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CITY OF DIAMOND BAR n�
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. 21825 E.Copley Drive
�- (909)860-3195 Fax(909)861-3117 ��N 19 2001 � q PRES$
`�"%�����' BUILDING PERMIT APPLICATION � FVRMLY
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cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM I
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I HEREBV AFFIHM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8�2JB/CefPOh
W CENSELAWFORTHEFOLLOWINGREASON�SEC.7o31.5BU51NESSANDPROFESSIONSCADE:ANYCITYOR (n
U COUNTVWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVS7RUC-
w TURE.PRIOR TO ITS ISSUANCE,Q50 REOUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED w Patio/Deck �I
STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 70 THE PROVISIONS OF THE CON7RACTORS LI�
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDE%EMP- (� II
V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLLARS(550D).):
Z ❑I,ASONRJEROFTHEPROPEFi7V,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1rtIBfCi21 -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7odt,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRAC70Fi5 LICENSE LAW DOES NOT APPLY 70 AN OWNE{i OF � �
PqOPERTV NMO BUILDS OR IMPROVES THEREON,AND MMO DOES SUCH WOHK HIMSELF OR HERSELF OR
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� OFFEREDFORSPLEIF,HOWEVER7NEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPHOVE FOR 7HE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTY,AMEXCWSIVELVCON7RACTINGWITHLICENSEDCONTRAC70R5
� TO CANSTRUCT 7HE PR0.1EC7(SEC.70��,BUSINE55 AND PROFESSIONS CODE:THE CANTRACTOpS LI- V31113�1Of1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSOHIMPROVESTHEREON,AND
� WHOCAN7RACTSFORSUCHPR0.1EC75WI7HACAN7MCTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. 8.6 P.C.FOF THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION W
� t HEHEBY AFFIRM UNDER PENAITY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � . �
� e(COMMENCING WITH SECTION 7000)OF DIVISION 30F 7HE BUSINESSAND PROFESSIONS CODE,AND Z
�X MY LICENSE IS IN FUI,I�F,_O�AND EFFECT. m
� LICENSE C SS `, IIC.NO. j
U DATE ` CONTRACTOR a
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� WORKERS'COMPENSATION EC � Q
� I HEREBV AFFIRM UNDER PENALTY OF PEfiJUHV ONE OF THE fOLLOWING DEC RA IONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-IN RE R WORKERS' _ �
¢ CAMPENSATION,AS PROVIOED BV SECTION 37000F THE LABOR CO R THE GERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION
Q 3700 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WOf1KERS'CAMPENSATION INSURANCE CARRIER AND POIICV NUMBERARE: CONSTRUCTION
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� CARRIER PLAN REVIEW
' Z POLICY NUMBER �ELEC,T,R
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� (iHIS5ECT10NNEmNOTBE00MPLEfEDOFTHEPERMfTISFORONEHUPDREDD0I.LARS(5100)ORLESS} UMBING �
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS P IS ISSUED,I
(} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 A BECA BJ TO THE
� WORNERS'COMPENSATION LAWS OF CALIFORNIA, AG E IF I OULD BECOME INSPECTION FEE
� SU&IECT TO THE WORKERS'CAMPENSATION P ISION ECT 700 0F THE LABOR �
� D I SHALL FORTHWITH COMPLV WITH T E PRO 10 SUANCE �. �
� ��3a-0.2 �.��-,-- - -
DAT : APPLICANT. � , . -
wWARNING:FAILURE TO SECURE WORKERS'C MPEN TIO ERAG UNLAWFUL,AND SHALL BE ENERGY P/C r�'
LL SUBJECTANEMPLOYERTOCRIMINALPENAL7IESANDCIVILFINESUP O NEHUNDREDTHOUSAND ENERGYPEFMIT I 1 !1 h /. ..
DOLLARS(f700,00D).IN AODITION TO THE COST OF COMPENSATION AM GES AS PflOVIDED FOR IN ^--•
� SECTION 3708 OF THE LABOR CODE,IN7EREST,AND ATTORNEYS Es. RETENTION FEE: j J M I tl t) V ��)�,/
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� CONSTRUCTION LENDING GENC PRE-ALT FEE: I �
� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A ONST UCTION LENDING AGENCY '���-� -/� ,
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH TMIS PERMI7 ED(SEC.3097,qV.C.). � — _____
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� LENDER'S NAME
� LENDER'S ADDRESS
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORflECT. TOTAL FE ES '
w I AGREE TO COMPLY WITH ALl CITV AND COUNTV OqD INANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRU ,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7Y TO ENTER UPON THE
� ABOVE�M NTI NED PROPERTV���eeertrtm��ww SPECTION PURPOSES.
Z � �� COMMENTS
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� SIGNAT E DATE 1
= RECPT.NO. � PAID BY VALIDATION �
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P PY, PY. PY, PY, PP PY
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FTGS/FORMS/STEEL ; ; FHA REQMTS
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E�ECTRIC GROUND � � UNDER FLOC?R DUCT
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GR�UND PLUMBING ; ___ UN�ER FLOOR GUf�IDUIT �
---- ----- ----._..._._..__
S�AB GRADE _ FIREPLACE FOUNDATION _I
TEMP POWER i !_ FIREPLACE BOND BEAM__ __ _._
WATER SERVICE � MID HT. BONQ BEAM __ ___
_ ...-- -
ROOF SHEATHING _; 8 FT. BOND BEAM _ � _ ____
FRAMING/VENTPLIATION I FINAL BOND BEAM __ _____ � __ _
ROOF COVER PRE-GRADING _
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH P�UNIBING FINISH GRADING
SHOWERJTUB TEST i P�OL ELECTRIC
EXT. IATH/SIDING POOL FENCING
WALL 1(VSULATION POOL FINAL I
CEIL.ING INBULATIOIV OFF SITE IMPS.
DRYWALL NAI�ING DEDICATIONS
SEWER FIiVAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZOhIING
FINAL COhiST. FlRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FIiVAL ELECTRIC � DEV. FEES PAID '
FINAL PLUMBING ENERGY
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SEPTIC TAIVK SIZE
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