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CITY OF DIAMOND BAR
-----�� -- DEPARTMENT OF COMMUNTTY&DEVELOPIv1ENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
'-���� BUILDING PERMIT APPLICATION FIRMLY
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APN TRACT DATE CONST. GROUP
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEHEBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM E%EMP7 FROM THE CANTRACTORS LI� Gefe90/CefpOft
W CENSELAWFORTHEFOLLOWINGHEASON(SEC.703t.5BUSINESSANDPROFE5510N5CADE:ANVCITYOR (n
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w TURE.PRIOR TO I75 ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO 7HE PROVISIONS OF THE CANTRACTORS LI-
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' Pool/Spa
Q FESSIONSCODE)ORTHA7HEORSHEISEXEMP7THEREFROMANDTHEBASISFOH7HEALLEGEDEXEMP- (�
V TION.ANV VIOUTION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z qe-Roof
A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLLARS(5500).�:
� ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COrtIf118fC121 �
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7046,BUSI- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF �
PROPER7V WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOFK HIMSELF OR HERSELF OR
� THFiOUGH HIS OR HEFi OWN EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NOT IN7ENDED OR� m
Q OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE-
Z 710N,7HE OWNER�BUILDER WILL HAVE 7HE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUIID OR
� IMVFOVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWI7HLICENSEDCONTRACTORS
� TO CANSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VaIUOIlOf1 ADJ.AREA
W CENSEUWDOESNOTAPPI.YTOANONTJEROFAPROPERTYWHOBUILD50RIMPROVES7HEREON,AND
� WHOCANTRACTSFORSUCHPR0.IECTSWITHACAN7RAC70R(S)LICENSEDPURSUANTTOTFIECAN7RAC� DUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. 8.6 P.C.FOR THIS REASON Q
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DATE OWNEFi �
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�Q LICENSED CONTRACTORS DECLARATION w
CC I HEREBY AFFIRM UNDER PENALN OF PERIURY THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER � '
d 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
`X MY LICENSE IS IN F F E AND EfFECT. � �^ � m
� LICENS S LIC.NO. L �
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V DATE � CONTRACTOR a
W �� WORKERS'COMPENSATION DECLARATIO a
NI HEfiEBY AFFIPM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICA7EOFCANSENT705ELF�INSUREFORWORNERS' 2 �
¢ �CAMPENSATION,AS PROVIOED BY SECTION 770o OF THE LABOR CODE,FOR THE PERFORMANCE w
Q OFTHE WORK FOR WHICH THIS PEHMIT IS ISSUED. �
w VEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION
Q 370o OF TH BOR CADE,FAAAR THE PER RMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV 1([i� O�A N URANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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� CARRIER r PLAN REVIEW
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� (iHISSECfYJNNEmNOTBENMPLEfEDOF7HEPEWMISFORONEFN1�FiED001.LPA5(f100)ORLE55). PLUMBING �1
Z I CERTIFV 7HA71NTHE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED,I MECHANICAL
(�7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
N WORKERS'COMPENSATION UWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHEL480R C1.�C`(-1j�
� I FOR WITH COMPLV WI�}��E PRC/ISION / /� ISSUANCE �A vtJ
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p DATEx� APPLICANT. .
J WARNING:FAILURE O SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5�00,000),IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN (��\
J SECTION 3708 OF THE UBOR CODE.INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: , \ V�+
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a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDEq PENALTY OF PERJUHV THAT THERE IS A CONSTRUCTION IENDING AGENCY
a- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CN.C.).
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� LENDER'S NAME
F- LEN�ER'SADORESS
w TOTAL FEES I _�, �
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE TNAT THE ABOVE INFORMATION IS CORRECT.
� I AGREE TO COMPLV WITH ALl CITY AND CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 1��
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE �
Z AB E�MENTION PROPE TV FOR I SPE ION P�RPOSES. COMMENTS
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� SIGNAT O R DATE
= RECPT.NO. PAID BY VALIDATION
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GROUND PLUMBINCti I�� __ __, i UNDER FI_OOR CiJ��C�UIT ;:
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SLAB GRADE � � FIREPLACE FUUr�fU�TiON � _
TEMP POWER FIREPLACE BOND BE1�M __ ___ __
WATER SERVICE MID HT. BOND BEAM ` _ _
ROOF SHEATHIPVG 8 Ff. BOND BEAM i
FRAMIf�GNEIVTILIATION I ! FINAL BOND BEAM ; ____
ROOF COVER PRE-GRADING
ROUGH HEATING ___ BENCHING —� _�_
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ROUGH ELECTRIC ROUGH GRADING
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ROUGH PLUMBING ; ' FINISH uRADING
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SHOWER/TUB TEST ; POOL ELECT(�IC
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EXT. LATH/SIDI(VG ' , POOL FENGING �
WALL IfVSULATIOiV ' POOL FINAL ';
CEILING INBULATION � OFF SITE IMPS.
DRYWALL fVAILI(VG � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
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GAS AIR TEST _��_ FINAL ZONING � __ __
FIIVAL CONST.. � . �!RE DEPT. FINA'L
FINAL HEATING j HEALTH DEPT. FiNR� �
FIMAL ELECTRIC � DEV. FEES PAID
FINAL PLUfihBING j ENERGY
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