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� CITY OF DIAMOND BAR
ry---1� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES S�P � O �i��;;� �
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRE$S
������'� � • BUII.DING PERMIT APPLICATION i I R M LY
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�o D RIESS I S I � S,VP��.L�iY �[STA ��' �DATE CATION i � q NUMBEFW � � #C /
ISSUE TYPE OCC
� N ` � LOT� TRACT DATE CONST. V:_ I�I, GROUP �
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ADDRESS ��I E Ira�n��� /��S� I�(Z. ZONING SEBACKS '
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� APPLICANT UL'�S ���[� TEL. (�DS)S�'I REAR ❑
� SIDE/SIDE STREET RW ❑
CONTAAGTOR ��•G� �/�.GLI I�S SIDE � p
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� DESIGNE 111� S �r���G NO.DWEL. NO. NO.
a ADDRESS 40 ' E A � UNITS STORIES BEDROOMS
� CITY-�AAI LV►5 (�15�GI.�IP��� TEL 07 �l'1-
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLAFATION SFR/ADD/FIEM ' �
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� 1 HEREBY AFFlRM UNDER PENAL7V OF PERNRY THAT I MI EXEMPT FROM THE COHTRACTORS LI- G8td9B/CB�OfI
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:ANYCI7VOR (n
U COUHTYWHICHRC-0UIRESAPERMRTOCON5TRUCT,ALTER,IMVROVE,DEMOLISH,ORREPAIRANVSTRUG W Patio/Deck
Z NP.E.PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMEM 7HAT HE OR SME IS LICENSED PURSUAHT TO THE PROVISIONS OF 7HE CONTRACTOHS LI� .
C CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOI/SP8
?E FESSqNSCODE)ORhUTHEORSHEISEXEMPT7HEREFROMANDhIEBASISFORTHEALLEOEDEXEMP•
V TION.AHI'VIOlAT10NOFSECTION7W1.5BYANYAPPLICANTFORAPERMITSU&IECT57HEAPPLICMlTTO Z Re-Roof
F A CIVIL CENALTV OF NOT MORE THAN fNE HUNDRED DOLURS(t500).):
� ❑I,/�SOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial 2� �j� -
WILL DO THE WORK AND hIE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a/,BUSI- J
NESS AHD PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
� VROPEHf`lVAiOBUILDSORIMPROVESTMEREON,ANDWHODOESSUCVIWORKHIMSELFORHERSELFOR m � � �
(t TMROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUGi IMPROVEMENTS ARE NOT INTENDED OR
QOFFEREDFORSALEIF,FIOWEVERTMEBUIIDINGORIMPROVEMENTI550lDWITHINONEVEAROFCOAI7LE-
Z �'TION,THE OWNEfibUILDER WILL HAVE THE BURDEN OF PROVINO THA7 HE OR SHE OID NOT BUILD OR
� IMPiqVE FOR THE PURPOSE OF SALEJ.
W ❑I,AS ONMER OF hIE VROPEHTV,AM EXCLUSNELV CONTRACTINO WRH LICENSED CONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V61U8fI0f1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TOAN OMMER OFA PROPERTY VA10 BUILDS OR IMPROVES THEHEON,AND
� WFIOCONTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTO7HECONTRAG QUANTITY DESCRIPTION FEE
� TORS LICENSE UW.).
Q ❑I AM EXEMFT UNDER SEC. B.8 P.C.FOR THIS REASON U
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- � DATE ONRlER �"
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F LICENSED CONTAACTORS DECLARATION W
� 1 HEREBYAFFIRM UNDER PENALTY OF PEfUUflY THAT I AM IICENSED UNDER PROVISIONS OF CHAPTER V. ,
d Y(COMMENCWU N7TH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
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� UCENSE C SS LIC.NO. �
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V DATE CONTRACTOR � 7 7't'1�+�� -
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� � WORKERS'COMPENSATION DECLARATION a
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N 1 HEREBY AFFIRM UNDER PENALTV OF VERIURY ONE OF THE FOLLAWING DECUMTIONS:
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� I HAVE AHD WILL MA�NTAIN ACERfIFlCATE OF CONSENT TO SELF-INSUHE FOR NORKERS' 2 ' �"'
� COMPENSATION,AS PFOVIDED BV SECTION J70o OF THE LABOP CODE,FOR THE PERFORMANCE W �
�f F THE WOHK FOR WH�qI THIS PERMIT IS ISSUED. � . ,
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W _I HAVE AND WILL MAINTAIH WORKERS'COMPENSATION INSURANCE,AS REaUIRED BV SEC710N �O t, (� e �/�/� �I ^ �`^(1
O 37000FTHEUBORCOOE.FORTHEPERFORGANCEOFTHEWORKFORWHICH7HISPERMITIS a (�� �� ✓ �v
ISSUED.MY WORKERS'CO PENSATION INSU`RANCE CARRIER AN�PCyICY NUMBER ARE: CONSTRUCTION
� CARRIER • '� "--iJ�y�� �fl PLAN REVIEW�
� POLICYNUMBER � �2 � �" ELECTRIC � .O/.��� �
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0 (fH6SECTqNNE�NDTBE00AiLETmOFiVEPEfiATISfOROP1EMR�DREDDQIARS(S10D)ORLESS� PLUMBING .
