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��_ CTTY OF DIAMOND BAR �
- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building lnspection Hotline(909)839-7027 PRESS
'A"'. BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE r APPLICATIO PERMIT p/C
ADDRESS���-�$4" P\V'1t�"���S DATE NUMBER'�a`#g� I�- I03�
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� CENSE UW(CHAPTER 0(COMMENCINO WITM SECTION 7oa0)OF DIVISION 3 OF THE BUSINESS AND PqO� � POOI/Sp8
, � FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND hIE BASIS FOR 7HE ALLEOED E%EMP- (�
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Z WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEflED FOR SALE(SEC.70N,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF j
PROPEHTY NM1iO BUILDS Ofi IMPROVES TMEREON,AND NMO DOES SUCH WORK HIMSEIF OR HERSELF OR
wTMROUGH HIS OR HER ONTI EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT ME OR SHE DID NOT BUILD OR
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w ❑I,ASOWNEROFTHEPROPERTY,AME%ClU51VELVCANTRACTINaWITHUCENSEDCONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7w�,BUSINESS AND PROFESSIONS CODE:THE CONTMCTOFS LI- V8IU3flOf1 ADJ.AREA
W CENSE LAW DOES NOTAPPLV TO AN ONTJER OF A PHOPEHTY WFq BUILDS 0R IMPflOVES THEREON,AND
� WFIOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
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� DATE ONRJER H 'y
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�Q LICENSED CONTRACTORS DECLARATION �
2 I HEREBVAFFIRAI UNDER PENA�TY OF PERJURV THA71AA1 LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCIN�WITH SECTIIXJ 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �
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N I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z
Z� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' a
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COMPENSATION,AS PPOVI�ED BV SECTION 3700 OF THE 1A80R CODE,FOR THE PERFORMMICE U
Q OF TME WORK FOR WHICH THIS PERMIT IS ISSUED. �
w _1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATKKJ INSUqANCE CARqIER AND POLICY NUMBER ARE: CTION �Q
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Z I CERTIFY 7HAT IN THE PEFFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
CJ SHALL NOT EMPLOV ANV PEHSON IN ANY MANNER SO AS TO BECAME SU&lECT TO THE •
(n NbRKERS'COMPENSATION LAWS OF CALIFORNI/�AND AQREE THAT IF I SHOULD BECOME CTI N FEE
? SU&IECTTOTHEWORNEFS'COMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR J
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� WARNIN(i:FAILURE TO SECURE WOH)(ERS'COMPENSATION COVERAGE IS UNLqWFUL,AND SHALL BE ENERGY P/C �
� SU&IECTANEMPLOVERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSAND ENER Y
DOLURS(f100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �.})
� SECTION 3708 OF THE UBOR CODE,WTEREST,AND ATTORNEVS FEES. ENTION FE ' �/
O CONSTAUCTION LENDING AGENCY ��
PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THEFE IS A CONSTRUCTION LENDINO A�ENCV '
FOR THE PEFFORAIANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDERS NAME
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w I CERTIFY TMAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES 1��+� �'�
� I AGREE TO COMPLV N7TH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO EMER UPON hIE '
Z ABOVE-MEMIONED PFOPER7Y FOR INSPECTION PUR70SE5. COMMENTS
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� P�ITTEE /� � r-�_ // .
AT EOFPERMIiTEE DATE (^
� RECPT.NO. ��'Y.� PAID BY ✓�QB�— VALIDATION_�_
WHITE—Depariment Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SET BACK • FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. B�ND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SID�NG POOL 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 FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. F�NAL
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEPTIC TANK SIZE
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