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CTI'Y OF DIAMOND BAR
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�"%����� BUILDING PERMIT APPLICATION FIRMLY
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBY AFFIRM UNDER PENAL7V OF PERIURY THAT I AM EXEMPT FROM THE CAN7RACTORS LI� G8f89B/CBfpOR
W CENSE UW FOR THE FOILOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CITY OR (n
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMI7 70 FILE A SIGNED w Patio/Deck
S7ATEMENT THAT HE OR SHE IS LICENSED PUFSUANT 70 7HE PROVISIONS OF THE CON7RAC70HS LI-
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa
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V TION.ANYVIOLA710NOFSECTION7031.SBVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANT70 Z Re-Roof
A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLLARS(SSoo).J:
❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.7001,BUSI- J COmfnBfClel -
� NE55 M!D PROFESSIONS CO�E:THE CONTRACTORS LICENSE LAW DOES NOT A7PLY TO AN OWNER OF �
PROPERTV NMO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSEIF OR HERSELF OR
� 7HROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m
w OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOtDWITHINONEVEAROFCOMPLE-
� TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASONRJEROFTHEPROPERTY,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS
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� 70 CANSTRUCT THE PR0.IECT(SEC.7oa1,BUSINESS AN�PROFESSIONS CADE:THE CONTRACTORS LI- V81U8SIOf1 Q�� ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OWNER OF A PROPER7V WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCANTRAC7SFORSUCHPRQIECTSWITHACANTRAC70R�5)LICENSEDPURSUANTTOTHECON7RAC- QUANTIN DESCRIPTION FEE
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� ❑I AM ExEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PEiLIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
� LICENSE^CL7A�SS�,t \J� LIC.NO.�,{� ��� j
V DATE 11 d.�\Q�� CONTRACTOR d
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� WORKERS'COMPENSATION DEC ARATION �
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� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLARA710NS: Z
Z _I HAVE AND WILL MAINTAIN A CER7IFICA7E OF CONSEN7 70 SELF�INSURE FOR WORKERS' 2
Q CAMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,fORTHE PERFORMANCE W
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS RE�UIRED BV SECTION ^J
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS / �d
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION !!
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� CARRIER ^� �y PLAN REVIEW
Z POUCV NUMBER��G� \ ���� ELECTRIC
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� (1HISSECTqNNE�NOTBECYMPLEfEDOF71-IEPEfUNTISFORONEM11�DfiEDDOLLPAS(f10D)ORLESS). PLUMBING
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Z I CERTIFV THAT IN THE PEfiFORMANCE OF THE WORK FOR WHICH 7HI5 PERMI715 ISSUED,I MECHANICAL �-�--�� .��� I P� �Y����
(.�} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE �--L� -�� �'�- ' �' ' �-+�-�
�/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECTTO THE WORNERS'COMPENSATION PgR�OpV�ISpIONS OF SECTION 37000F THE LABOR � � �
CODE,I SHALL FORTHWITH COMPLV WITH THe // VISION$,� ISSUANCE
� �y� SMIP I � ��
p DATE: � APPLICANT: �/—� � v
J WARNING FAILURE TO SECURE WORKERS'COMPENSATI� ON COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C I.
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� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT ���0•
DOLLARS(f100.000�,IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
� SEC710N 37oe OFTHE LABOR CODE,INTEREST,ANDATTORNEV'S FEES. RETENTION FEE: ����
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THEiiE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ.
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� LENDER'S NAME
F— LENDER'SADDRESS
� TOTAL FEES ��3, 7 d
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z A NTIONED VROPERTV FOR INSPECTION PURPOSES. COMMENTS
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= RECPT.NO. �O�O PqID BY C VALIDATION
~ WHITE—De artment Copy,YELLOVJ—Finance Copy,PINK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co
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SET BACK �� FLOOR JOlST
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FTGS/FORMS/STEEL ; –:-„-- --., ----._I..----.---
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ELECTRIC GROUND � ' i UNDER FLOOR DUCT
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GROUND PLUMBING ' UNDER FLOOR CU�IdUIT _ , � _____
SLAB GRADE _ FIREPLACE FOUNDATION_ _
-- _ ._ -- --
TEMP POWER _ , ___ __� FIREPLAC� BUND BEAM _ �
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WATER SERVICE � _ ___� MID HT. IIOND BEAM �
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ROOF SHEATHING I���GI 8 Ff. BOND BEAM � ____
FRAMINGNENTILIATION FINAL 80ND BEAM _ _ � ____
ROOF COVER PRE-GRADING �
ROUGH HEP,TING BENGHING � _
ROUGH E�ECTaIC I ROUGH GPADING
--- �--�---- ---- --___.__ �._..___._ - ----------
RQUGH PLUMEING ; i FINISH GRA�ING
� __.._. _....._._ __...---._._------
SHOWER/TUB TEST � � POOL ELEGTRIC �
EXT. LATH/SIQING POOL FENCING
WALL Ii�SULATION POOL FINA� j
CEILING If��ULATION OFF SITE IMPS.
DRYINALL NAILING DEDICATiONS !
SEWEp � FINAL Et�G. � ------- --
--__. ..._ -� __----...------___
SEPTIC T,4NK LAiVDSGAPE/IRRIG. `
SEEP PITl�.L. ON SITE iMPS.
GAS AIR TEST FIIVA�ZONING
FIfVAL COh1ST. .� !�(� Q,�,�- , FIRE DEPT. FINAL ___ _ _
FINAL HEATING I j HEALTN DEPT. FINAL _
FINAL ELECTRIC I, I DEV. FEES PAID ,
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FIfVAL PLUMBING I ENERGY !
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SEPTIC TANK SIZE
SEEP PIT/U SIZE — --
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