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CITY OF DIAMOND BAR ' �\ ,
--�---J�� --- DEPARTMENT OF COIvIIvILJNITY 8c DEVELOPMENT SERVICES �
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��"-���� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE ��� �'�/�•'p �/�� APPLICATION (,,._ �
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM E%EMPT FROM THE CANTRACTORS LI� Gflf8Q8/CBfPOh
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANYCINOR (n
U CAUNTVWHICHREDUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W P81i0/DBCk
Z TUqE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CANTRACTORS LI- w
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO� � POOUSp3
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V 710N.ANV VIOUTION OF SECTION 7031.5 BY ANYAPPLICANT FOR A PERMI7 5U&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
� ❑I,ASONRJEROFTHEPROPER7Y,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECAMPENSA710N, � Commercial -
Z WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BU51- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPER7Y WHO BUILDS OR IMPROVES THEREON,AN�WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGHHISORHEROWNEMPLOVEES,PROVI�E�THATSUCHIMPROVEMENTSARENOTINTENDEDOR m
w OFFERE�FORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEROFTHEPROPERTV,AMEXCIUSIVELVCON7RAC71NGWI7HUCENSEDCONTRACTORS
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� TO CANSTRUC7 THE PRQIEC7(SEC.70��,BUSINE55 AND PROFESSIONS CADE:THE CONTRAC70R5 LI- V21Ue�iOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OMMER OF A PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTFAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
�� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALiY OF PE0.IURV THAT I AM LICENSED UNDEH PROVISIONS OF CHAPTER �
� Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
`X MV LICENSE IS IN FULL FORCE AND EFFECT. m �
0 LICENSE C SS , LIC.NO. j
V DATE� O � CONTRACT a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEilEBY AFFIRM UNDER PENALTY OF PE0.IUPY ONE OF THE FOLLOW WCa DECLARATIONS: Z
Z I`H-AVE AND WIIL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
µMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE LABOR CODE.FOR 7HE PERFORMANCE U
Qv OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED. ' �
w I HAVE AND WILL MAINTAIN WORKEPS'COMPENSATION INSURANCE,AS(iEOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS
ISSUED.MV ORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION
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� CARRIER� it.D� \ S A � r Q� PLAN REVIEW
Z POLICVNUMBER� �,�� �� ELECTRIC
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0 (1FilSSECTqNNE�NOTBECi.'Y�WLETEDOFiHEPERMITISFORONEHUt�DREDDOl1AFiS(t100)ORLESS� PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C.�} SHALL NOT EMPLOV ANY PEHSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&IECT TO THE WOfiKERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
� �DE,I SHALL FORTHWITH COMPIV WITM THOSE PROVISIONS. ISSUANCE
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p DATE: �1 I.I V !/ APPLIC . SMIP
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J WARNING:FAILURE 70 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SUBJECTANEMPIOYERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
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d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDEH PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
� LENDER'SADDRE55
� TOTAL FEES � � .
� I CERTIFV THAT I HAVE fiEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
� I AGREE TO COMPLV WITH ALL CITY AND CAUNTV ORDINANCES AND STATE UWS RELATWG TO BUIIDING �
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ��
Z ABOVE-MENTIONED PFOPERTY FOR INSPECTION PURPOSES. �J
Q �` �� !� COMMENTS
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= RECPT,k0. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,G ENRO File Copy,GREEN—Applicant's Copy
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ELECTRIG GROUND I
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GRQUND P�UMBING�r ___ �____ '; UNDER FLOOR CC��IDUIT__ ;
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SLAB GRADE i ____ _ __� FIREPLACE FOUNDATION !
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TEMP POWER , ___ I._. FIREPLAGE BONC7 BEAM
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WATER SERVICE � i MID HT. BOND BEAM ____
ROOF SHEATHING V , 8 FT. BOND BEAM � _______
FRAMINGNENTILIATION�__ __ � FINAL BOND BEAM __ _ ____ J _____
ROOF COVER ' PRE-GRADING __
ROUGN HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
RQUGH PLUNIBING � _ � FINISH GRADING } _ _______
SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATH/SID1�lG POOL FENCING
WALL.INSULATION POOL FIIVAL �
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL NAIUNG � DEDICATI�NS
SEWER FIfVAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PfT/l.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL COfVST. � FIRE DEPT. FINA� '
FINAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC i DEV. FEES PAID
FINAL PLUMBING ENERGY
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CUi1li iVl E iVT'S
SEPTIC TANK SIZE
SEEP PIT/U SIZE -
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