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, , ,_�`_ CITY OF DIAMOND BAR
. DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
. � ' 21825 Copley Drive,Diamond Bar,CA 91765 PRESS
' "�- (909}839-7020 Fax(909)861-3117 Building Inspection HoUine(909)839-7027
������W BUILDING PERMIT APPLICA1�torr FIRMLY
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE COMRACTORS LI� G8fE9B/CHfPOlI
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wNRE,7R�OR TO ITS ISSUANCE,AL50 REWIRES TME APVUCANT FOR SUCH PERAAIT TO FILE A SIONED
� STATEMENT TNAT HE OR SHE IS 110EN5ED PURSUANT TO THE PROVISIONS OF THE CONTRAG70R5 LI�
� CENSE UW(C%UPTER G(COMMENCINO WITH SECTION 70a0)OF DIVISION 30F THE BUSINESS AND PRO- V' POOUSpe
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WILL W TNE NlORK.AN�THE STPl1CTUAE IS NOT INTENDE�OF OFFERED FOR SALE(SEC.lou,BUSI- J
� NE"w^AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PiiOPERTV WFIO BU0.05 OR IMPROVES THEREON.AND NM110 DOES SUCH WORK HIMSEIF OR HERSELF OR
� 7}1ROU(3N NIS OR HER ONTJ EMPIOVEES,PROVIDED THAT SUCM 1MPROVEMENTS ARE NOT INTENDED OR m
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Z IMpROV[�FOR 7HE VURPOSE OF SALE).
= p'l,AS OWNEROFTHE PROPERTV,AM EXCLUSIVELV CONTMCTIN6 VrtTH UCENSED CONTRACTORS
� TO CONSTftUCT THE PHQIECT(SEC.7W6,BUSINESS AND PROFESSIONS COOE:TME CONTMCTORS LI- V8IU8��Ofl ADJ.AREA
� CENSE LAW DOES NOT APPLV TOAN OWNER OFA PROPERTV NM110 BUILDS OR IMPROVES TMEREON.AND
W/iOCONTMCTSFOHSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
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d B(COrdMENCINO WITH 5ECT10N 7000)OF DIVIS�ON 3 0G THE BVSINESS�ND PROFESSIONS CODE,AND Z
X MY LICEN5E IS IN FULL FORCE AND EFFECT. m
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� WORKERS'COMPENSATION DECLARATION �
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� 1 HEREBV AFFIRM VNDER PENALN OF PE0.)UAV ONE OF THE FOLLOWfNG DECUR�TiONS:
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� _I HAVE AND WILL MAINTAIN A CENTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' 2
Q CAMVENSATION,AS PROVIDED BY SECTION 370o OF TME LABON CADE.FOR THE GERFORMANCE `U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w 1 HAVE AND WILL MNNTAIN WOqKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 oF THE LABOR CODE.FOR THE PERFORMM'CE oF THE WORJ(FOF WHICH 7NI5 PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARFIER AND POLICV NUMBER ARE: CONSTRUCTION
� �RR�Eq PLAN REVIEW
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' Z I CERTIFV THAT IN THE PERFORMANCE�F THE WORN FOR WHIp1 THIS PERMIT IS iSSUED,I
C} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE INSPECTION FEE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOUID BECOME
SU&IEGT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTKKJ 370o OF THE UBOR ��� �
� CODE,1 SF1AlJ.FOf7TMNITH COMPIY WITH TNOSE PROVIS�ONS. SU CE
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p DATE: APPLICANT: �
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� WARNING:FAILURE TO SECURE M/ORKERS'COMPENSATbN COVERAGE IS UNLAWFUL,AND SHALL BE
� SUOJECT AN EMPIOYER TO CRIMINAL PENALTIES ANO CIVII FINES UP TO ONE HUNORED THOUSMlO ENERGY PERMIT
DOLLAAS(S10o,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAQES AS PROVIDED FOR IN
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w CONSTRUCTION LENDING AGENCY PR LT FEE:
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CC IHEREBVAFFIRMUNDERPENALTVOFPERJURVTHATTHEREISACONSTRUCTIONLENDINOAGENCV XT�►5i� � / ��� �`�
� FOR THE PEFFOiU1ANCE OF TME WORK FOR M?i1CH THIS PERMIT IS ISSUED(SEC.3007,CIV.C,�. •
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� LENDERS NAME
F= IENDER'SADDRESS
� I CERTIFV TNAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES � / ��/�
w I AQf1EE TO COM7LV WITH I1L CffY ANO CAUNTV ORDWANCES AN�STATE UWS PEUTING TO BUILDING
� �pNSTRUCTION.AND HEREBY AUTHOR2E REPRESENTATIVES OF THIS COUNT'TO ENTEP UPON THE
� ABOVE-MENTqNED PROPEFTV FOR INSOECT40N PURPOSES. .
Z COMMENTS
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N SIONATUHEOFPERMITfEE DATE RECPT.NO. P DBY � VALIDATION
� WHITE—Depertment Copy.YELLOW--Flnence Copy,PINK—Assassor Copy.GOLDENROo--File Copy,GREEN—ApplicanYs Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UN�ER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER�fUB TEST POOL ELECTRIC
EXT.LATH/SIDING PO�L FENCING
WALL INSULATION POQL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COIVIMEfVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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