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_1 f� CITY OF DIAMOND BAR 0 C T 2 5 2002
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
w 21660 E.Copley Drive Suite 190
(909)8G0-3195 Faz(909)861-3117 , PRE$$
���^ BUII.DING PERMIT APPLICATION • � , � FIRMLY.,
o DDRIESS �S � S �� �� � DATE CATION �V NUMB R� #/C D�f"'�
� ISSUE TYPE OCC
� APN LOT TRACT DATE CONST. GROUP
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v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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COUNTVWHIGIREOUIRESAPERMRTOCONSTRUCT.ALTER�PHOVE.DEMOLISH.ORREPNRM/Y57AUC- W P8t10/DBCk
lURE,PRIDR TO RS 139UANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT 70 FllE A SIONED w
� BTATEMENT THAT HE OR SHE IS IJCENSEO WRSUAHT TO THE PROVISIONS OF THE COH7MCTOR9 LI-
CENSE LAW(CHAPTER G(COMIJENGN(i WI7H SECTION 7000)OF DIVISIDN 3 OF THE BUSINESS AND PRO- � P�USpO
FESSIONSCODE)OR7}IATHEORSHEISE%EAIPTTHEREFROMANDTHEBASISFORiHEALLEOEDE%EMP- (�
TION.MIV VIOLATION OF SECTION 7031.6 BV ANV MPLICANT FOR A PERMIT SU6IECTS THE MPLICANT T0 Z Re•Roof
� A CML VENAL7V OF NOT MORE TT1AN FNE HUNDRED DOLURS(f60D).):
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W�LL DO 7HE WOHI(,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,BUSI- J
� NE55 AND PiqFE5510N3 COOE:7HE CONTMC70RS IICENSE LAW DOES NOT A7PLY TO AN OWNER OF
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B iHAOUGH HIS OR HER OMM EMPLOYEES,PROVIDED THAT SUCN wPROVEMINTS ME NO7INTENDED OR m
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Z �'TION,THE OWNER-BUILDEfl MALL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� WPRWEFOR7HEPURP09EOFSALE} �
w ❑I,A40MMEROF THE PROPEHfY,MI IXCLUSIVELV COMRACTINO N7TH LICENSED CONTRACTORS
� TO CONS7RUGT THE FRO.lEC7(SEC.7oa�,BUSINE55 AND PROFESSIONS CODE hIE CONiRACTORS ll- V91U0f1 ADJ.AREA
� CENSE UW DOES NOTMPLV TO AN OWNER OF A PROPERTV N710 BUttDS OR IMPROVES THERC-0N,/V�D
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aC I HEREBV AFFlRM UNDER PENA�TY OF PERIURV 7FIA7 I AM LICENSED UNDER PROVI910NS OF CHA7TER �
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� _IHAVEANDWILLMAINTAINACEHfIFICATEOFCONSENTTOSELF-INSUREFORIMORKERS' $ '
Q COMPENSATpN,AS PROVIDED BV SEC710N 37000F THE LABOR CODE,FOR THE 7ERFORMANCE U
OF THE WORN FOR N?11q1 THIS PERMIT IS ISSUED. W
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Q _1 NAVE AND WILL MAINTAIN WORKERS'COMPENSATqN INSU{UNCE,AS REWIRED BV SECTION �
97000F 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WOR!(FOR WHICN THIS PERMIT IS �D
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Z I CERTIFY T}UT PI THE PERFORMANCE OF h1E YARI(FOR WHIq1 THIS PERMIT IS ISSUED,1 MECHANICAL
SHALL NO7 EMPLOV/UlY CERSON W ANY MANNER SO AS TO BECOME SU&IEC770 7HE
(/� WORKERS'COMPENSATION UWS OF CALIFORNIh�ND A6REE TMAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION OF SECTION 370o OF 7HE IABOP
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� WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAQE IS UNUWFUL,AND SHALL BE
LL SUBJECTMIEMPLOVERTOCRa1fNALPENAL71E5ANDCMLFINESUPTOONEHUNDREDTFKKISAND ENERGYPERMIT � A
D�LL�IAS(f100.000�.IN/�DDITION TO THE COST OF COMPENSATqN,DAMA6E5 AS PROVIDED FOR IN
J 9ECTION 370E OF THE LABOR CODE,INTEREST,AND ATTORNEI"5 FEES. �
p� RETENTION FEE: �
OCONSTFiUCTION LENDIN6 AGENCY PRE L/FbE:� �
� I HEREBV AFFIRM UI�ER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTIOfJ LENDINO A�ENCY (/� L 0 � .
Z FOR THE PERFORMANCE OF 7HE WORK FOR WHICH TMIS GERAIIT IS ISSUED(SEC.�OY7,CIV.C.). ��7 . . .
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� LENDERS NAME � � , � .
� LENDERSADORE55
w I CERTIFV THAT I HAVE RE}D THIS APPLICATION AND STATE TTUT THE ABOVE INFORMATqN IS CORRECT. TOTAL FEES � � � ° `
� I AQREE TO COMPLV N7TH ALL CRV M1D COUNTV ORDINANCES AND STATE UWS RELATWO TO BUILDING , ,
� CONS7RUC710N.M1D HEREBV AUTHORRE REGRESENTATIVES oF tH15 COUNTv TO ENTER UPON 7HE �D� n 1A1�S�J�`�'I �1�JV 1 v`-� n
Z ABOVE�MEHTIONED VROPER7Y FOR INSPECTKKJ PURPOSES. COMMENTS v v V(/ � T �1 ��v�`/
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� � � RECPT.NO. 1 �D pp�p gy VALIDATION
WHITE—Deperbnent Copy,YELLOW--Finence Copy,PINK—Asaessor Copy,GOLDENROD--File Copy,GREEN—ApplicanCs Copy
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FTGS/FORMS/ST�EL � FHA REQMTS �
ELECTRIG GROUND �- UNDER FLOOR DUCT
GROUND PLl1MBiNG UNDER FLOOR CUMDUIT �
SLAB GRADE FIREPLACE FOUNDATIOfV
TEMP POWER ' FIREPLACE BOND BEAM '
WATER SERVICE MID HT. BOND BEAM � '
ROOF SHEATHING 8 F7:BOND BEAM � �
FRAMINGNENTILIATION ' FINAL BOND BEAM '
ROOF COVF_R PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING - FINISH GRADING
SHOWERITUB TEST POOL ELECTRIC
EXT. LATH/SIDING ��p•{'� POOL FENCING
WALL INSULATION .. P<JOL FINAL
GEILING fNSULATION OFF SITE IMPS.
DRYWAL.L NAIUNG DEDICATfONS �
SEWER FINAL EfVG.
SEPTIC TANK ' LANDSCAPE/IRRlG. i
SEEP PIT/L.L. - ' ON SITE lMPS.
UAS AIR TEST FINAL ZONI�lG
FlNAL CC�NST. , FIRE QEPT. FINAL
FI�1AL HEATING . � HEALTH DEPT. FINAL �
FiNAL ELECTFtIC DEV. FEES PAID
f�liVAL PLUMBING . ENERGY
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