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CITY OF DIAMOND BAR �������
----�-��` -- DEPARTMENT OF COMMIJNITY&DEVELOPMENT SERVICES
; � 21825 E.Copley Drive JUN 1�
'� (909)860-3195 Fax(909)861-3117 � P�tESS
' '`����'� BUILDING PERMIT APPLICATION FI RM LY I
} JOBSITE APPLICATION Q� /' PERMIT / q P/C
o ADDRESS��� presa do pt.� �iQMond P�ar DATE v-b^�' NUMBER /� ( �7 #
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� CITY V ZIP TEL. - Z PROPOSED USE VV
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p� OWNER-BUILDEA DECLARATION SFR/ADD/REM I
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p I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV 7HAT I AM ExEMPT FROM THE CONTRAC70R5 LI� G8f89B/CeIpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o31,58USINESSANDPROFE5510NSCODE:ANYCITYOR (n
U CAUNTYWHICHREOUIRESAPERMITTOCANSTRUCT.ALTER,IMPROVE,DEMOLISH,ORF7EPAIRANVSTRUG � '
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PFOVISIONS OF THE CON7RACTORS LI�
� CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� V" PooUSpa
� FESSIONSCODE)ORTHATHEORSHEISEJ(EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
V TION.ANYVIOlA710NOFSEC710N7031.5BVANVAPPLICANTFORAPERMI7SUBJEC757HEAPPLICANTTO Z RB-R001
A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLARS(5500).):
❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITH�WAGESASTHEIRSOLECAMPENSATION, �
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a4,BUSI- J COrt1rtIBfCi81 -
� NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERT'WHO BUILDS OR IMFROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m
Q OFFEHEDFORSALE.IF,HOWEVER,hIEBUILDINGORIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
� IMPROVE FOR 7HE PURPOSE OF SALE).
❑I,AS OWNER OF 7HE PROPER7Y,AM EXClU51VElV CONTRACTING WI7H LICENSED CONTRAC70RS
� 70 CANSTRUCT THE PR0.IECT(SEC.7014,BUSINESS AND PROFESSIONS CADE:THE CONTqACTORS LI- VelUetlOfl � ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPHOPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCON7RACTSFORSUCHPR0.IECTSWITHACANTRACTOR(5)LICENSEDPURSUAN7707HECONTMG QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR 7HI5 REASON Q
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DATE OWNER �
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� UCENSED CONTAACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER �
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 90F THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY UCENSE IS IN FULL FORCE AND EFFECT.
� LICENSECLASS V""J'/�� 1�IIG ���.No. �'��b2b �
U DATE��/D I CONTRACTOR I� � O� G�1 n d
� WORKERS'COMPENSATION DECLARATION �n C• a
� I HEREBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICA7EOFCONSEN770SELF-INSUREFORWORKERS' 2 -^' �'�
¢ CAMPENSATION,AS PROVIDED BV SECTION 370o OFTHE UBOR CODE,FOR THE PERFORMANCE W
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
W �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION „/�
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 ���
ISSUED.MY WORKERS'CAlMPENStATION INSUarp NCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION ��.
¢ CARRIER �I Q r V A q PLAN REVIEW
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Z POUCV NUMBER �J�__r__I'I�' ,��!� ELECTRIC
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� (i}i65ECT10NNE�NOTBE00MREfmOFTHEPERMfTISFORONEMII�DHEDDOLUfiS(5100)ORLESS) PLUMBING .(^_`(..�"'._.___
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH T RMI IS ISSUED,I MECHANICAL I����� �n{ 'I I ���
�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 TO BEC BJEC TO THE � ��� n 4�
� WORKERS'COMPENSATIONLAWSOF ALIFOqNIA,AN GREETATIFISHOUDBECOME INSPECTIONFEE I` p(,
SUBJECTTOTHEWORKERS' EN A ROVI51 SOF CTIO 37000 THELAB L_' �(
� CODE,I SHALL FORTHWITH COMPLV H THO E PR SIO S ISSUANCE [2 1 !
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p DATE: APPLICANT; ,
� ENEfiGY P/C vti'a s I
J WARNING:FAILURE TO SECURE WORKERS'CO ENSATION COVERAGE WFUL,AND ALL BE ��� �
� SUBJECTANEMPLOVERTOCRIMINALPEN ESANDCNILFMESUPTOONEHUNDREDT SAND ENERGYPERMIT --= - -
DOLLARS(f100.000�,IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVID FOR IN �`�'
� SECTION37080F7HELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: T
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURV 7HA77HERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB7,CIV.C.).
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� LENDER'S NAME
� LENDER'SADDRESS �Q '
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE A90VE INFORMATION IS CORRECT. TOTAL F E ES /(f 1,
w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTEfi UPON THE
� ABOVE�MENiIONED PROPERTV FOR INSPECTION P OSES.
Z COMMENTS
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� SIGN 7 REOF RMITTEE DA7E
= RECPT.NO. PAID BY VALIDATION
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FTGSlFORMS/STEEL � ! FHA REQMT5 � _
E�ECTRIC GROUND ' ��UNDER FLOOR DUCT � � i
GROUND PLUMBING UNDER FLOOR CU�IDUIT � ' _____ __
SLAB GRADE __�___ _ �__._ FIREPLAGE_FOUNDATION � �
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TEMP POWER FIREPLACE BOND BEAM _ __
WA7ER SERVICE _� � MID HT. BOND BEAM �
R�OF SHEATH!(VG j�/Y/Dl �./G�*.a `� 8 �. BOND�B�AM ' ' --
FRAMING/VENTILIATION FINAL BOND BEAM i
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ROOF COVER PRE-GRADlNG � ,_____ _,
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUfVIBIiVG ; FINISH GRADIh1G
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SHOWERlTUB TEST POOL ELEGTRIC
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EXT. LATH/SIDIfVG POOL FENCING I
WALL INSULATION � POOL FINAL � � �
CEfLING I(V�ULATION ' OFF SITE IMPS.
DRYV�/ALL NAIUNG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSGAPE/IRRIG. ���
SEEP P'fT/�.L. � ' ' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINA�
FINAL HEATING HEALTH DEPT. FINAL
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FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY !
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