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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES
W 21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS / 3
APN LOT TRACT
OWNER (% 7e1�
ADDRESS
CITY ZIP TEL.
APPLICANT TEL.
CONTRACTOR 4.7.
ADDREpSS
CITY F r P.'i,I(u+o� ZIP` is TEL?ISL� 2�( R'91d7
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFRRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITY OR
COUNTY NMICH REOUIRESA PERMRTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC-
TURE, PRIOR TO ITS 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 LF
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VKXAT10N OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (6600).):
O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70M, BUSI.
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HUS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPL.E.
TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
❑ L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 701, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BURRS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
❑ 1 AM EXEMPT UNDER SEC. B. t P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERUURY TRAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS W FULL
^FORCE AND EFFECT.
LICENSE CLASS
C.
l LIC. NO.
DATE 6.4Ji�_97_-De3qc32cD COMRACTO
WORKERS' COMPENSATION DECLTDECLA.
I HEREBYAFFIRM UNDER PENALTYOF PERJURY ONEOFTHE FOLLOWI RAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SECOMPENSATKIN,AS PROVIDED BY SECTION 3700 OF THE LAB
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED Bye ECTION
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH�TIiIS PERMIT IS
ISSUED. MY WORtKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(DYSSECIXINNEEDNOTBEODWLETEDOFTHE PERMITIS FOR DOU.ARS($I )ORLES%
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR CH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO TO COME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AGL
ATIFIS D BECOMESUBJECT TO THE WORKERS'COMPENSATK)NS TgN 37 F THECODE, ISHALL FORTHWITH COMPLY WITH RO IO
DATE: (2,_v2ft APPLICANT: r
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (6100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 37M OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3D07, CIV C.).
LENDERS NAME
LENDER'S ADDRESS �-
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
ale. , /t
PERMITTEE NT)
SIGNATUR&OF PERMITTEE ATE
WHITE—Department Copy, YELLOW—Finance Copy. PIN?
EXPIHU10
SEP 1 0 I PRESS
FIRMLY
APPLICATION PERMIT J
P/C
DATE NUMBER /
#
ISSUE TYPE
OCC
DATE CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
❑
SIDE/SIDE STREET
RW
❑
SIDE
❑
PROPOSED USE
NO. DWEL. NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
U)
Garage/Carport
W
Patio/Ddck
LL
Pool/Spa
0
Z
Re -Root
Commercial
Co
Valuation ADJ.AREA
QUANTITY DESCRIPTION
FEE
_U
• 5
H
W,
a
S,
W
CrIP
•
f
INSPECTION FEE
ISSUANCE
SMTP I
TE
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
a75
�F
COMMENTS -
RECPT NO. PAID BY
VALIDATION -
Of v IJY- uuWMNNUL1 1`110 L;Opy, GREEN—Applicant's Copy
CITY OF ®OA( OND BAR
INSPECTMN RECORD
.» n D �. {„�(o f•�+"�,
,'�"rye1�:. ryyy'1fe'��/, Q >. yy :.. D • 1 - p ...
� V 0
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SET BACK ��
FLOOR JOIST
FTGS/FORMS/STEEL
FHA REOMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR COf�if)UIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
_
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND BEAM
ROOF SHEATHING
8 FT. BOND BEAl0
FRAMINGNENTILIATION;
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
_
FINISH GRADING
SHOVVERCTUB 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.
j SEEP P,TIL.L.
ON SITE IMPS.
FINAL -ZONING
If\,A :;ONST.
FIDE DEPT. FINAL
HEATING
HEALTH DEPT. FINAL _
i .. Z l- ELECTRIC
DEV. FEES PAID
':!'PLUMBING
ENERGY
C40MENTS
SEPTIC TANK SIZE=
SEEP PIT/U SIZE
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