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CITY OF DIAMOND BAR
� ---��� — DEPARTMENT OF COrRvIUNITY&DEVELOPMENT SERVICES
21825 E.Cop►ey Drive
(909)860-3195 Fax(909)861-3117 PRESS
�`'-�����' BUILDING PEI2MIT APPLICATION FIRMLY
� JOBSITE , �� �/, i✓�J ��L �� APPLICATION PERMIT P/C
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p DATE MBER # I
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I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f89B/C8IP0lI
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROFE5510NSCODE:ANYCITVOR (n
U COUN7YWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- �
� W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STA7EMEN7 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO� � POOVSpO
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
U TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMI7SU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL 7ENALTY OF NO7 MORE 7HAN FIVE HUNDRED DOLLARS(f500).):
Z ❑I,ASON?JEfiOFTHEPROPEHTY.ORMVEMPIOVEESWI7HWAGESASTHEIRSOLECOMPEN5A710N, 0 COmmBfCiel -
WILL DO THE WORK,AND THE STRUCTUFE IS NOT INTENDED OR OFfERED FOR SALE(SEC.7044,BU51- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
, PROPER7VNTiOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR
� THROUGH HIS OR HEH OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS AfiE NOT INTENDED OR m
Q OFFEREOFORSPLE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR 7HE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPER7Y.AME%CLUSIVELYCONTRACTINGWITHUCENSEDCONTRACTORS
� 70 CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CON7RACTORS LI� V21U2�1Of1 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
i�- � WHOCONTRACTSFORSUCHPR0.IECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y 70RS LJCENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBYAFFIRM UNDER PENALTV OF PERJURV THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z
X MV LICENSE IS IN FULL FORCE AND EFFECT. / �!J `� • I�.e
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V DATE CONTFACTOR�.( JL//./YS A1I/SG7 a .
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENAL7Y OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
0 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELf-INSURE FOR WORKEflS' _
¢ CAMPENSATION,AS PROVIDED BY SEC710N 370o OF THE LABOR CODE.FOR 7HE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMI7IS ISSUED. �
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMP��+ATION INSURANCE C�a RIER AND P UCY NUMBER ARE: CONSTRUCTION
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CARRIEH �-f PLAN REVIEW
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Z —�G� � I �Z�-�--- ELECTRIC
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� (iHISSECTIONNE�NOTBEOLMPLEfEDOFhiEPERAYTISFORONEFNI-0REDDOI.LA0.S�f1W)ORLESS} PLUMBING I . �
Z I CERTIfV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM T IS ISSUED.I . MECHANICAL
(.�} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS O BECAME SUBJ T TO THE
� WORKERS'COMPENSATION LAWS OF CAUFOHNIA,AND REE T AT IF I SH ULD BECOME INSPECTION FEE
= SUBJECT TO THE WORKERS'COMPENSATION P OVIS OF ION 37 OF THE LABOR n /�
CA E.I SH L FORTHWITH COMPLV WITH 'H E P i o . ISSUANCE 4� ��
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p DATE� �� APPLICANT: l �� ' L Nl� SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE I UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN a
� SECTION370BOFTHELABORCODE,MTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: t •�V
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� I HEfiEBVAFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUC710N LENDING AGENCY
�- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
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� LENDER'S NAME
� LENDER'SADDRE55 �
� TOTAL FEES �j�•S�
� 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORPECT. �
w I AGREE TO COMPLV WITN ALL CITV AND COUNTV ORDINANCES AND STATE L4WS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTA7NE5 OF 7HI5 COUN7V TO ENTER UPON THE '
� ABOVE� ENTIONED PROPEHTV FO NSPECTION PURPOSES.
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= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, OLDENROD—File Copy,GREE —Applican s Copy
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GROUND PLUMBING i ____ i UNDER �LOOFt CUNDUIT �
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TFMP POWER I ....� ____.�. __FIREPLAGE_BUND BEAM _ -__�_._._
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WATER SERVICE � M(D HT. BOND BEAM
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ROOF SHEATHING 8 Ff. BUND BEAM
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FRAMIfUG/VENTILIA710N � FINAL BOND BEAM ; ______
ROOF COVER � PRE-GRADING �__ !.._____ ____...___..
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ROUGH HEATING 6ENCHlNG
ROUGH ELECTRIC �— RtJUGH GRADING
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ROUGH PLUiV1B�PJG J� T ; FiNISH GRADING
SHOWER/TUS TEST i PfJOL ELECTRIC
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EXT. LATH/SIDING � POOL FENCING
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WALL INSULATIOiV � i POOL F1NAL _ ;
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CEILING IN�ULATION � QFF SITE IMP�. __.._�_
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DRYWALL NAIUfVG j DEDICATIONS
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SEWER FiNAL ENG.
SEPTIC TANK LANDSGAPE!IRRIG.
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SEEP P!T/L.L. � ON SITE IMPS.
GAS AIR TEST FfNAL Z�NING
FINAL C(7iVST. ! I G�RE DEPT. FINAL �
FINAL HEATING HEALTH DEPT. FINAL
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FINA�ELECTRIC _---�— � DEV. FEES PAID
FINAL PLUMBING ENERGY
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