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' CITY OF DIAMOND BAbt � I
--�f� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190 � �
(909)860-3195 Fax(909)861-3117 PRESS
/ ������`w BUILDING PERMIT APPLICATION � � FIRMLY
f JOBSITE /��,� � APPLICATION I f �O PERMIT P/C
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W TURE,PRIOR TO ITS ISSUNICE,/�LSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CANTMCTORS LI�
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPe
FESSqNS OODE)OR TFIAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.AM'VqUTqN OF SECTION 7031.5 BV ANYAPPLICANT FOR A PEHMIT SU6IECTS THE APPLICANT TO Z qe-Roof
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MIILL DO THE WOit!(,AND THE STHUCTURE IS NOT INTENOEO OR OFFERED FOR SALE(SEC.7Uu,BUSI- J
NESS AND PipFESSIONS CODE:TME CONTMC70R5 LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PROPEHfYNR10BURDSORIMPROVES7HEREON,ANDWHODOESSUCHWORKHIMSELFOHHERSELFOR m
� THRDUGH HIS OR HER ONM EAIPLOYEES,PHOVIDED THAT SUCFI IMPROVEMEMS ARE NOT INTENDED OR
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Z 'TION,THE OWNER-BU�LDER WILL HAVE THE BURDEN OF PPOVING THAT HE OR SHE DID NOT BUILD OR
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O I,AS OMMER OF THE PROPEHfY,AM E%ClU51VELV CONTRACTINO WI7H LICENSED CONTMCTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7oH,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI- V0lueil0ll ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OWNER OF A PROPERTV NM1iO BUtLDS OR IMPROVES THEfiEON,AND
� W/qCONTMCTSFORSUpiPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUAHTTOTHECONTMG QUANTITY �DESCRIPTION FEE .
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDEF SEC. B.6 P.C.FOR THIS REASON �
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u" DATE OWNER V
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNOER PENALN OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
��� MY LICENSE IS IN FULL FORCE AND EFFECT.
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[� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECURA710N5:
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� 1 HAVE AHO MlILL MAINTAIN A CERTIFICATE OF CONSEHT TO SELF-INSURE FOR N'ORKERS' _
� COMPENSATION,AS PROVIDED BV SECTION 3700 OF 7HE LABOR CODE,FOR TNE PEHWRMANCE w
OF THE WORK FOR NRiICH THIS PERMI7IS ISSUED. �
� �I HAVE AND WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REQUIRED BV SEC710N
QQ 37000F THE UBOR COOE,FOR hIE PERPDRMMICE OF THE WORK FOR WMICH THIS PEHMIT IS ���
ISSUED.MV V10 ERS'COMPENSATION INSURANCE CARFIER AND POLICV NUMBER ARE: CONSTFUCTION
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� . Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
('} SHALL NOT EMPLOV ANV PERSON IN ANY MAtJNER SO AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIfORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
I � SUBJECT TO THE WORKERS'COM7ENSATION PROVISIONS OF SEC710N 3700 OF THE LABOR ZS r��
CAD,I SFi FORTHWITM COMPLV WITH THOSE PROVISIONS. ISSUANCE
O DATE: S � APPLICANT. ���� SMIP �•l �
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w ENERGY P/C
� WARNINO:FAILURE TO SECURE WORNERS'COMP ATION CO ERAGE IS UNUWFUL,AND SHALL BE
LL SUBJECTANEMPLOVER70CRIMINALPENAL7IE ANDCIVILFIN 'SUPTOONEHUNDREDTHOUSAND ENERGYPERMIT '
DO�URS(i100.000).IN ADDITION 70 THE COST COMPENS N,DAMAGES AS PROVIDED FOR IN
� SECTION 370E OF TIE IABOR CODE,INTEREST,AN rs cEEs. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �L r�_7�I�I�I
� I HEREBV AFFIflM UNDER PENALTV OF PERIURV THA77HERE IS ACONS7RUCTION LENDING AGENCY �/�
d FOii THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.�087,CIV.C.). I�OF D1C1 �
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�"' BUILI)ING AND S �
LENDER'S NAME i
F— LENDER'SADDRE55 ( /�
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w ICERTIfVTHATIHAVEREADTHISAPPUCATIONANDS7A7ETHATTHEABOVEINFORMA710NISCORRECL �'�OTAL FEES , J�J��� "
� I AGREE 70 COMPIv WI7H ALL CI7Y AND COUNIY ORDINANCES AND STA7E UWS RELA7ING TO BUILDING .{`
CONSTRUC710N,ANO HEREBV AU7HORIZE REPRESENTATIVES OF hIIS COUNTY TO EMER UPON THE .
I Z ABOVE•MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS �� �
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� SIONATUR ITTEE ' DA7E ;:,' !' ✓ I
� :. RECPT.NO. PAID BY VALIDATION
WHITE-0epartment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
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GR�UND PLUMBING UNDER FLOQR CCJI�DUIT, i _ , , ,. '"
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TEMP POWER FIREPLACE BOND BEAM
WATER SEFiVICE MIQ HT. BO(�D'BE,AM�===:_:.>'_,- : :.. •• .:.� : �. % .
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RDUGH PIUNIBING � � FINISH GRADING
SHOWER/TUB TEST - POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATiON � POOL FINAL
CEILING INSULATION � O�F SITE 1MPS. � ��
DRYWALL NAILING �1-(�� DEDICATIONS � �^
SEWER F1NAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/�.L. � ' � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL C(�NST. � FIRE DEP7. FINAL
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