BEAM ' � � � , FRAMINGNENTILIATION 1��-L-� � FINAL BOND BEAM ROOF COVER �- PRE-GRADING RQUGH HEATING BENCHING ' ROUGH ELECTRIC �- ROUGH GRADING ROUGH PLUMBING �- �.. FINISH GRADING � SHOWERlT'UB TEST POOL ELECTRIC '� • EXT.LATH/SIDING PQOL FENCING � • WALL INSULATION POOL FINAL . - CEILING INSULATION `. -.'.�, ' OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. ' SEEP PIT/L.L. � . ON SITE IMPS. GAS AIR TEST - t' , =� FINAL ZONING FINAL CONST. ��• FIAE DEPT.FINAL ; FINAL HEATING • •� ` • ' . HEALTH DEPT. FINAL - FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY , • ' •. . . : , _ . �F�' s • - � -- • .. • ,;i � ' . . , �. COMMENTS � `' � ' ... 1..� �� . � . i _ .� _. . • � . ' . � . • '' j ; � • �l`. ! - -. _. _ . _ : ; , �<< . , • -\ � � ��Y �� ,- . - . �,,�_ ..,� .�; ��:;:. . - _- - - , �vuf t' i CJ`i f . - � i: :'r. SEPTIC TANK SIZE " � � SEEP PITN SfZE � ''� • �7� � -�'��—"��, � � _ . �'� s-��r r °�'��l'���"'�1 ' / . - � .r�p vo,r� �� n ��-L � � . ,� �J�a ��--•�.����s:.. 1��� Z- , �,. . . ,' , ,, �d -�1 �.,-���,.���J �f� , .. \ .. \ _ .� .`1 ' _. �1•:' • • �` . � 8 ��