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1��_ CITY OF DIAMOND BAR �/
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES /
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'°""� BUILDING PERMIT APPLICATION FIRMLY
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� PLICATION PERMIT p/C
o ADDRESS DATE I NUMBER����#
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o ADDRESS � ZONING SETBACKS
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o APPLICANT TEL. SI�SIDE STREET � RW ❑
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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p I HEREBV AFFIRM UNDER PENALTV OF PERRIRV THAT I AA/E%EMPT FqOM THE CONTRACTORS LI- GBfe(]0/C8lPOh
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W TURE,PRqR TO ITS ISSUANCE,�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATENENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(qiAPTER o(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PRO- � POOVSpO
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� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, COfI'IrtIOfCIe1
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEHEO FOR SALE(SEC.701a,BUSI� �
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � / /M
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w THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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w ❑I,ASOWNEROFTHEPROPERTV,AMEJ(CLUSNEIVCONTMCTWGWITHLICENSEDCONTRACTOHS
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W CENSE UW DOES NOTAPPLV TOAN OVMER OF A PROPERTV WHO BUILDS OR IMPROVES h1EREON,AND �
� NM1fOCANiRACT5FOR5UCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAP pUANTITY DESCRIPTION .
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRAI UNDEH PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Z �/� , /�/
� 4(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND w L/
��� MY LICENSE IS IN FULL FORCE AND EFFECT. m
� UCENSE CLASS UC.NQ �
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� WORKERS'COMPENSATION DECLARATION �
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLIOWING DECLARATIONS: �
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� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�WSURE FOR WORNERS' a
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COMPENSATION,AS PROVIOED BV SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMANCE U
OF THE WORK FOq NM1IICH THIS PERMIT IS ISSUED. W
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIFED BV SECTION
Q 37o00FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 /�/ �
ISSUED.MV WORKERS'CAMPE A N IySURANCE CAR�POI,yC�NI�I�ER ARE: CONSTRUCTION
jCARRIER '� �V � PLAN REVIEW
Z POLICV NUMBER � � �'(� � ELECTRIC � ��
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0 (rFflSSECf10NNE�NOTBECOA41.EfIDOFhEPERAiriSFOppNEFl1�DFiED00LL�fiSR�OU)ORIESS} PLUMBING �
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Z I CERTIFV 7HAT IN THE PEFFORMANCE OF THE WORN FOR WHICH 7HIS PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
(/j WORKERS' MPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&lECT O THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F THE LABOq r�.
CODE.I HALL FORT ITH COMPLV WITH THOSE RAOVISIONS. ISSUANCE �j
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1p DATE: APPLICANT: ��� r��1� SMIP � �f
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"'� WARNINQ: AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
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� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNOREDTHWSAND ENERGYPERMIT
DOLURS(S1oo,000),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
w SECTION37080FTHEUBORCODE.INTEREST,ANDATfORNEVSFEES. RETENTIONFEE: � �
O CONSTRUCTION LENDING AGENCY PR -ALT FE�
� I HEREBV AFFIPM UNDEF PENN.TV OF PERJURY THAT THEHE IS A CONSTRUCTION LENDINO AOENCY ���
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�.
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� LENDER'S NAME
F— LENDER'SAODRE55
w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, TOTAL FE ES ��Q /K7
� I AGREE TO COMPLV WITH ALL CI7Y AND COUNTV ORDINANCES AND STATE UWS REUTIN6 TO BUIL�INO
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CWNTV TO ENTER UPON THE '
Z ABOVE-MENTIONE�PERTV INSPECTION PURPOSES. COMMENTS '
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� SIONAN OF ATE i
� RECPT.NO. PAID 8 / VALIDATION
E-0epaAmant Copy,YELLOW—Finance Capy,PINK—Assessor Copy,GOLDENR D—File Copy,GREEN—Appl(canYs Copy
�I�'Y O� DI�i1�OND �,�,R
I�SE��CT'If�N RECORD
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL 'o-,, FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM •
ROOF SHEATHING 8 FT. BOND BEAM '
FRAMINGNENTlLATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGN PLUMBING FINISH GRADING
SHOWER�1'UB TEST POOL E�ECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRlG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST y � FINAL ZONING
FINAL CONST. • FIRE DEPT. FINAL
FINAL HEATING �, i HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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