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CITY OF DIAMOND BAR / I�G��� '
---�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES / �.�v
21660 E.Copley Drive Suite 190 �/�/'`%��
� (909)86Q3195 Faz(909)861-3117 �(/ PRESS
�`'��'��+w BUILDING PERMIT APPLICATION � FIRMLY
o� JOBSITE " DATE CATION �,O� PERMIT �}1 P/C
ADDRESS ���, SG#'h�rrt �Q rl� - �IY.M. ¢� NUMBER 1 ��� a O
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APN LOT TRACT DATE CONST. GROUP
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Q ADDRESS PROPOSED USE G' '
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� DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
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y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEREBY AFFlRM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FROM 7HE CONTMCTORS LI- Geffl9B/CBfpOA
W CENSEUWFORTHEFOILOWINOREAAN(SEC.70J1.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (J�
C7 COUNTI'WHICHREWIRESAPERMRTOCONS7RUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8f10/DBCk
w NRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CAN7MCTORS LI� �
� CENSE LAW(CHAPTER i(COMMENCINQ WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSqNS CODE)OR THAT HE OR SHE IS EXEMPT 7HEREFROM AND THE BASIS FOR 7HE ALLEQED EXEM7-
V TqN.ANVVIOUTIONOFSECTION7o31.5BVANYAPPLICANTFORAVERMITSU&IECTSTHEAPPLICANTTO Z Re-Raot
� A CIVIL PENALTY OF NOT MORE 7HAN FIVE HUNDRED DOLURS(S5o0).):
� .OI,ASOWNEROFhiEPROPERTXORMVEMPLOVEESWITHWAGESASTHEIR50�ECOMPENSATION, � CORIfnBfCl81 . �
MALL DO THE WURK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.701�,BUSI- J
� NESS ANU PROFESSIOHS CODE:THE COHiRACTORS LICENSE UW DOES NOT APPLY 70 AN OWNEH OF �
PROPEHfY Vh10 BUILDS OR IMPROVES THEREON,M1D VAiO DOES SUCH WOfiK HIAISELF OR HERSELF OR
� TNiqUGH HIS OR HER OWN EMP�OYEES,7ROVIDED THAT SUGi IMPROVEMENTS ARE NOT INTEN�ED OR m
Q ,OFFERmFORSALEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z 'TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAi HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALEj.
w ❑I,AS ON?IEHOF THE PROPEHfV,AM EXCLUSIVELY CONTMCTINO WRH LICENSED CONTMCTORS
[[ TO CONSTRUCT THE PRQIEC7(SEC.7oM,BUSINESS M!D PROFESSIONS CODE:7HE CAN7RAC70R5 LI• OIlOf1 Q ADJ.AREA
W CENSEUWOOESNOTMPLYTOANOWNEROFAPROPERiYWHOBUILDSORIMPROVESTHEREON,AND
� WMOCOi(TMCTSFORSUp1PR0.1ECTSWIhIACONTRAC70F(5)LICENSEDPURSUAH(TOTHECONTRAG OUANTITY DESCRIPTION FEE �
Y lORS LICENSE LAW.).
� O i AM EXEMPT UNDEfl SEC. � B.8 P.C.FOR THIS R ASON Q
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� � LICENSED CONTRi�CTORS DECLARATION � W
� 1 HEREBY AFFIRM UNDER PENALTY OF PEfLIURY THAT I AM LICENSED UNDER PROVISIONS OF CNAPTER �
� i(COAIMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS M1D PROFESSIONS CADE,AND Z
�� MY UCENSE IS IN FULL FORCE/JID EFFECT.
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� UCENSE CLASS LIQ NO. � j
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS; U
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� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN7TOSELF-INSUREFORWORKERS' $
: COMPENSATpN,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PERf-0RMANCE U
Q � OF THE WORK FOR WHICH THIS PEflMIT IS ISSUED. �
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W _1 HAVE ANO WILL MAIHTAIN WORNERS'COMPENSATION INSUMNCE,AS RE�UIHED BV SECTION
Q 37000F THE LABOR CODE.FOR THE PERFORMMlCE OF THE WOPK FOR WHICH THIS PERMIT IS �
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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Z I CERTIFY THAT IN THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL '-
(}� SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� � WORKERS'CAMPENSATION UWS OF CALIFORNIA,AN�AGREE THAT IF I SHOU�D BECOME . INSPECTION FEE
� SU&IECTTOTHEWORKERS'COMPENSATIONPROYISIONSOfSECT10N37000FTHEU80R -
� COOE,I SHALL FORT}/WITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �i ti '^�. �� � � ___�
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p DATE: APPLICANT: SMIP ���' 0
J WARNIN�:FAILURE TO SECURE WORKERS'COMPENSA710N COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C _ �Y���ga �
LL SU&IECT NI EMPLOVEH TO CRIMINAL PENAL71E5 AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT I
DOLLARS(i100,000),IN IDDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN '
� SECTqN 3708 Of THE UBOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � � c
" a . CONSTRUCTION LENDING AGENCY ��i��� __.-..--------
PRE-ALT FEE: . I��
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� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CANSTHUCTION LENDING AGENCY
FOR THE PEHFORMANCE OF 7HE WOFiK FOR WHICH 7HIS PERMIT IS ISSUED�SEC.90�7,CIV.C.). .
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' � LENDER'S NAME �
F-- LENDER'SADORESS
� TOTAL FEES
� 1 CERTIFV THAT I HAVE READ THIS APPUCA7ION AND STA7E 7HAT 7HE ABOVE MFORMATION IS COHRECT. �
w I AGREE TO CAMPLV WITH AlL CRV M1D COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING ^
� CANSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATIVES OF 7HIS COUNTY TO ENTER UPON THE "� � i`/ [J\'-
ZABOVE-MEFRIONED PROPERTV FOR INSPECTION PURPOSES. COM NTS � �/ �� � � s � �" �'
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SIONATURE OF PEHMITTEE' � � ' ATE
= RECPT.NO. PAID BY � VALIDATION �°"� `
� ~ WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SET BAGK ' FLOOR JOIST
FTGS/FORMS/STEEL • FHA REC�MTS '
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ELECTRIC GROUND ! UNDER FLOOR DUCT
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GRC�UND PLUMBING UNDER FLOOR CU�4DUIT _�
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SI�AB GRADE FIREPLACE FOUNQATION � ____
TEMP POWER FIREPLACE BONQ BEAM
WATER SERVI6E MID HT. BOND BEAM
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ROOF SHEATHING .''. : . 8 FT. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVF_R PRE-GRADWG �
ROUGH HEATiNG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUiVIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. IATH/SI�DING POOL FENCING
WALt_INSULATION i POOL FINAL
CEILlNG INSULATION �FF SITE IMPS. V
DRYWALL(VAILING DEDICATIONS
g�{�,tER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. • .' ON SITE IMPS.
GAS AIR TEST �INAL Z(}NING .
FINAI.CC�NST. FIRE DEPT. FINAL
FINAL NEATING HEALTH DEPT. FINAL •
FINAL.E�ECTRIC DEV. FEES PAID
f=���L PLUMBfNG ENERGY �
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