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CITY OF DIAM ND BAR
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21825 F..Copley Drive
� (909)860-3195 Faac(909)861-3117 PRESS
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p I HEREBV AFFIRM UNDER PENALTV OF PERIUHY 7HA7 I AM E%EMPT FROM THE CONTRAC70RS LI- G8f8CJB/CBfpOR
W CENSE LAW FOR 7HE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CI7V OR (n
U CAUNTVWHICHREQUIRESAPERMI770CANS7RUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W PeflO/DBCk
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMI7 TO FILE A SIGNEO w
STATEMENT THAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI-
� CENSE LAW(CHAPTER B(COMMENCING WI7H SECTION 7o0o)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREfROMANDTHEBASISFORTHEALLEGEDEICEMP- (�
V TION.ANV VIOLATION OF SEC710N 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z qe-Roo(
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED OOLLARS(f5oo�.):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIqSOLECAMPENSATION, � COrtIrtlBfCie1 -
WILL DO THE WORK,AND THE S7RUCTURE IS NO7 INTENDED OR OFFERED fOR SALE(SEC.70a�,BUSI- J
� NESS AND PROFESSIONS COOE:THE CANTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGHHISORHERONRJEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMEN7SARENOTINTENDEDOR m
w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- �
� TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
�_ ❑I,ASONTJEROFTHEPROPERTY,AMEXCLUSIVELVCANTRACTINGWITHLICENSEDCONTRACTORS
TO CANSTRUCT THE PR0.1EC7(SEC.70�1,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- VelUeilO� � ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN ONMER OF A PROPERN WHO BUILDS OR IMPROVES THEREON,AND
� WHOCANTRACTSFORSUCHPR0.JEC75WITHACANTRAC70R(5)LICENSEDPURSUANTTOTHECAMRAC- QUANTITY DESCRIPTION FEE
Y 70RSLICENSELAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS FEASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNOER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
X MY LICENSE IS IN FULL FORCE AND EFFEC7.
� LICENSECLASS��'7/�'39RIC UC.N0.-1o��/�'� j
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U DATE �V� �b�D� CONTHACTOR KC VIIUI GO�IS VC �h� a
� WORKERS'COMPENSATION DECLARATION IhG• a
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLAFATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _
a CAMPENSA710N,A5 PROVIDED BV SEC710N 370oOF 7HE UBOR CODE,FOF THE PERFORMANCE w
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
W �1 HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SEC710N /'�
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF TFIE WORK FOR WHICH THIS PERMIT IS /�` �v
ISSUED.MY WORKERS'CAMPENSATI N INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � !
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� CARRIER 1 r PIAN REVIEW
0 POLICYNUMBER I�I�L'�Z�!—�I ELECTRIC
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� (fHISSECTIONNE�NOTBEO7MPLEfEDOF7ViEPERMfiISFORONEHUI�DREODOLLARS(5100)ORLESS). PLUMBING
Z I CERTIFY THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS P MI S ISSUEO,I MECHANICAL .J
� WORKERSTCOMPENSATION RA OF CALIFO NEA,AND S TREE 7� IF I EUL BECOME INS?ECTION FEE ,./�1\ � ��w,w! �.�. � /� '
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? SUBJECTTO THE WORNERS'COMPENSATION PR VISIOf�� OF S TION 7000F HE LABOR
COpDE, SHALL FORTHWITH COMFLV WI(H THOSE OV i'10 S. ISSUANCE h (�(�
p DATE: OO O�IUI pppUCANT: 1 � � SMIP .� v I'f'� i
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J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND LL BE ENERGY P/C �
LL SU&IECTANEMPLOVERTOCFIMINALPENALTIESANDCIVILFINESUPTOONEHUNOREDT SAND ENERGYPERMIT ��� /
DOlLARS(f1o0,0ao),IN ADDITION 707HE COST OF CAMPENSATION,DAAIAGES AS PROVID D OR IN
� SEC710N 37oB OF THE LABOR CADE.INTEHEST,AND ATTORNEY'S FEES. RETENTION FEE: –" - - --
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEi7EBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB7,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS -
� TOTAL FEES � 7. 7�
� I CERTIFY THAT I HAVE READ THIS APPLICA710N AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRE NTATIVES OF 7HI5 COUN7V 70 EN7ER UPON THE
� ABOVE�MENTIONED PROPERTV FOR INSPECTIO U OSES.
Z COMMENTS �
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� SIG TUREO ERMI7TE DATE
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SLAB GRADE v ._____ __ _ FIREP�ACE FOUNDATION !
TEMP POWER i FIREP�ACE B(JND B�AM___.. _— v-_ —
WATER SERVICE __�_ MID HT. gOND BEAM _ __
ROOF SHEATHING D O�`�) _ - --- 8 FL B�NQ BEAM i _
FRAMIPJGNENTILIATION FINAL BOND BEAM i
ROOF COVER PRE-GRADING
ROUGH HEATING BENGHING
ROUGH ELECTRIC ROUGH GRADING � `
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ROUGH PLUMBING FINISH GRADING
SHOWERITUB TEST POOL ELECTRIG
EXT. I.ATH/SIDIfVG POOL FENCING
WALL INSULATION POOL FINAL !
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CEI�ING IN�ULATION QFF SITE IMPS.
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DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/l.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIfVAL CONST. FIRE DEPT. FINAL
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FINAL ELECTRIC DEV FEES PAID
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