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�� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190 PRESS
� (909)860-3195 Fax(909)861-3117
`�`'��' BUILDING PERMTT APPLICATION �IRMLY
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c� ISSUE TYPE OCC
APN LOT TRAC DATE CONST. GROUP
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" ADD SS G1�n 61'� ZONING SETBACKS
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� DESIGNER NO.DWEL. � O. � NO.
ADDRESS UNITS STORIES BEDROOMS�
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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0 1 HEREBY AFFlRM UNDER PENALTV OF PERIURV THAT I MI EXEMP7 fROM THE CONTRACTORS LI- G8l8g9/CflfPOR
W CEHSEUWFORTHEFOILOMlINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVCITVOR (n
U COUHfYWHICHREOUIRESAVERMRTOCONSTAUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W P81i0/DBCk
Z TURE,VRIDR TO ITS ISSUANCE,ALSO REOUIRES THE AP7LICAHT FOR SUCH PERMIT TO FILE A SiGNED -
w STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI- W
�S CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 70D0)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
7C FESSIONSCODEJOHTHATHEORSHEISEJ(EMPTTNEREFROMANDTHEBASISFOR7HEALLEOEDE%EMP- (� � . .
v TION.ANVVIDLATIONOFSECTION7091.5BVANYAPPIICANTFORAPERMITSUBJECTSTHEAPPLICANTTO g-Rpp� 2 �Q
AC PENALTY OF NOT MORE THAH FfVE HUNDRED DOLURS(i500).):
AS OWNER OF THE PHOPERTV.OR MV EMPLOYEES WI7H WAGES AS THEIR SOLE COMPENSATION,
Z � Commercial –
. WI THE MfORK AND THE 5TRUCTUHE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70H,BU51� J
� NESS IWD PROFESSIONS CODE:THE CONTMC70RS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTV MRfO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� TMiqUGH HIS OR HER ONM EMPLOYEES,VROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR m
w OFFERmPDRSALEIF,VqWEVER7MEBU�LDINGORIMPROVEMINTI550LDWITHINONEYEAROFCOMPIE-
Z �TqN,THE OWNER$UILDER WILL HAVE 7HE BURDEN OF PROVING iHAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS OWNER OF THE PROPEHTY,AM E7(CIUSIVEIY CONTRACTING WITH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRO.IECT(SEC.70H,BUSINESS AHD PROFESSIONS CODE:THE CONTMCTORS LI- V81U8fI0f1 ��O ADJ.AREA �
W CENSEUWDOESNOTMPLYTOANONMEROFAPROPERTVNM1iOBU1LD50RIMPHOVESTHEREON,AND
� NRfOCOMMCTSFORSUq1PR0.1ECTSWITHACONiRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG pUANTITY DESCRIPTION FEE
� 10R5 LICENSE UW.).
❑I AM IXEIAPT UNDER SEC. 8 C.FOR THIS REASON U
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� DATE ' OWNER •�� �
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� LICENSED CONTRACTORS DECLAFATION • W
� 1 HEREBYAFFIRAI UNDER PENALTY OF PERIUM THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � .
� Y(COMMENCINO WITM SECTpN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
�� W LICENSE IS IN NLL FORCE AND EFFECT, m
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F UCENSE CLASS IIC.NO. J .
V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION a
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OFTHE FOLLOWING DECLARATIONS: �
C� a
� 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
� COMPENSATpN,AS PROVIDED BY SECTION 370o OF THE UBOR CODE,FOR THE PERFORMANCE w
OF 7HE WORK fOR WHICH THIS PERMIT IS ISSUED. �
0
W _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SEC710N
Q 37o00F THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS VERMIT IS �
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
jc�aqiEa PLAN REVIEW
� POLICV NUMBER ELECTRIC
p (fFLLSSECTIONNE�NOTBE00AKETmOF7FEPERAffISFORONEF0.NDREDDOLL�RS(5100)OqLESS) PLUMBING
Z 1 CERTIFY THAT IN THE PERFORMMICE OF 7HE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(3 SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS 70 BECOME SU&IECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORN10.NdD AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR �
CODE,I SHALL FORTHWIiH COMPLV WITH THOSE PROVISIONS. ISSUANCE
� SMIP
p DATE: APPLICANT: —�s � ,
� ENERGY P/C
J WARNINO:FAILUHE TO SECURE WORKERS'COMPENSATION COVEHAGE IS UNUWFUL,AND SHALL BE
� SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
OOLUHS(i1o0.oao).IN ADDITION 70 THE COST OF COMPENSATqN.DMIAGES AS PROVIDED FOR IN �
� SECTION 37oB OF iHE U1BOR CODE,INTEREST,AND ATTORNEV'S FEES. ' RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �`�/
Q I HEREBY AFFIHM UNDER PENALTV OF PERIURY THAT THERE IS A CANSTRUCTION LENDING AGENCV �a + � 7�� -
ZFOH THE PERFORMMlCE OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED(SEC.�087,CIV.C.�. BU�DIN l.tl L � < �
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� � LENDER'SNAME
F– LENDER'SADDRESS
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� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATE7HATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES
w I AOREE TO CAMPLV WITH PLL CITY AND COUNTY ORDINANCES AND STATE UWS RELA7ING TO BUILDING
� CONSTRUCTION,AND HEREBV AUfHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTEH UPON THE
ZVE-MENTIONED VROPERTV FOR INSPECfION PURPOSES. COMMENTS ���
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SIO REOFPERMI.EE DATE
RECPT.NO. PAID BY VALIDATION
WHITE—DepeAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOIDENROD--File Copy,GAEEN—Applicent's Copy
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CITY OF DIAMOND B�IR
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FTGS/FORMS/STEEL FHA REQMTS �
ELECTRIC GROUND ' ' UNDER FLOOR DUCT, '
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FQUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE • � MID HT. BOND BEAM
ROOF SHEATHING -' ` (=1b°�`�S 8 FT'. BOND BEAM
FRAMINGNENTILIATION �_ � FINAL BOND BEAM
RODF COVER PRE-GRAQING
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GFiADING �
ROUGH PLUPVIBING FINISH GRADING `
SHOW,�F�'[UB:�EST ' POOL ELECTRlC #
EXT�LATH/SIDING POOL FENCING f
WALL INSU.L'/,�T10N � � �POOL FINAL
CEILI'�G'INSULATION OFF SITE IMPS. ? ' I
DRYWALL NAILING DEDICATIONS
SEWER FINAI.ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIfVAL CONST. FIRE DEPT. FINAL .
FINAL HEATING HEAL7H DEPT FINAL
FIMAL ELECTRIC DEV. FEES PAID '
FINAL PLUMBING ENERGY
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