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�,� CITY OF DIAMOND BAx ���I���
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' ��'TM'Y � J � BUII.DING PERMIT APPLICATION FIRMLY
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ADDRESS -/ Y TW �Y� DATE NUMBER #
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APN LOT �TRACT DATE � ' `�' o� CONST. GROUP
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� ADDRESS ZONING SEfBACKS
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� I HEREBY AFFIRM UHDEH PENALTV OF PERIURY 7HA7 I AM E%EMPT FROM THE CONTRACTORS LI- G8f89B/CBfPOR
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w NRE.VRpR TO ITS ISSUANCE,ALSO RC-0UIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED w
� STATEIdENT 7HAT HE OR SHE IS LICENSEU PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- �
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
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TpN.ANV VIOUTION OF SECTION 70.'f1.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
� AGVIL PENALTV OF NOT MORE 7HAN FNE HUNORED DOLURS(i500).):
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VALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70u,BUSI- J
NESS ANO PROFESSIONS CODE:THE CON7RACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
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Q ,OFFEREDFORSALEIF,HOWEVER7MEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPIE- '
Z TpN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVIN�THAT HE OR SHE DID NOT BUIID OR
� IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS OWNER OF 7HE PROPEHfY,AM EXCLUSIVELV COI�ITfUCTINO WI7H LICENSED CONTRAC70RS
� TO CONSTRUCT THE PRQIEC7(SEC.7oa1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V01118I1Of1 ADJ.AREA
W CENSE UW DOES NO7MPLY TOAN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND
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OO I AM EXEMPT UNDER SEC. B.d P.C.FOR THIS FiEASON U
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� DATE OWNER ~
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� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WITH SECTION 7000)OF DIVISION J OF TFIE BUSINESS/VJD PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION a
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� 1 HENEBV AFFlRM UNDER VENALN OF PERJUPY ONE OF THE FOLIOWING DECL�RATIONS:
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0 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF•INSURE FOR WORKERS' 2
� OONPENSATION,AS PROVIDED BV SEC710N 970o OF THE LABON COOE,FOR THE PERFORMANCE �U
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL AIAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REaUIHED BY SECTION
Q 370o OF THE LABOR COOE,fOR 7HE PERFORMANCE OF THE WOFiK fOR WHICH THIS PERMI7IS
ISSUED.MY WORKERS'COMPENSATION INSUR/WCE CARRIER AND POLICY N ER ARE� CONSTRUCTION
� CARR�ER � + PLAN REVIEW
� POLICYNUMBER ELECTRIC
0 (fHISSECTqNNEEDNOTBE�EfEDOFiF�PERMTISFORONEFitRDFED00LL?AS(5100)ORLESS? PLUMBING �
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W MECHANICAL
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I ,
(,�J SHALL NOT EMPLOY ANY PERSON IN ANY MPNNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND ACREE THAT IF I SHOULD BECAME INSPECTION FEE
S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION]70o OF h1E IABOR � '
CODE,I SHALL.FOFiTHWITH COMPLY WITH T�E PROVI ONS. ,( � ISSUAN6E
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p DATE: APPLICANT: , .
� ENERGY P/C
J WARNIN�:FAILURE TO SECURE WORKEHS'CAMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
� SU&IECT AN EMPLOYER TO CRIMINA�PENALTIES AND qVIL FINES UP TOONE HUNDRED TMOUSAND ENERGY PERMIT
DOLLARS(t100,000),IN AODITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN
� SECTqN 37oe OF iHE U160R CODE,IN7EREST,AND A770RNEY'S FEES. � RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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Q I HEREBY AFFIRM UNDER VENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
� FOH THE PERFORMANCE OF THE WORK FOR WHICH THIS FEfiM1T IS ISSUED(SEC.3087,CIV.C.�. �
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� LENDER'S NAME
F— LENDER'SADDRESS
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOHMATION IS CARRECL TOTAL FEES �I�O
� I AGFiEE TO COMPIV WI'H ALl CITY AND COUNTY ORDINANCES AND STATE LAWS REUTINO TO BUILDING
CONS7RUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUN7V 70 ENTER UPON THE �
ZABOVE- EN710NED PROPERTY POR INSPECTION PURPOSES. COMMENTS I
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� SIGNA7UHE OF PERMtT7EE DATE
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SLAB GRADE FIREPLAC�F.OUNQATION • �
TEMP POWER FIREPLACE BONQ BEAM -
WATER SERVICE MID HT. BOND�BEAM
ROOF SHEATHING • 8 FT. SOND BEAM � � �
FRAMINGNENTfLIATION � FINAL'BOND BEAM � i—r �^
ROOF COVF_R PRE-GRADING -
ROUGH HEATlNG' BENCHING
ROUGFi ELECTRIC ROUGH GRADING
ROUGN PLUMBING � � FINISFt vRADING !
SHOWER/TUB TEST � ' P�OL ELECTRIC �
EXT. IATH/SIDING POOL FENCING
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SEPTIC TANK LANDSCAPE/IRRIG.
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FINAI.C�hlST. FIRE C}EPT. FINAL �
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