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`` k �� CTTY OF DIAMOND BAR
` �---��-- DEPARTMENT OF COMMUNITY&.DEVELOPIv�NT SERVICES
21825 E.Copley Drive PRESS
"' (909)860-3195 Faac(909)861-3117
"`:9�"`� BUILDING PERMIT APPLICATION FI MLY
N JOBSITE �� • "{� DATE CAT10N � O I NUMB R #,C
� ADDRESS ISSUE � 01 'TYPE OCC
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wTURE.PRIOH TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOFl SUCN PERMIT TO FILE A SIGNED
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Z TqN,THE OWNER-BUILDER YALL HAVE 7HE BURDEN OF PROVINQ THAT NE Ofl SHE DID NOT BUILD OR
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w ❑1,AS OWNEROF THE PROPEFiTY.AM E7CCl.USNELY CAMRACTIN�WITN UCENSED CONTRACTORS _
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I HEFiEBV AFFIRM UNDER PENALTY OF PERIURV THAT I MI UCENSED UNDER PROVISIONS OF CHAOTER �
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� WORKERS'COMPENSATION DECLARATION �
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0 I HAVEMID WILL MAINTAIN ACEFTIFICATE OF CONSENT TO SELF�INSURE FOq WORNERS' 2
� � COMPENSATION,AS PROVIDED BY SECTION 37000FTHE LA60R CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WMICH THIS PERMIT IS ISSUEO. . �
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W I HAVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REWIRED BV SECTION ' �
Q 370o OF lHE LABOR CADE,FOR THE PERFORMANCE OF THE WORH FOR WHICH THIS PERMIT IS �
0 ISSUED.MV WORKERS'COM7ENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
� CARRIER PLAN REVIEW
� POUCV NUMBER ELECTRIC
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p �t�SSEcna+t+E�noTfleooe.�rmoFnerEaMrswaor+Ew.ror�moau�sfsimlaat�ss4 PLUMBIN � . .
w 1 CERTIFV THAT IN TME PEFFORMANCE OF THE WORK FOR VfHICH THIS PERMIT IS ISSUED,I MECHANI AL
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(} SHALL NOT EMPLOV M1V PERSON IN ANV MANNER SOAS TO BECAME SU&IECT TO THE INSPECTI N FEEJ U
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AQREE THAT IF I SHOULD BECOME
� SU&IECTTOTHE�NORKERS'COMPENSATKKJPROVISlON50F5ECTqN3�000FTHELABOR ISSUANC
� CODE,I SHALL FORTHWITH COMPLY WITH THOSE PRO�SIONS.
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w ENERGY � ' -
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�—y SUBJECTPNEM7LOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
OOLLARS(f100.0001.IN ADDITION TO TME C0.ST OF COMPENSATION,DAAIAGES AS PROVIDED FOR IN
J SECTION 3'!O6 0F TYIE UBOA CODE.INTEREST,AND ATTORNEI"S FEES. RETENTION FEE:
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w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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CL I HEREBV AFFIRM UNOER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION IENDING AGENCY
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� I.ENDER'S NAA1E
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� I CERTIFV TMAT I MAVE READ THIS APPUCATION AND STATE TMAT THE ABOVE INFORIAATION IS CORNECT. TOTAL FE ES ��� � �,/
� I ACaREE TO COMPLY WITH AlL CITY�ND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING �
� CONSTRUCTION,PND HEREBY AUTHORIZE REPRESENTATIVES OF TilS CWNTV TO ENTER UPON THE
Z ABO MENTl�NEO PR07ERTY FOR INSPECTION PURPOSES. �
COMMENTS
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� NAT EaMinee DATE RECPT.NO. •PAID BY VALIDATION
� . WHITE—Department Copy.YELLOW--Finance Copy,PINK—Assessor Copy.GOLDENROD—Fl�e Copy,GREEN—ApQlicant's Copy
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GROUND PLUMBING UNQER FLOOR CU�IDUIT
SLAB GRADE __ _ Flr�EPLACE FOUNDATION ��� _
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM '^
ROOF SHEATHING 8 Ff. BOND BEAM
FRAMIi�lG/VEfVTfUAT10N FiNAL BOND BEAM `
ROOF COVER PRE-GRADlNG
ROUGH HEATING BENCN1fVG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUfVIBING FINISH uRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING � � 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
FIN,4L COP�IST. rr��� �,�j GIRE DEPT. FINA6.
FINAL HEATING HEALTH DEPT:.�I�IAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING - • 1 ENERGY
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