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CITY OF DIAMOND BAR
�---�--��`` --- DEPARTMENT OF COrM�IUMTY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 F�(909)861-3117 PRESS
'`'%���� BUILDING PERMIT APPLICATION FIRMLY
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¢ ADDRESS_ ��� �/� ��P�LTd� APPLICATION PERMIT P/C
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p I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM EJ(EMPT FROM THE CONTRACTORS LI- GflfB J8/CBfPOf1
W CENSELAWFORTHEFOLLOWINGREASON�SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n
U COUNTYNMICHRE�UIRESAPEFMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8110/DBCk
w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS ll�
� CENSE LAW(CHAPTEH 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB
FESSIONSCODEJORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEOEXEMP- (�
� TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof �
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(S50o).):
Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOIECAMPENSATION, � Commercial -
WILI DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70�d,BUSI- J
� NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNEH OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CC THROUGFIHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENO71N7ENDEDOR m
� OFFEREDFORSALE.IF,HOWEVER,7HEBUILDINGOqIMPROVEMENTI550LDWITHINONEYEAFOFCOMPLE-
Z 710N,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPEHlV,AMEXCWSNELVCONTRACTINGWITHLICENSEDCONTRACTORS
� TO CANSTRUCT THE PROJEC7(SEC.7o�d,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V31U2�1Of1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANONTJEHOFAPFIOPERTYWHOBUILDSORIMPROVESTHEREON,AND
� MM1iOCONTRAC7SFOR5UCHPROJEC75WITHACANTRAC70R(S)LICENSEDPURSUANTTOTHECANTRAC- OUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
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� O I AM E%EMP7 UNDER SEC. B.6 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIfiM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �,
� �(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CAOE.AND Z
�X MY LICENSE IS IN FULL FORCEqAND EFFECL m I
� LICENSE CLASS �^`� LIC.NO. �" �� �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUHE FOR WOHKERS' _
¢ COMPENSATION,AS PROVIDED BV SECTION 770o OF THE LABOR CADE,FOR TME PERFORMANCE W I,
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOl11RED BY SECTION n '`
Q 37000F THE LABOR COOE,FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT 1S `OY,�I V
ISSUED.MY WORKERS'COMPENSA710N INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION J F .
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j CARqIER PLAN REVIEW
0 POLICV NUMBER II
Z ELECTRIC
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� (fHLSSECiIONNE�NOTBE00RIPLEfEDOFTHEPEW�/fTISFORONEMRDREDDOILARS(5100)ORLESS) PLUMBING
Z I CERTIFY THAT IN THE PERFORMANCE OF THE O K FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,'} SHALL NOT EMPLOY ANY PERSON IN ANY MA ER O AS TO BECOME SUBJECT TO THE
�/j WORKERS'COMPENSATION LAWS OF CALIF NI AND AGREE THAT IF 1 SHOULD BECOME INSPECTION FEE
� = SU&IECT 70 THE WOHKERS'CAMPENSA71 P VISIONS OF SECTION 3700 OF THE LABOR '� f;O?�
CADE.ISHALLFORTHWITHCOMPLVWIT H R ISIONS. ISSUANCE �\ v
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p DATE: 2 `��'APPLICANT. SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVEFAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSANO ENERGY PERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN /p
� SECTION 37a80F THE LABOR CODE,MTEREST,ANDATTORNEV'S FEES. RETENTION FEE: � � .�l I
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I
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� 1 HEREBY AFFIpM UNDEH PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCV
�- FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3097,CIV.C.). '�
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� IENDER'S NAME
F— LENDER'SADDRESS
� TOTAL FEES 1 +�
� I CERTIFV THAT I HAVE f1EAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I \ �' ��
� I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS RELATMG TO BUILDING � �
� CONSTFUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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� SIGNAT OFPERMITTEE DATE I
= RECPT.N0. PAID BY VALIDATION
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ELECTRIC GRdUND � ; � UNDER FLOOR DUCT , �
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GROUND PLUMBING __ � UNDER FLGOR CU(�IDUIT i
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SLAB GRADE _` .__� ____ _ FIREPLACE FOUfVDAT10N __;_____
TEMP POWER � I FIREPLACE BOND SEAM ;
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W,4TER SERVICE � � MID HT. BOND BEAM
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ROOF SHEATHIhJG. _ ,���c7 z- , 8 FT, BONQ BEAM _
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ROUGH HEATING BENCHING i
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ROUGH PLUNIBING I _1 FINISH GRADING __
SHOWERrfUB TEST � POOL ELECTRIC �
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EXT. LATH/SIDING � PO�L FENCiNG
WALL IIVSULATIOfV POOL FINAL
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CEILIPJG IIVSULATION ��OFF SITE IMPS. �
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DRYWALL iVAIUIVG � DEDICATIONS �
SEVdEFt FINAL ENG. � �
SEPTIC TANK LANDSCAPEIIRRIG. '
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SEEP PIT/LL. ; ON SiTE IMPS. j
GAS AIR TEST FINAL Z�NiNG '
FINAL CONST. � F!RE DEPT. FINA!.
FINAL HEATING � HEALTH DEPT. FINAL � �
FINAL ELECTRIC DEV. FEES PAID
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FINAL PLUMBiNG I ENE�GY
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SEPTIC TA�lK SIZE
SEEP PIT/U SIZE --._---�- ------
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