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CITY OF DIAMOND BAR .
----�� -- DEPARTMENT OF COMIvIUNITY&DEVELOPMENT SERVICES
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(909)860-3195 Fax(909)861-3117 PRESS
'"-v��� BUILDING PERMIT APPLICATION FIRMLY
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APN LOT TRACT DATE ���'— CONST. GROUP
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ADDRESS LS� S^C��Cl/��C�(�AY��~ ZONING SETBACKS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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I HEREBV AFFIRM UNDER PENAL7V OF PERJURV 7HAT I AM EXEMPT FROM THE CON7RACTORS LI� G8f89B/CBfpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o37.5BUSINESSANDPROFESSIONSCODE:ANYCI7YOR (n
U CAUN7VWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOlISH,OFiREPAIRANYSTRUC� �
W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIFES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� �
CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7aoo)OF�IVISION 3 OF THE BUSINESS AND PHO- POOUSpe
0 FESSIONSCADE)OHTHA7HEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANYVIOUTIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof I� �
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSoo).):
ZOI,ASONMEROFTHEPROPER7V,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COmmBfCIHI -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7a41,BU51- J
� NESS AND PROFESSIONS CADE:THE CONTRACTOFS LICENSE LAW DOES NOT APPLV TO AN OWNEF OF �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSEIF OR
� THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENiSARENO7INTENDEDOR m .
w OFFEREDFORSPLE.IF,HOWEVER,hiEBUILDINGORIMPROVEMEN71S50LDWI7HINONEYEAROFCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
�_ ❑1,AS OWNER OF THE PflOPERTY,AM EXCLUSNELY CONTRACTING WITH LICENSED CANTRACTORS /_�.r.n
TO CONS7RUC77HE PR0.IECT(SEC.70aa,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V21UatlOf7 �/V ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S�LICENSEDPURSUANTTOTHECONTRAC- OUANTITY DESCRIPTION FEE
Y TORS LICENSE UW.).
� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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DATE OWNER U
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�Q LICENSED CONTRACTORS DECLARATION w
2 I HEREBYAFFIRM UNDER PENAL7V OF PERJURV 7HA71AM LICENSED UNDER PROVISIONS Of CHAPTER �
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT. M
0 IICENSE CLASS �� 1 LIC.NO. � v — �-�� j
~ DATET^C� � CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECUfiA710N5: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q CAMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR 7HE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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Qw �I HAVE AND WILL MAINTAIN WOflKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION 2�
37ooOFTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS $� I/ J
ISSUED.MY WORKERS'-C�-O�M/P�E�NSA.�TION INSURTAN�CE�CARRI(�g�AND POLICV NUMBER ARE: CONSTRUCTION V
¢ CARRIER S 1 l'\ I�+ fN�1/ r PLAN REVIEW
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POIICV NUMBER�' �I�^ ELECTRIC
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� (�HISSECiIONNE�NOTBE00MPLEfEDOFTHEPERA4TISFORONEMl1�DREDDOLLPAS(E100)ORLESS� PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
CJ SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSA710N LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BE�OME INSPECTION FEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVI51 OF SECTION 37000F TH LABOR
CODE,I SHALL FORTHWITH COMPLV WITH H E PR VIS N5. ISSUANCE
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p DATE: a /�� APPLICANT: _ SMIP �
J WARNING:FAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
LL SU&IECTANEMPLOVERTOCRIMINALPENAL71E5ANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 37aB OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIRM UNDER PENAITV OF PERJURV THATTHERE IS A CONSTRUCTION LENDING AGENCV
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ. .
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2 LENDER'S NAME
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F_- LENDER'SADDRESS Q�
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� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE WFORMATION IS CARRECT. TOTAL F E ES �� . /
w I AGREE TO COMPLV WITH ALL CITY AND CAUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
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� CONSTHUCTION,AND HEHEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
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Uj SIGN UR PE DA7E
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs C,opy
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ELECTRIC GROUND i _ �
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TEMP PQWER ' ---- ' t=iREPLACE BC)ND BEAM _ � .__-- --
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WATER SERVICE � ' MID HT. BOND BEAM
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ROOF 5HEA7HING � l�_OL ' ' 8 FT. BdND BEAM � � I "
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FRAMINGNENTILIATION; : FINAL BO(VD BEAM I
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ROOF COVER f � PRE-GRADING ' _ �
ROUGH HEATING � BENCHI(VG �
ROUGH ELECTRIC i ROUGH GRADING i
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ROUGH PLUMBING ; `: FINISH GRADING
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SHOWER/TUB TEST i I i €�OOL ELECTRIC
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EXT. LATH/SIDING � ; ; PDOL FENCING. �
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WALL INSULATION ___ � ' PC)OL FINAL '
CEILIiVG INSULATION ; ! � OFF SITE IMPS. ---��-----� i —,-_ __ _
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DRYWALL NAILII�G I ; DEDICATIC7NS ;
SEWER t_ — , FIN-r A�ENG- —�-----___.___`
SEPTIC TANK � LANDSCAPE/IRRIG. �
SEEP PIULI. � ON SITE IMPS. '
GAS AIR TEST ; , FINAL ZONING
FINAL CONST. � �!RE DEPT. FIiVA"_. _
FINA�HEATING ;�HEALTH 'JEPT. F1�1AL
i ' pEV, FEES PAID �
FiNAL ELECTRIC , , �_, _____ _____
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FINAL PLUMBING �� i f ENERGY i
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