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CITY OF DIAMOND BAR �
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'°-.�`V BUILDING PERMLT APPLICATION FIRMLY
� JOBSITE APPLICATION � PERMIT P/C
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APN LOT�_ TRACT DATE CONST. GROUP
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� OWNER-BUILDER DECLARATION SFR/ADO/REM
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� I HEREBV AFFlRM UNDER PENPLTY OF PERIURV THAT I AM EXEMPT FROM THE CAN7RACTOF75 LI� G8fH9B/CfllpO/I
W CENSEUWFORTNEFO�IOWIN�REASON(SEC.7031.6BUSINESSANOPROFE5510NSCODE:P.NVCITYOR (n
U WUNTVNMICHREOUIRESAPE��TTOCANSTRUCT,AITER.IMPROVE.DEMOLISH.ORREPAIRANYSTRUG w patio/Deck
wTURE,PRpR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIONED
� STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO iNE PROVISIONS OF THE CONTMCTORS LI-
� CENSE LAW(C1IAPTEH e(COMMENCINO WITM SECTION 7000)OF DIVISION 3 OF THE OUSINE55 AND PRO� � P�USpe
� FESSIONSCAOE)OR7}IATHEORSHEISE%EMPTTHEREfflOMAND7HEBA515FORiHEALIEGEDExEMP�
TqN.ANV VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE TMM1 FNE HUNDRED DOLLARS(f5ao).�: _
O pl,A$OWNEROFTHEPROPERTY.ORMYEMP�OYEESWRNWA4ESASTHEIRSO�ECAMPENSATION. � COf111i18fG181
Z WILL DO THE WORK.NND THE STRUCNRE IS NOT IMENDED OR OFFERED FOR SALE(SEC.70��,BU51� J
� NESS AND PHOFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF �
PROPERTYVAIOBUILDSORIMVROVESTNERE-0N,ANDWHODO£SSUCHWORKHIMSELFORHEFSELFOR m
� THHOUGH HIS OR HER ONM EMPLOVEES,PROVI�ED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR ,
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Z TION,THE ONMER�BUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE DID NOT BNLD OF
� IMPROVE FOR THE PURPOSE OF SALE).
w �I,ASOWNEROFTNEPROPERTY,AME%CLUSIVELYCANTMCTIN�WITMUCENSEOCONTRACTORS
� t0 CONSTRUCT THE PRQIECT(SEC.70N,BUSME9S AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8t1Of1 ADJ.AREA
W CENSE UW OOES NOTAPPLY TO AN ON7JEN OF A PROPERTV WHO BUILDS OR IMPROVES THEREON.AND
� WFqCONTMC7SFOR5UCHPRQIECTSMlITHACANTRACTOR�S)LICENSEDPURSUN(TTOTHECONTFAG QUANTITY DESCAIPTION FEE
70RS IJCENSE UWJ.
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OO I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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l�"' DATE ONTJER U V��I
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� LICENSED CONTRACTORS DECLARA710N �
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I HEREBY AFFIRM UNDER PENALTV OF PERIURY 7T1AT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY UCENSE�S IN FULL FORCE M!D EFFECT. � '. m
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� LICENSE CLASS LIC.NO. �� �i J
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� WORKERS'COMPENSATION DECLARATION J
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� I HEREBY AFFIRM UNDEF PENALTV OF PERJURV ONE OF THE FOLLOWINQ DEqARATIONS: Z
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0 I H�VE AND WILL AIAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORI(ERS' 2
� COMPENSATION,AS PROVIDED BV SECTION 37o0OFTHE LABOR CODE,FOR THE PERFORAIANCE w
OF THE WORK FOR WMICH THlS PEfiMIT IS lSSUED. �
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w �AVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REWIRED BV SECTION
Q 370o OF TME LABOR CODE,FOR THE PERFORMMlCE OF 7HE WORK FOR WHICH THIS PERMIT IS
ISSUED,MV WO��MPE���A�CE C R rqµD PO ICY NUM ER ARE: CONSTRUCTION
jCARRIER �+��• �O► PLAN REVIEW
� POIICV NUMBER � ELECTRIC
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w MECHANICAL
� I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I
�} SMALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO TNE
� WORKERS'CAMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SU&IECTTOTHE�'�OFKERS'COMPENSATIONPROVISIONSOFSECTION9]OOOfTHELABOR ISSUANCE L �
� CODE.1 SHALL FORTHWITH COMPLV WIT�H THjOSE PROVIS !'�
p DATE:$. 7'fLLAPPLICANT: � SMIP
w ���� – - ENERGY P/C
� J WARNING:FAILURE TO SECURE MfORKERS'COAIPENSA710N fAVERAGE IS UNLAWFUL AND SHALL BE
�y SUBJECTANEMPLOVERTOCR�MINALPENALTIESANDCIVILFINESUPTOONEMUNDREDTFIOUSAND ENERGYPERMIT
OOLLARS(f��.�)�IN ADDITION TO THE COST OF COMPENSATION.DAMAOES AS PROVIDED FOR IN I O7\
J SECTION 3�08 OF THE LABOR CODE,INTEREST,AND ATTORNEr'S FEES. RETENTION FEE: `J
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w CONSTRUCTION LENDING AGENCY PRE-AlT FEE:
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� I HEREBV AFFIRM�UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LEN�WG AGENCV
n- FOR TNE PERFORMANCE OF THE WOFiN FOR NRi1CH THIS PfRM1T IS�SSUED�SEC.909�.CIV.C.). �
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� LENDER'S NAME
F- LEN�ER'S ADORESS _ ^/
� ICERTIFVTHATIHAVEREADTNISAPPLICATIONANDSTATEiHATTHEABOVEINFORMATKKJISCORRECT. TOTAL FEES i l� � , D
w I AGREE TO COMPLV WITN ALL qTY AND COVNTV ORDINANCES AND STATE LAM�S REIATINa TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
z ABOVE�MENTIONEO PROPERTY FOR INSPECTION PURPOSES,
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m PERM�TTEE NAME(PRIM)
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N SI6NA �TTE � � RECPT.NO. PAID BY VALIDATION
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� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL ' FHA REQMTS '
ELECTRIC GROUND b_�,�p UNDER FLOOR DUCT � '
GROUND PLUMBING UNQER F�OOR CU��DUIT
SLAB GRADE y � FIREPLACE FOUNDATlON
TEMP POWER f=1REPLACE B�ND BEAM
WATER SERVICE MID HT. 80ND BEAM
ROOF SHEATHING 8 FT. B(�ND BEAM � �
FRAMINGNENTILIATION ` FINAL BOtVD BEAM
ROOF COVER PRE-GRADlNG
ROUGH HEATING BENCHING
ROUGH ELEC7RIC _6_�.�jL ROUGH GRADING
ROUGH PLUMBING FINISH uRAi��NG
SHdWER/TUB TEST POOL ELEGTRIC
EXT. LATH/SIQING POOL FENCING
WALL INSULATIOiV POOL FlNAL
CEILING INSULATION ^ OF�SITE IMPS.
DRYWALL NAIUNG DEDICATIONS
SEWER FiNAL ENG. �
SEPT(C TANK LANDSCAPE/tRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AiR TEST FINAL ZDNING
FlNAL CONST. � FIRE DEPT. FINAL ' '
FINAL HEATING HEALTH DEPT. FINAL
FINA��LECTRIC � i 4��L, DEV. F�ES PAID
FINAL PLUMBING � ENERGY
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