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CITY OF DIAMOND BAR EXPIRED
i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190 DEC 2 71000
(909) 860-3195 Fax (909) 861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE
ADDRESS 2J I s QfY`et AAA0 Z). 6. -717 E��'
APN LOT TRA
OWNER
ADD ss1 f i c•"r.t OM+t r
CITY AIL ZIP /% S—TEL C 1 e
APPLICANT TEL. — IJ
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR 714E FOLLOWING REASON (SEG 7031.6 BUSW ESSAND PROFESSIONS CODE. ANY CrTY OR
COUHTYN7YCH RCOUYNES A PERMITTOCONSTRUCT,ALTER IMPROVE, DEMOLISH, OR REPAIR ANY STRUC-
TOPE• PPOR TO RS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 1000) OF DIVISION 7 OF THE BUSINESS AND PRO.
FESSONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXENP-
T10N. ANY VIOLATION OF SECTION 7071.5 BYANYAPPLIJJIT FOR A PERMIT SUBJECTS THE APPLICANT TO
A L MALTY
PFXOFOF NO'T MORE Ti W1 FIVE HUNDRED OOl1AR5 (f 5001 ):
AS OWNER OF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
141 E WORK, AND THE STRUCTURE i5 NOi INTENDED O0. OFFERED FOR SALE (SEG 701414. B1151
S ANO ESSIONS COOS THE CONTRACTORS INCENSE LAW DOES NOT APPLY TO AN ONNEfl OF
PROPERTY. BUILDS OR IMPROVES THEREON, AND VMO DOES SUCH WORK HIMSELF OR HERSELF OI
THFAXMI• HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFFERED FOR SALE 6, HOWEVER THE BUILDING ORIMPROVEMENTIS SOLD WITHINONEYCAR OF COMPILE.
TION, THE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR 511E DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
O L AS OWNER OF THE PROPERTY, AM EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSIONS CODE', THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOP4S) LICENSED PURSUANT TO THE CDNTRA6
TORS LICENSE LAW.).
OIAMCXEMPTUNAERSEG C. FO IS REASON
DATE T _OWNER 211
ICENSED CONTRACTORS D CLARATION
I HER AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISK)N9 OF CHAPTER
of
CNG WITH SECTION 7000) OF DIVISION 70F THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENS N FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO.
DATE CONTRACTOR
WO ERS'COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENAL PERJURY ONE OF THE FOLLOWING DECLARATIONS.
_IHAYEANOWLLMAINTNNA FK -ATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED B CTIONS7000FT14ELAMRCOCF FORTHEPERFORMANCE
OF THE WORK FOR WHICH THIS PE IS ISSUED.
—1
O
HAVE AND WM1L MAINTAIN WORKERS' ENSATN INSURANCE, AS REOUIRED BY SECTION
71000E THE LABOR CODE. FOR THE PERFO ANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WOn1KERS' COMPENSATON INSU CE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICYMUMBER
(De55ECRCN NEED NOT BE C011SUIEDOFTE PEi1LJT 6FOR N7SDOCLLAIY' RIWICRLES51
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WNICHT PERMIT IS ISSUED.I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER So AS TOBECOMES ECT TOTME
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATON PROVISIONS OF SECT10N 7700 OF THE LABOR
CODE, 1 SMALL FORTHWITH COMPLY WITH THOSE PROVISIONS,
I
DATE: APPLICANT;
I
WARNING: FAILURE BJYE SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL
SUECTAN EMPLOYERIO CRIMINAL DENALTIES AND CML F W ES UP TO ONE HUNDRED THOUSAND
DOLLARS (1100,000). INADDITION TOTHE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN
1 SECTONWN OF THE LABOR OWE. INTEREST, AND ATTORNEYS FEES.
L CONSTRUCTION LENDING AGENCY
i
1 HEREBY AFFIRM UNDER PENALTY OF K FOR
THAT THERE L4 ACONSUED (SEC.
AGENCY
FOR THE PERFORMANCE OF THE WORK iOR WHICH THIS PERMIT IS ISSUED (SFC. 70 W, CIV C.).
1
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 ACRE TO COMPLY WITH ALL CRY AND COVNrY ORD W ANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE -MENTON ED PROPERTY FORINSPE PURPOSES.
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EOF PE TTEE D E
i / PERMIT So P/C
DATEAPPLICATION Z g�NUMBER
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
L-1
SIDE ❑
PROPOSED USE . N
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
U)
Garage/Carport
W
Palio/Deck
LL
PooVSpa
C7
Z
Re -Rost
Commercial "
m
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
U
H
U
w
W
L7
2
CO
M
J
a
4
U_
2
LU
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE •'D�
S�
SMTP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
0 S�
TOTAL FEES •
COMMENTS
1�
RECPT. NO. PAID B VALIDATION
WHITE—Department Copy, YELLOW—Fnanoo COpy, PINK—ASSeSSON LAW,, tuuwtNHuiU-- t,opy. unccrv—np)Alcern 3 ulpy
CITY OF DIAMOND BAR
INSPECTION RECORD
e .e
DATE INSPECTOR
SET BACK ; ,
INSPECTION DATE INSPECTOR
'• FLOOR JOIST
FTGS/FORMS/STEEL
FHA REQMTS
ELECTRIC GROUND
UNDER FLOOR DUCT, '
GROUND PLUMBING
UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE. FOUNDATION -
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE -
MID HT. BOND BEAM -
ROOF SHEATHING
-- 8 FT. BOND BEAM
FRAMINGNENTILIATIbN ' -
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
-ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
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. FINAL
FINALELECTRIC
DEV. FEES PAID -"
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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