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CITY OF DIAMOND BAR �X�\�
-----���— DEPARTMENT OP'COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 PRES$
'c (9U9)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702'7
' ��9��W BUILDING PEItMIT APPLICATION � FIRMLY
� JOBSITE ��J/j� S��j�� �/� T.err� � DATECATIOp66, �j NUMBER I F f�� #/C
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� OWNER-BUILDER DECLARATION SFR/ADD/REM '
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p I HEREBV AFFIRM UNDER PENALTV OF PERNIRY THAT I Nd EXEMPT FROM THE CON7RACTORS LI- G8f890/CBfpOf1
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wTURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIONED
� STATEMENT THAT HE OR SHE IS llCENSED WiiSUANT TO THE bROVISIONS OF TNE CONTRACTORS L6
� CENSE LAW(CHAPTER 9(COMMENpNO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO• � POOUSPB
FE5310N5 CODE)OR THAT HE OF SHE IS EXEMPT 7NEREFROM AND THE BA515 FOR THE/U.LEGED EXEMP- (�
7qN,/�M'VIO�ATION OF SECTION 7a91.5 BV ANV APMICANT FOR A PERMIT SUBJECTS THE APPUCANT T0 Z Re-Roof
� A pVIL PENALTV OF NOT MORE 711AN FIVE HUNDRED DOLURS(i500).):
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Z VALLDO THE WORK,MiD THE STRUCTURE IS NOT INTEND£D OR OFFERED f-0R SALE(SEC.7W/,BU51� �J
� NESS M1D VROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT AP7LV TO AN OWNER OF �
PROVERTYWFIOBUlLD50HIMPROVESTHEREON.ANDNMODOESSUCHWORNHIMSELFORHERSE�FOR m
Q THAOUGH HIS OR HEROWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR
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_ ❑I,ASOWNEROFTHEPROFEHTV.AME%ClUSNELVCAMRACTWOWfTHLICENSEDCONiMCTORS �
w TQ CANSTRUCI THE PROJECT(SEC.70u,BUSINE55 ANO PROGESSIONS COOE:THE CONTRACTORS LI- VBIUel�Of1 ADJ.AREA
� CENSE UW DOES NOTAPPLV TOAN OVMER OF A PROFERTV WHO BUILDS OR IMPROVES THEREON,AND
Vh1000NTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)UCENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE
70RS UCENSE UW.).
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� UCENSED CONTi7ACTORS DECLARATION �j
�. , � � I MEREBV AFFlFUA UNDER PENALTV OF PERIURY THAT I AM UCENSED UNOER PROVISIONS OF CHAPTER �
, d D(COMMENCW(�WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
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� I HEREBV AiFIRM UNDER PENALTY OF GERJURV ONE OF THE FOLLOWING OECIAAAT10N5'.
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0 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WORKERS' 2
� COMPENSATION,AS PPOVIDED BV SECTION 3700 OF TME LPBOR CODE,FOR THE PERFORMANCE `U
THE WORK FOR NM1iICH THIS PERMIT IS ISSUED. c1
� �w I HAVEAND WILL MtJNTAIN WORKERS'COMPENSA710N INSURANCE,AS REWIqED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF TNE WORK FOR WNICH THIS PERMIT i5
ISSUED.MY WORK C MPENSATION INSU ANCE CARRIER/AND POIICV NUMBERARE: CONSTRUCTION
� CARRIER � d PLAN REVIEW
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� POLICV NUM9ER �_ F��� — ELECTRIC
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Z I CERTIFV THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I
� SHALI NOT EMPLOV ANV PERSON IN ANV MNJNER 50 AS TO BECOME SUBJECT TO THE INSPECTION FEE
� �MDRKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOl1LD BEC-0ME �
S SUBJEC7TO7HEWORI(EFiS'COM7ENSA710NPROVISIONSOFSEC710N37000FTHEUBOR ISSUANCE � •°
CODE.�S FOR I7M COMPIV WITH TN SE PmROVI5lON5.
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p DATE: /�APPLICANT: i �� �
w ENERGY P/C
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J SUBJECTANEMPLOVERTOCRJMWALPENALTIESANOCIVIIFINESUP700NEHUNOREDTHOU5�f1D
� OOLLARS(floo.0ao�,M ADDITION TO TME COST OF GOMFENSATqN,DAMAGES AS PROVIDED FOR IN ENERGY PERMIT
J SECTqN 3708 OF THE LABOR COOE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: ��� .
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w CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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CC 1 HEREBV AFFIRM UNDEi7 PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENOWO AGENCY
� FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,GV.CJ. '
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� LENDEFYS NNAE
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¢ I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES •���
W I AOREE 70 COMPLV WITH ALL CRV ANO CAUNTV ORDINANCES AND STATE LAWS REUTING TO BUIIDING .
� CANSTRUC710N,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE
Z ABOVE-MEMIONEO GROPERTV FOR INSPECTION PURPOSES. . '
COMMENTS
� G'�l�i�a� ���/�iv�-
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m PERMI7TEE NAME(PR1Nn
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N SIONATURE OF PERMITT / ATE
RECPT.NO. PAID B�� VAI.IDATION
� WHITE—Dapartment Copy,YELLOW—Flnence Copy.PINK—Assessw Copy,GOLDENROD—File Copy,GREEN--Applicant's Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHE,4THIfJG 8 FT. BOND BEAM
FRAMINGNENTILATION FIPIAL 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
WA�L 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. F�RE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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