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CTTY OF DIAMOND BAR ,
--��� — DEPARTIvIENT OF COIvIIv1UNITY&DEVELOPIv1ENT SERVICES
21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
"'-�� BUILDING PERMIT APPLICATION FIRMLY
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Z TURE,PRIOP TO ITS ISSUANCE,ALSO RC-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE COMRACTORS LI� �
� CENSE LAW(pUPTEH D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� POOUSpB I
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wTHROUGH MIS OR HER ON7J EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
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Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO TNAT HE OR SHE DID NOT BUILD OR
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CL I HEHEBV AFFIqAI UNDER PENALTV OF PE0.IUFV h1AT I AM LICENSED UNDER PROVISqNS OF CHAPTER �
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� I HEREBV AFFIRM UNDER PENALTV OF PERJUFV ONE OF THE FOLLOWING DECLARATIONS: Z
� _IHAVEANDWILLMAINTAWACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORICERS' _
Q COMPENSATqN,AS PROVIDED BV SEC710N 370o OF THE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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_I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION ��/ � 1
Q 7700 OF THE UBOR CODE,FOR THE PEHFORMANCE OF THE WORK FOR WHICH THIS PERAIR IS //�)
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Z I CERTIFV THAT IN THE PEPFOqMANCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ,��� � �n n� I
C.�J SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
� WORKERS'COMPENSATqN UWS OF CALIFORNIA,AND AGREE THAT IF I SHOUID BECAME INSPECTION FEE �
� SU&IECTTOTHEWORKERS'COMPENSATIONPROVIS1pN50F5ECTION3o00FTH6'LABOW �`
� CODE.I HALL F�HTHWITH COMPLV WITMQH09�,ROVI51 N, ��� ISSUANCE '
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� SUBJECTAN EMPLOVER TO CRIMINAL PENALTIESAND CIVIL FINES UP�TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(floo.o00),IN PDDITION TO THE C0.5T OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
� SECTqN 3708 OF THE LABOR CODE,INTEFEST,AND ATTORNEI"5 FEES, flETENTION FEE:
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O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEPEBV AFFIqM UNDEF PENALTV OF PERIURV THAT THERE IS ACANSTRUCTION LENDING AOENCY
FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED(SEC.3081,CIV.C.).
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� LENDER'S NAME
� LENDER'SADDHESS
w I CERTIFV THAT I HAVE READ THIS APPLICATqN A1JD STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES /�� . �O
� I AGREE TO COMPLV WITH A�L qTV AND CWNTV ORDINANCES AND STATE UWS RELATING TO BUILDING .
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS CWNTYTO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTV JFOR INSPECTION PUqPOSES. COMMENTS -
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SLAB GRAQE FIREPLAGE FOUNDATION
TEMP POWER FIREPLAGE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING '�_�.-p{. � 8 FT. BOND BEAM _
FRAMING/VENTILtATION FINAL BOND BEAM
ROOF COVER `2���-- _ PRE-GRADING
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EX7. LATHISIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILIfVG INBULATION QFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTiC TANK , � , LANDSCAPE/IRRIG.
SEEP PIT/LL. � ON SITE IhAPS.
GAS.AIR TEST FINAL ZONING
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