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1111131:
CITY OF DIAMOND BAR /
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE I/OQ S . p O CC O%�U
ADDRESS
APN LOT TRACT
OWNER A/ oue /3rA�Jtn l
ADDRESS
CITY ZIP Y176 ^ 5- TEL.977 Vel
APPLICANT TEL.
CONTRACTOR 4e w, s % Sons • 6o7✓9
ADDRE S 41071 C :A/PA/m4 AL /C
CITY /%*vAWjjN ZIP74 VO TEL.7AYl3?
ARCHMNG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FDR THE FOLLOWING REASON (SEC. 7071.6 B'USINESSAND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REQUIRES APERMrTTO CONSTRUCLALTER IMPROVE. DEMOLISH, OR RENURANY STRUC-
TURE, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L6
CENSE LAW (gUPTER 9 (COLIMENCPIO WITH SECTION TWO) OF DIVISION 7 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM A00 THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
N'1
A CPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 111500).1:
O LAS OW/NEROFTHE PROPERTY, ORMY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILLWDO THE WOM AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". SUSI-
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF
PROPERTY WHO KURDS OR IMPROVES THEREON. AND M40 DOES SUCH WORKHMSELF OR HERSELF OR
THROUGH HS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FORSALE IF, HOWEVERTHE SULDWOOR IMPROVEMENT IS SCID WITHIN ONE YEAR OF COMPLE-
TION, THE OWNER -GUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE}
O L AS OWNER OF THE PROPERTY AA EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC, 7014. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY TORN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WNOCCNTRACTS FOR SUCH PROJECTS W ITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTMG
TORS LICENSE LAW.).
O IAM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
I (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
W LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE LA 3'7 13 ERIC LIC. NO. W iC t5 01
DATE I CONTRACTOR 4(![•'J Y DVS
WORKERS' COMPENSATION DECLARATION :N,
SEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS;
�_ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4.SU.E FOR VAfiKER.S'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FORWHICH THIS PERMITLS ISSUED.
1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION
7700 OF THE LABOR CODE. FCR THE PERFORMANCE OF TME WORK FOR WHICH THIS PERMIT 15
ISSUED. MY WORKERS COMPENSATION W SUnANCE CARRIER AND POLICY NUMBER ARC:
CARRIER CIA -r& g -N17 1`11: --_.._. ���}}}--�-----��------}}}}{{
POLICYNUMBER y`/G -[+l 04=n yiiQ
(RC. SECTION NEEDNOT BE OOLIPETEDOF THE REMIT 15 FOR ONE HfONED DOW! 111100) LESS?
1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS COMPENSATION PROW° S OF SECTIO! 3700 OF THE LABOR
PHALL
FORTHWITH COMPLY WITH ,fEP IKONS.DATE: Q 1 APR ICANT:
WARNING: FAILURE TO SECURE WORKE AS' COMPENSATION COI&AAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRWNAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND
DOLLARS (6100,000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY 714AT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7097, CIV. C.).
LENDERS NAME
LENDER'SADORESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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PERMITTEE NAME (PRINT)
I RE PE ITT OATS
APPLICATION•. () D'
PERMIT'
P/C
DATE f-
NUMBER
It
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
❑
SIDEISIDE STREET
RW
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SIDE
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PROPOSED USE
PROPOSEDUSE
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NO. DWEL. NO.
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UNITS STORIES , BEDROOMS
DESCRIPTION SO. FT
FACTOR PSF
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Garage/Carport
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Valuation
ADJ.AREA
QUANTITY DESCRIPTION
FEE
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CONSTRUCTION
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ELECTRIC
PLUMBING _zffy_Q_
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MECHANICALR
T�T� 1Y) S AEE1
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INSPECTION FEE
ISSUANCE
SMIP
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ENERGY PIC
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
COMMENTS
A
RECPT. NO. PAID BY
VALIDATION
WHITE—Department Copy. YELLOW --Finance Copy. PINK—Assessor Copy, GOLDENROD—File COW GREEN—Applicant's Copy
CITY OF DIAMOND BAR.
INSPECTION RECORD'
f
ISET BACK-
FLOOR JOIST
FTGS!FORMS!STEEL
I J'FHA REQIMTS .7
ELECTRIC'GROUND
UNDER FLOOR DUCT - -
GROUND PLUMBING r
UNDER FLOOR CONDUIT
SLAB GRADF
FIREPLACE -FOUNDATION
lTEVlP_POWER_____'
FIREPLACE BOND BEAM
1-7
'WATER SERVICE
-MID HT. BOND BEAM
ROOF SHEATHING: -
8 FT. SOND.BEAM
FRAPAWGIVENTILIATION
FINAL' BOND BEAM
lROOF COVER
PRE -GRADING
!ROUGH HEATINGHING
BENr
ROUGH ELECTRIC _L-
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST -
POOL ELECTRIC
EXT L-jr%TH/SIDING
POOL FENCING
!WALL INSULATION-
POOL FINAL
CEILING INISULPATION'0FF
SITE IMPS.
DRYVoALL-NAILING__ it
DEDICATIONS
1SEWER-
FINAL ENG.
,ISEPTICTANK I
LANDSCAPE(IRRIG.
ONSITE IMPS.
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IG �' S Al'
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1F!Nfm.L HE-ATING
ELECTRIC
FINAL ZONING
FIRE DEPT. FINAL
HEALTH DEPT. FINAL
FEES PAID
_DEV.
ENERGY
•
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VI
%
ace -,,Lj
SEPTIC T ANK SIZE
SEEP PIT/U SIZE