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CTI'Y OF DIAMOND BAR I
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��'%��� BUILDING PERMIT APPLICATION FIRMLY
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APN LOT TRACT DATE CONST. GROUP
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a CONTRACTOR �V��F�Z SIDE ❑
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cn DESCRIPTION SQ.FT. . FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT 1 AM E%EMP7 FROM THE CONTRAC70R5 LI� G8ld90/CBfPOR
W CENSEUWFORTHEFOLLOWINGFEASON�SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
C..� COUN7VWHICHREDUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORFEPAIRANYS7RUP '
� w TURE,PRIOR TO I75 ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W PaI10/DBCk ��
STATEMENT THAT ME OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS Of THE CON7RACTORS LI-
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSP2
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJEClS THE APPLICANT TO Z Re-Roaf
A CIVIL PENAL7V OF NO7 MORE 7HAN FIVE HUNDRED DOLURS(t500).):
ZOI,ASON?JEROFTHEPROPER7V,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1rtlBfCl81 -
WILL DO 7HE WORK,AND THE STRUCTUPE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.704d,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTOf75 LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSEIF OR
2 THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDf-0RSALEIFHOWEVERTIIEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- �
Z TION,THE OWNER�BUIL�ER WILL HAVE THE BURDEN OF PROVING THAT HE Ofi SHE DID NOT BUILD OR
� IMPROVE FOR 7HE PURPOSE OF SALE). .
w ❑I,ASOWNEROF7HEPROPERTV,AME%CLUSIVELYCAN7RACTINGWITHLICENSEDCON7RACTORS
� TO CONSTFUC7 THE PR0.IECT(SEC.7ola,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ll- V81U8�1On ADJ.AREA
W CENSE LAW DOES NOTAPPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
F WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
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O ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS ASON Q
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DATE OWNER �
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� LICENSED CONTRACT ECLARATION W
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I ICENSED UNDER PROVISIONS OF CHAPTER �
d 9(COMMENCIN�WITH SECTION 7000)OF DIVISION 3 O E BUSINE55 AND PROFESSIONS CODE,AND Z
X AIY LICENSE IS IN FULL FORCE AND EFFECT.
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� LICENSE CLASS LIC.NO. j
V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECURATIONS: Z
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUFEFORWORKERS' _
Q CAMPENSATION,AS PROVIDED BV SEC710N 370o OF THE LABOH CODE,FOR 7HE PERFORMANCE U
OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. W
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w _I HAVE AND WILL MAMTAIN WORKERS'COMFENSATION INSURANCE,AS REOUIRED BY SECTION
Q 37000F THE LABOR CODE,FOR THE PEFiFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� I O
ISSUED.MY WORKERS'CAMPENSATION INSUHANCE CARRIEH AND POUCV NUMBER ARE: CONSTRUCTION �
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� CARRIER PLAN REVIEW ,Q � lL7 '
'Z POIICV NUMBER ELECTRIC
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� (fH6SECT10NNE�NOTBEOJMPLETEDOFTHEPERMfTISFORONEHUWREDOCLLAiLS(E100)OfiLESS). PLUMBING �
Z I CERTIFVTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL �
(} SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
�/j WORKERS'COMPENSATION LAWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE �
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR T
CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
� SMIP
p DATE: APPLICANT. r
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SUBJECTAN EMPIOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PEAMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT 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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� LENDER'S NAME
F— LENDER'SADDRESS `
� TOTAL FEES I\ I
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. � U '�
w I AGREE TO COMPLV WITH ALL qTY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUIIDiNG
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPERTV FOR INSPECTION FURPOSES.
' Z COMMENTS
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m PE EE NA E(PRINT
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Uj SIGNATUR PERMI E DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SET BACK I ��� FLOOR JQlST � �
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FTGS/FORMSlSTEEL _�� C��-- _ : FHA REQMTS '
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E�ECTRIC GROUND ; � , UN�ER �LOOR GUCT ---- _._ � .
-- ----- ._...---- ._.._1... -- -...._�� -- ' - . _.-------
GROUND PLUMBING _ UfVf]ER FLOOR CUhIDUIT ; _ ____
SLAB GRADE FIREPLACE FOUNDATIQN �
-----�---._--__;_-_____ -._.._. ..�---- ----- -�-____ ----.___.._
TEMP POWER i ; FI�EPLAGE B�ND BEAiv1 i __ __
- -�-
W;4TER SERVICE � ___ '_, MID HT. BOND BEAM _____ __
_ __. __. - -----
�� ' 1�8�`f`. BC7fV� B�a�f i
ROOF SHEATHING �
- _.__ - --- - --- �-
----
FRAMING/VENTILIATIOt��V _(/_� _ ._ __ _ � FINAL BOND BEAM _, _______ I
___ ---
ROOFCOVER -- _ PF?E-GRAD{NG --- -- �-_- ---
ROUGH HEATING BENCHING ___ i
ROUGH ELECTRIC ��D � � RC�UGH GRADWG �
- - _- ,-- --- _ � .____ � _. ._.._-- _1.---__
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ROUGH PLUMBING ; FINISH uRADiNG __ _____
SHOVVER/TUB TEST � ; POOL ELECTRIC
_ _.� -------�- -- _._._-- ---.___ ---.._....._._.-------
EXT. LATH/SIDING ' PC70L FENCING __ _____
WALL INSULATION POOL FINAL !
-- ---- --- � ---.. _
GE�LIfVG IIV�ULATIOIV __ _� O��SITE IMPS_ � �
DRYWALL NA{LIiVG `D�.�fi_�.� D�DICATIDNS ��----__- ---
SEWER , FINA�EN�. (
--- _-.._ ---._...-------.__ __..
SEPTIC TAR1K ` LANDSCAPE/IRRIG.
--
SEEP PIUL.L. ; ON SITE IMPS.
-- �- --- ---....__._. __.____,.-fi_- -----..._.__
GAS AIR TEST j FlNAL Z�NING ; `
FINAL CONST. � F�RE DEPT. FINAl.
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Fit�AL HEATING � ; HEAITH GEPT. FIi�IA� ' � � _
FINAL ELECTRIC ! � DEV_FEES PAID __ _ _
FiNAL PLUMF3iNG � ' � FNERGY � i
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GUMi�lENTS _ _— �_�---- -
SEPTIC TANK SIZE
SEEP PIT/U SIZE -
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