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�— � CITY OF DIAMOND BAR ���'���
--� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
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(909)86Q3195 Fax(909)861-3117 PRES$
���'�'� BUII.DING PERMIT APPLICATION � FIRMLY
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� ISSUE � 7YPE OCC
APN LOT TRACT DATE CONST. GROUP
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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Z TUHE,PRIOq TO ITS ISSUANCE.ALSO REOUIRES THE APPLIC�NT FOR SUCH PERMIT TO FILE A SIGNED
�l� STATEMENT THAT HE OR SHE IS�ICENSEO PURSl1M1T TO hiE PROVISIONS OF THE CONiRAC70RS Ll- w
� CENSE UW(CHAF7ER Y(COMMENCWO WI7H SECTION 7000)OF DMSION J OF THE BUSINESS AND PRO� � POOUSpB
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TION.AHVVIOlAT10NOFSECTION7031.6BYAHYMPUCANTF-0RAPERMITSUBJECTSTHEAPPLICAMiTO Z Re-Roof
� ACML PEHALiV OF NOT A/OiIE T11AN FNE MUNORED DOLLARS({600).):
� ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWIhIwAQESASTMEIRSOLECOMPEN5A710H, � Commerciet . -
WILL 00 THE WORK AND THE STRUCNRE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70Is,BU51- J
� NES9 M!D PROFE9910N5 CODE THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEHTY YVFp BUILDS OR IAIPROVES THEREON,AND WHO DOES SUCH WOR)(HIMSELF OR HERSELF OR
Q TIROUGH HIS OR MER OWN ENPLOYEES,PROVIDED THAT SUp1 IMPROVEMENTS ARE NOT INTENOED OR m
� OFFEREDFORSALE.�F.HOWEYERTMEBUIIDM�ORIMPROVEMENT1SSOlDVATMINONEVEAHOFCOAIPLE-
Z �'TIDH,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVPN3 7HA7 HE OR SHE DID NOT BUILD OR
� W VROVE FOR THE PURP0.5E OF SAL�. .
�J ❑1,A4 OWNEA OF THE PROVEHTV,AM IXq.U51VELV CONTRACTBKi N7TH LICENSED CON�RAC70RS
[� TO CON"TRUCT THE PRO.IECT(SEC.7os1,BUSINE59 AND PROFESSIONS CODE:THE CONTMCTORS LI� V01U8IIOf1 ADJ.AREA
� CENSEUWDOESNOTMPLYTOANOWNEROFAPROPERTVWI�OBUILDSORWPROVE3h1EREON.AND
N4qCONTRACT9f-0R6UqiVR0.1ECT9W17HACONTRACTOR(S)LICENSEDPUfiSUAHTTOTHECONTAAG pUANTITY DESCRIPTION FEE �
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� O I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q �
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DATE ONMER U �
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� I MEREBV AFFIRAI UNDEN PEIULT'OF PERAIRV THAT I AA1 UCENSED UNDER PROVISIONS OF CHAP7ER � �
S Y(COMMENCYW MTTM SECTION 7000)OF DMSION 3 OF THE BUSINESS MID PROFESSIONS CODE.AND Z
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� UCENSE CLASS �7 �C-� LIC.NO. ��9� � j -
U~ DATE � CONTRACTOR � a.
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� WORKERS'COMPENSATION DECLARATION
� I HEREBV AFFlRM UNDER PENALTY OF PERJURY ONE OF THE FOILOWINd DECLARATqNS: Z
� _IHAVEANDWILLMAINTAINACEiiTIFIGTEOFCONSENTTOSELF-INSUREf-0RWORKERS' �
Q COMPENSATION,ASPROVIDEDBVSECTION37ooOFTHEUBORCODE,FORTHEPERWRMM7CE U
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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� _I HAVE AND WILL AWNTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTqN
Q 3700 OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR N711CN 7HI5 PERMIT IS
ISSUED.MYWORKER9'COMVEN9AI�INSUWWCE RANDPOLICYNUMBERARE: CONSTRUCTION
jCARRIEH ����'��-�-�'��4.I�/ PLAN REVIEW '
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL 47 A!A\ IJ 11 k�
(7� SH�11 NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE � �"��u f�'J .
y WORKERS'COMPENSATION LAWS OF CKIFORNI/�AND AGREE THAT IF I SMOULO BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
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� WARNINO:FAILURE T SECURE WOAKERS'COMPENSATqN CAVEMOE IS UNUWFUL,AND SHA1L BE ENERGY P/C . . _ > D A
� SUBJECTANEMPLOVERTOCAIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT '1TY vr a�l�l�l�la �'" . �
DOILARS(f100.000�.W ADDITION TO THE C0.5T Of COMPENSATpN,DNAAOES AS PROVIDED FOF IN '�1
� SECTION J7oe OF THE UBOR COOE.INTEHEST,AND ATTORNEV'S FEES. � RETENTION FEE: �LT�DYl, �v L J�l L
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEpEBV AFFlRM U1AER PENALTV OF PERIURV THAT THEflE IS A CONSTRUCTION LENDWG AGENCV "
FOR iHE PERFORM�NCE OF hiE WORK FOR WHIq1 THIS PERMIT IS ISSUED(SEC.3007,CfV.C.). ,
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� LENDERS NAME � �
F- LEN�ER'SADORESS /�
� I CERTIFV THAT I HAVE READ THIS MPLICATION AND STATE THAT THE/�BOVE INFORA/ATION IS CORRECT. TOTAL FE ES � /y--
w I AOREE TO COMPLV N1TN ALL CITY AND COUNTV ORDINANCES M1D STATE UWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ' `/
ZABOVE�MENTIONED PROPERTV FOR INSPECTION PURP0.5E5. COMMENTS �
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� SIOHATUREOF E � DATE �
I RECPT.NO. PAID BY VALIDATION
� WHITE rtment Copy,YELLOW—Finence CaPY.PINK—Assessa Copy, OLDENR06�ile Copy,GREEN—ApplicanYs Copy
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FTGS/FORMS/STEEL �, ' � FHA REQMTS " `- � � ' '
ELECTRIC GROUND jD � d • � UNDER FLOOR DUCT '
GROUND PLUMBING UNDER FLOOR CU�{Du1T a, �� 4� �" .�` ' �
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SLAB GRADE FIRERLACE FOUNDATION � ..:....:; , •
TEMP POWER FIREPLACE BOND BEAN9
WATER SERVICE MIQ HT. BONI�:BEAM a�.: 'i .: ';;� � � •.'"t _
ROOF SHEATHING 8 FT. BQND BEA(G�� '� - - • ''�' "'=~ �
FRAMINGNENTILIATION FIN3aL ND�B'EAM '�•� ' � �' """ ''�
RC?OF COVER PRE-GRADING '
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ROUGH ELECTpIC RQUGM GRADING
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SHOWERrfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSUTATION - POOL FINA� '
CEILING INSUTATiON OFF SITE IMPS.
DRYWALL NAIUNG � � �, ,-. DEDICATIONS
SEWER � � FINAL ENG.
SEPTiC TANK � UINDSCAPE/IRRlG.
SEEP P1T/LL. ON SlTE IMPS.
GAS AIR TEST j�,S D F1NAL ZONING
FINAl.C(�P�1S7. ,"� ;_' ' ' . \ FIRE DEPT. �INAL
Fl�J�t HEATING HEALTH DEPT. FINAL
r�1�l�,L ELECTRIC DEV. FEES PAID
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