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- CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT ' AA
:,,,,� 21660 E.Copley Dme Suite 190 `+`,��, �� �� PRESS
(909)86Q3195 Fax(909)861-3117
��'^^'� BUILDING PERMIT APPLICATION FIRMLY
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c� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
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N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
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� OWNER-BI:ILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTV OF VERJURY THAT I AM E%EMPT FROM THE CANTRACTORS LI- Gef6gB/CefpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCI7VOR (n
U COUNTYWHICFiRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W P81i0/DBCk �
w NRE,PRIOR TO ITS ISSUANCE,ALSO REDUIRES TME APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w -
� STATEMENT THAY HE'OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7ME CON7RAC70RS ll•
� CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PRO- � PooVSpa
FESSIONS CADE)OR THAT HE OR SHE IS EXEMPTTMEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (� /+� �y�
� TION.ANV VIOUTION OF SECTION 7031.5 BYANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof —)� U �v�/
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDHED DOLURS(5500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 CORIR19fC181
I Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED POR SALE(SEC.70//,BUSI- J
� NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE UW DOES NO7 APPIV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCN WORN HIMSELF OR HERSELF OR
CC � THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NO71N7ENDED OR m
w OFFEREOFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMEHTISSOLDWITHINONEYEAROFCOMPLE-
0 TION,THE OWNER•BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEFOFTHEPROPER7V,AME7(CLUSIVELVCANTRACTINGWITHLICENSE�CONTRACTORS
Q TO CANSTRUCT THE PR0.IECT(SEC.701�,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U9f1Of1 ADJ.AREA
W CENSE UW DOES NOT APPLY 70 AN OWNER OF A PROPERTY WHO BUILDS OR IMPNOVES THEREON,AND
� W11000NTRACTSFORSUCHPRQIECTSWI7HACONTRACTOR�S�LICENSEDPURSUAN7TO7HECONTMG QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑1 AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON U
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u" DATE OWNER �
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� UCENSED CONTRACTORS DECLARATION w
¢ I HEREBV AFFIRM UNOER PEN/�LTV OF PE0.IURV THAT I AM LICENSEO UNDER PROVISIONS OF CHMTER �
d Y(COMMENCING WITH SECTION 7o0o)OF DIVISION J OF THE BUSINESS AND PROFESSpNS CODE.AND Z
MV LICEHSE IS IN FUL�FORCE AND EFFECT.
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� LICENSE CLASS ��� LIC.NO. •O� j
V DATE 'Q CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION a
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� I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWINO DEClAMT10NS:
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� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR NlORKERS' _
� COMPENSATION,AS PROVIDED BV SECTION 9700 OF 7HE LABOR CODE.FOR THE PERWRAIAHCE �U
OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. �
�
w �1 HAVE AND WILL MAIN7AIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q � �700 OF 7HE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS
ISSUED.MY RKERS' MPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� CARRIER �'X) �r e��,� PLAN REVIEW
Z roucr u ea rd ELECTRIC
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0 (nlssEcipNME�ra7BEa0MPLE7�oFnEFEwaiswROME1a.��oriEDoalnfisR�ro)oatESSL PLUMBING
Z I CERTIFY THAT M THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(J SHALL NOT EMPLOV ANY PERSON IN ANY MPNNER SO AS 70 BECOME SUBJECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFOfiNIA�ND AGHEE THAT IF 1 SHOULD BECAME INSPECTION FEE
? SUBJECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR
CODE,I SHALL FORTHWITH COMPLV WI7H THOSE PROVISIONS. �SSUANCE
� SMIP '�
p DATE: APPLICANT:
W ENERGY P/C �
J WMNINO:FAILURE 70 SECURE WORKERS'COMPENSATbN COVERAGE IS UNUWFUL.AND SMALL BE
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� SUBJECT AN EMPLOVER TO CRIMINAL PENAL71E5 AND CIVIL FINES UP TOONE HUNDRED 7HOUSAND ENERGY PERMIT
DOLURS(i100.000),IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
J SECTION 370e OF THE UBOR CODE,INTEREST,AND ATTORNEYS FEES. � HETENTION FEE: n ��
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pw.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �1�-..^ 4 " f
Q I HEREBV AFFIHM UNDER PENALTV OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO AGENCY
n- FOR THE PERFORMANCE OF THE WOHK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.]OY7,CIV.C.�.
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� LENDER'S NAME
1— LENDER'SADDRE55
� I CERTIFY THAT I HAVE READ THIS AP7LICATION AND STATE iHAT THE ABOVE INFORMATION IS CORRECi TOTAL FEES � ' .
w I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES/WD STATE UWS REU7ING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HIS CAUNTV TO EMER UPON THE
ZABOVE�ME ED PROPERTV FOR INSPECTqN PURPOSES. COMMENTS
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� RECPT.NO. PAID BY VALIDATI
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appllcant's Copy
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SET BACK � FLOOR JOIST
FTGS/FORMS/STEEL� FHA REQMTS ' �
ELECTRIC GROUPlD UNDER FLOOR DUCT� ! � � �
GROUND PLUMBING UNDER FLOOR CUf�IDUIT
SI.�B GF�ADE FIREPL.ACE FOUNDATION - � '
TEMP POlAlER - FIREPLACE BOND BEAM � -� - - -
NlIATER SERVICE — — MID HT. BOND BEAM � � '
ROOF'SHEATHING ' - 8 FL BOND BEAM
FRAMI�IG/VENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATIfVG BENCHING �
FdOUGH ELECTRIC ROUGH GRADING
ROUGH PLUPNBING FINISH GRADIfVG �
SHOWERlTUB TEST POOL ELECTRIC �
EXT.L.ATFi/SIDING POOL FENCIfVG- �
lAIALL INSUL�4TION POOL FINAL �
CEILING IfVSULATIOfV OFF SITE IMPS.
DRYV�lALL iVAILING DEDICATIONS
SEFRlER FIfVAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SE�P PIT/L.L. OiV SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINP,L ELECTRIC DEV. FEES PAID
FIf�AL PLUIViBING ENERGY
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COAli�liENTS
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SEPTIC TP,f�K SIZE �' � -
SIEEP PIT/U SIZE
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