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' _f��_ CITY OF DIAMOND BAR ✓
DEPARTMENT�OF COMMUNITY&DEV�LOPMENT SERVICES �
21810 Copley Drive,Diamond Bar,CA 91765 ' ,
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �
��9^'� BUILDING PERMIT APPLICATION FIRMLY I
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ISSUE � TYPE OCC �
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ADDRESS PROPOSED USE A��.t .�u EY1 G�pS�
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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� STATEMEM THA7 NE OR SHE IS LICENSED PURSUANT TO THE PRONSION"OF 7NE CONTfUC70R3 LL
� CFNSE UW(LNAPTER Y(COMMENCINC�WITH SECTION'lOoO)OF O1VIS10N 7 OF THE BUSINE55 PNO PRO- � POO�SpB
FESSIONS COOE�OR THAT HE OR SHE 19 EXEMPT 7MEREFROAI AND THE BASIS FOR THE ALLEOED EXEMP• � - �
� � TION.ANYVIOLATIONOFSECTION7031.5BVANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z qg-Roof
� �CMI,VENALTY OF NOT MOAE TUN FIVE HUNOREO DOl1AR5(f600)J: .
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z WILL DO iHE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERE�FOR SALE�SEC.70N,BUSI� J
NESS AND GROFESS10N5 CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN.OWNER OF
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� THHOUGH WS OR NER ONTJ EMFLOVEES,PRONDEU THAT SUCH IMPROVEMENTS ANE NOT INfENDFD OR '
OFFERED FOR SALE IF,HOWEVE0.7HE BUIIDINO OR W PROVEMEM IS SOID WITMN ONE VFi1A OF COMPLE
TqN,THE OWNER�BUILDER N7LL HAVE TME BURDEN OF PROVINa THAT ME OR SHE DID NO7 BUIID OR
= IMPROVE WR THE VURPOSE OF SALE). � � � O O� �. . .
❑4 AS OWNER OFTHE PROPERTY,AM ExCLUSNELV CONTMC7RIU WITH IICENSED CONTRACTORS /�_� �
Q N CONS7RUCT iHE PRO,IECT(SEC.7011.BUSINESS AN�PROFESStONS CODE:7HE CONTRACTOHS ll- VeIUHtlOn �31��� • 'TT AQI.AREA
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�Q UCENSED CONTRACTORS DECLAHATION � � � � � .
CC I HEREBV AFFIRAI UNDER PENALTV OF PERIURY THAT IAM LiCENSED UNDER PROVISION9 OF CHAPTER �
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XL' AIY UCENSE IS IN FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION � � � � � 1
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� I HEREBV AFFIfl►1 UNOER PENALTV OF PERJUHV ONE OF THE FOLLOWWG DECLARATIONS: �
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O _IHAVEANDWILLMNNTAWACEAT�FICATEOFCANSENTTOSELF-INSUREFOFiWOPo(ERS'
� C0IAPENSA7iON.AS PROvroED BV SECTroN a7ooOF TNE LnBOR COpE.iOH TNE PERWRMANL£ W
OFTHE WORK FOR N711CH THI9 PERM�T IS ISSUED. / � ,
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_I HAVE AND MALL MAINTAIN WORKER3'COM7ENSATqN MSURANCE;ti4 REOUlRED BV SECTION
Q 370o OF THE IABOR CODF,iOH THE PERWRMANCE OF THE WORK FOR WHICH THIS PE�UIR 19 '"��1 �L
ISSUFD.MY WORKEPS'CAMPENSATION INSURANCE CMAIER(WD.POLICY NUMBER ARE CONSTRUCTION� __ __ _
� G,Rq�Eq PLANREVIEW ��'g ..45
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w I CERTIFV TUT IN THE PEAFOqMANCE OF THE WOR1C FOR KMICH TNIS PERMIT IS ISSUED,1 MECHANICAL�
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(,�} JWl NOT EMPLOV ANY PERSON IN ANY IdAM�ER 50 AS TO BECAME SUBJECT TO THE�
� WORNEAS'f:OMPENSATbN UWS OF CAIIFORNl0.�ND AGREE THAT IF I SFIOUID BECOME �NSPECTION FEE
SU&IECT707HEMnDp1(ERS'COMFENSATIDNPROVt510N80F5ECTION770oOFTMELABOR 7/) . �
�j CpOD�E.I SHALL FORfHVlI7H COMPLV WITH 7r105E PROV1510NS. � ISSUANCE ��p
� A7E `�7 SI I� APPL�cANi: -SMIP I �.� �
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� SUBJECT AN EMPLOVER TO CAIA/INAL PENALTIES A/JD CML FlNES UP TOONE HUNORED TFfOUSM7D ENEROY PERMIT
DOLLAR$(S1a0,000),W ADDITK7N 70THE COST OF COMPENSATKkJ,DAMAGES AS PROVIDED FOR IN . � -
� 6ECTION37alOF7HELABORCODE,WTEREST,ANDATfORNEY3FEE5. ' RETENTIONFEE: _
O� . CONSTRUCTION LENDING AGENCY pRE�-,�jl�.T,F�EE�/:,� .
� i MER�Y AfG1RM UNDEH PENALTV OF PERIURY THAT TNEAE 15 ACONSiRUCT10N LENDW�AOEHCY ///l.]/ /•
Z �FOP TME PERFORMANCE OF 7NE WOFK FOR NM1i1CH 7HI5 PERMI7IS ISSUED(SEC:�3091.CN.G). _
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�� LENDERSNMIE
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�� �ICER7IFYTHA7IHAVEREADTHISAPPLICATIONANOS7A7ETHATTHEABOVEINFOWAATIDNI3CORRECT. TOTAL FEES � �/ ."V ;
� W I A6REE TO COMPLV N7TH ALL CT'AND COUNTY ORDMANCES AND STATE UWS REUT WO TO BUILDINO �` 'i��� �.� "�I" `� \ �1�
� CONS7RUCilON,ANO HEREBY AUlNOHIZE REPRESENTATiVES OF TH15 COUNfY TO ENfEfi UPON THE 1 � �� ' (�3,,���
Z� ABOVE-MENTqNED�ROPERTYFORINSPEC7lONPURPOSES �COMMENTS � ' ��•��`�� u` �
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RECPT..NO. PAID�9Y� VALIDATION
� WHITE—DepaAment Copy,YELLOW--Finer�ce CopY.PINK—Asseuor Copy,GOLDENROD--Ffle Copy;GREEN—ApplicanYs Copy
CIT�( OF DIAMOND BAR . _
ItVS9'ECTI�N REC4RD
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE fIREPLAtE FOUNDATIOIJ
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHItJG 8 FT.BOND BEAM
FRAMING/VENTILATIOId FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING •
SHOWER/TUBTEST POOL ELECTRIC
EXf.LATH/SIQING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FItdAL
' FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING EfVERGY
FINAL PLANING
FINAL ENGINEERING ' o �
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SEPTIC TANK SIZE
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