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CITY OF DIAMOND BAR
� ^--�"��`— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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�,w . 21825 Copley Drive,Diamond Bar,CA 91765 ��
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839- PAE$$
'"�'� BUILDING PERMIT APPLICATION
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} JOBSITE /J � �f L� S,q�/���1j N APPLICATION � 'Q PERMITdQ��C�ZZ P/C '
o ADDRESS � � � a'�� �� ���� DATE LG�� NUMBER #
°^ Ai'N L T TRACT ISSUET1T �� TYPE OCC
DATE l CONST. GROUP
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p ADDRESS � �� ZONING SETBACKS
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� ADDRESS � �'e ' , PROPOSED USE
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� Gflf890/CBfPOfS
W CENSE UW FORTHE FOLLOWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CADE:ANV CITV OR (n
U CIXJN7YWHICHREOUIRESAPERMITTOfANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG �
W TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
S7A7EMEN7 7HA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER 9(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB
. 0 FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V 710N.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMI75U61ECTSTHEAPPLICAN7T0 Z Re-Roof
A CIVIL PENA�TV OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
Z ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COfilfflBfClel
WIIL DO THE WORK,AND 7HE STRUC7URE IS NOT INTENDED OR OFFERE�FOR SALE(SEC.7041,BU51� J �
N NESS AND PROFESSIONS CAOE:THE CAN7RAC70R5 LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF Oq
� THROUGH HIS OR HEfl OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDWRSALEIF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR TFIE PURPOSE OF SALE).
W ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCON7qACTINGWITHLICENSEDCONTRAC70RS
Q TO CONSTHUCT THE PROJEC7(SEC,70��,BUSINE55 AND PROFESSIONS CADE:7HE CAN7qACTORS LI- V81U8S�Of1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAGROPERTVWHOBUILDSORIMPROVES7HEREON,AND
� WHOCANTRACTSFOFSUCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.�.
�� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION' w
� I HEREBY AFFIRAI UNDEH PENI�LTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F 7HE BUSINESS AND PROFESSIONS CODE,AND Z
��� MV LICENSE IS IN FULL FOFCE AND EFFECT. m
� LICENSE CLASS LIC.NO. j .
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U DATE CONTRACTOR a.
� WORKERS'COMPENSATION DECLARATION � l. N � �
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� I HEREBV AFFIFM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z �, �O U O V
Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' _
¢ fAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOH fADE,FOR THE PERFORMANCE U
O OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
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j CARRIER PLAN REVIEW
Z POUCVNUMBER ELECTRIC
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� (iHISSECIqNNE�NOTBECOMFtEfEDOF7FFPEPAQTISFORONEFNt�DREDDOLIAfIS(E100)ORLESS). P G
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Z �1 CERTIFY THAT IN THE PEPFOFMANCE O THE WORN FO WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL 6.i�r
(.�} SHALL NO7 EMPLOV ANV PERSON IN ANV ANNER SO AS BECOME SUBJECT TO THE
Uj WORKERS'COMPENSATION LAWS OF CAL ORNIA,AND EE THAT IF I SHOULD BECOME IN FEE
� SUBJECTTOTHEWORKERS'COM7ENSAT NPROVI510 5 FSECTION HE�UBOR � ^�
� DE. ALLFORTHWITHCOMPLYWITH OSEPR ISSUANCE i–,i
� $
p DATE:`\ APPLICAN:
J WARNING:FAILURE TO SECURE WORKERS'CAMP SA N CAVERAGE IS UNLAWFUL,AND SHALL BE ENEAGY P/C
� SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND EN GY MIT
DOLLARS(f100,o00),IN ADDITION TO THE COST O OMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,A nrToaNErs FeEs. TENTION FE � ,�� .
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV � � -
n- FOR THE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.), 9�
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� LENDER'S NAME
H LENDER'SADOHESS
� TOTAL FEES �p
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. �.�
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STA7E IAwS FEUiING TO BUILDING
� CANSTR TION,AND HER V AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
� ABOVE�M NTIO D PROPE TV FOR INSPECTION PURPOSES.
Z � �,n f COMMENTS
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m PEHMITTEE AME(PRINT) 'I �
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� SIGNA7URE0 E E D
= RECPT.NO. PAID BY VALIDATION
~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST '
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT `y
GROUND PLUMBING UNDER FLOOR CONDU►T
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/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL 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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