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CTI'Y OF DIAMOND BAR
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21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 � PRESS
�"���Y� BUILDING PERMIT APPLICATION FIRMLY
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p I HEREBY AFFIRM UNDER PENALTY OF PEfiIURY THAT I AM EXEMP7 FROM THE CON7RAC70R5 LI� GefB[JB/CB�OR
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w TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIfiES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STA7EMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� LL'' Pa�USpB
� FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEFEFROMAND7HEBASISFORTHEALLEGEDEXEMP- (!3
TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z Re-Roof
� A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLlARS(S5o0).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITH:WAGESASTHEIRSOIECAMPENSATION, 0 Commercial -
Z WILL DO THE WORK,AND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.704I,BU51- J
N NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ?
PROPERTY VhlO BUILDS OR IMPROVES THEfiEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� � THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDFORSALE.IF,HOWEVER711EBUIL�INGORIMPROVEMEN71550LDWITHINONEVEAHOFCOMPLE-
� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR
Z IMPROVE FORTHE PURPOSE OF SALE).
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� 70 CANS7RUCT THE PRQIECT(SEC.7041,BUSINESS AND PROFESSIONS COOE:7HE CONTRACTORS LI- V81U8fi0f1 ADJ.AREA
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� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUAN7707HECONTRAC- QUANTITY DESCRIPTION FEE
� TORS LICENSE LAW.).
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALN OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CO�E,AND Z
`X MV LICENSE IS IN FU FO E AND EFFECT. ���� m �/
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� WORKERS'COMPENSATION DECLAR TIO HH �
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLAR T� Z
� I HAVE AND WILI MAINTAIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WOHKEFS' _
¢ CAMPENSATION,AS PROVIDED BV SEC710N 370o OF THE LABOR CO�E.FOR 7HE PERFORMANCE �U
OFTHE WORK FOfl WHICH 7HI5 PEHMIT IS ISSUED. �
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w I HAVE AND WILL MAINTAIN WORKERS'COMGENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE R CODE,F R T E PERFORMA dCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY 0 ( M E N I CE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� CARRIER PLAN REVIEW
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� (THISSECiIONNEmNOTBE00MPLEfEDOFTHEPERA4TISFORONEHUI�DREDDOLLAFLS(L1a0)ORLESS). PLUMBING
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE �
� WORKERS'COMPENSATION LAWS OF CAUFORNIA,AND AGFEE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECTTO THE WOfiKERS'COMPENSATION PROV 10 OF SECTION 37000F THE UBOR
� ,I�F�4 RTHWITH COMPLV WI TH E P O I / ISSUANCE
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p DATE: APPLICANT:
J WAHNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COS70F COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37aBOFTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENT�ONFEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEHEBV AFFIRM UNOER PENALN OF PERJURV 7HAT THERE IS A CONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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S LENDER'S NAME
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F_- LENDER'SADDRE55
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� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
w I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCESAND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEFiEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� AB E�M TIO ED PR PEAT F R INSPECTION PURPOSES.
? /� /'� COMMENTS
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FTGS/FORMS/STEEL , ; � FNa RECZMTS
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ELECTRIC GROUND UNDER FLOQR DUCT ,
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GROUND PLUMSING �___ _ ; UNDER FLOOR.CUMQUIT _ ; __ ____
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SLAB GRADE � ___ -_----�,__v._._. ._._FIREPLAGE_FOUNDATIC3(V i..._.___.._.___
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TEMP POWER ; �IREPLAGE B�ND BEAM '
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WATER SERVICE MID HT. BQNG�BEAM _ • _
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ROOF SHEATHIiVG 8 Ff. BONQ SEAM
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FRAMING/VENTILIATION I FdNAL BOND E�EAM �
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ROOF COVER PRE-GRAQING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADfNG
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ROUGH PLUNIBING j FINlSH GRA�ING
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SHOWER/TUB TEST POOL ELECTRIC
EXT. IATH/SIDING POOL FENCING
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WALL INSULATION j POC?L FINAL
_ _.-- -- ---- --_____�_
CEILIidG INjULATiON OF�SITE IMPS.
DRYWALL PVAILING
i �EdICATIONS -- -._.___..._..._.__._.._
SEWER FINAL EIVG.
SEPTIC TARIK LANDSCAPE/IRRIG.
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SEEP PIT/L.L. QN SITE IMPS.
GAS AIR TEST FINAL ZONING
FI(VAL CONST. � , �!RE DEPT. FINA�
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FINAL HEA7IR�G i HEALTH DEPT. FINAL
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FINAL ELECTRiC DEV. FEES PAID
FINAL PLUMBII�G ENERGY
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CO�/iiViEi�TS
SEPTIC TAP�K SIZE
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