Z 1 CERTIFV iHAT IN iHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 ISSUED,1 MECHANICAL,� ' �� ��� � �
(} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SOAS TO BECAME SUBJECT TO THE , ,
� WORKERS'CAMPENSATION UWS OF CALIFORNIq AN�AGREE THAT IF I SHOULD BECOME INSPECTION FEE: '��'�
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE IABOR � • +
CODE,I SHALL F�HWITH COMPLV WIT1 THOSE PROVISIONS. ISSUANCE
p DATE: L APPLICANT: � • SMIP � '��
� ' ' ' ENERGY P/C �
WMNINO:FAILU E TO SECURE WORKERS'COMPEN� ION COVERAGE IS UNUWFUL,ANO SHALL BE
� SU&IECTANEMPLOYERTOCRIMINALPENALTIES �CIVIL'FINES,UPi00NE,HUNDREDTHOUSAND �� �' '� �ENERGYPE�MI7��""�� " �' `� � , Y \ � > �
OOLLARS(f1o0,o00),IN ADDITION TO7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTqN 97oe OF THE LABOR CODE.INTEREST,AND ATTORNEY'S fEES. � RETENTION FEE:
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d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� � I HEREBV AFFIRM UNDER PENALN OF PERIURV 7HAT THERE IS A CONSTRUCTION LENDING AGENCV
n- FOR THE VERFORMANCE OF THE WORK FOR NAiIG1 THIS VEHMIT IS ISSUED(SEC.30G7,CIV.CJ. � � _ . •
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� LENDER'S NAME �T
F— LEN�ER'SADDRE55 �
� I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE hiAT TiE ABOVE INFORMATION IS CORRECT. T �AL F E { �
� I AGREE 70 COMPLY WITH ALL CT'AND COUN7Y ORDINANCES AND STATE LAWS RELATING TO BUILDING � /- G����� � �b� ,
COHSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HIS COUNTV TO EHTER UPON 7HE 1 C/ /'���
ZA80VE-MEIfTIONE�PROPER7V FOR INSPECTION PURPOSES.'� COMMENTS �
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� RECPT.NO. � PAID BY VALIDATION
WHITE�epertment Capy,YELLOW�inance Copy,PINK—Assessor Copy,G EN OD—File Copy,GREEN—ApplicanYs Capy
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SET BACK • � � � FLOOR JOI�T :; �� � � �
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FTGS/FORMS/STEEL, FHA REQMTS . - -
ELECTRIC GROUND' ' `� � UNDER FLO.DR DU�T . , ,.,, . . � °� �` • , •Y ••
GROUND PLUMBING ,� UNDER FLOdR GU�fDUIT � � . '�'`� •
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SLAB GRADE � y If' � � �- . FIREF�A�'E fOU�DATION'�, . ' , ' _ . •
TEMP POWER � FIREPLACE BOND B�AM _ � '
WATER SERVICE ' MID HT. BOND BEAM �� ' ' '� �-' ' ' .
ROOF SH�ATNING- . ' ''.�.1/ !l ' .. • ' 8 FT. BONDi��'AM � : � ' •.: �
FRAMINGNENTILIATION � FINAL BONf� BEAM . .�. �
RO�F COVER PRE-GRADING . - �=, �- � �
ROUGH HEATWG !.�' �� BENCHIIVG.•'`` � . = ; , , . � . . , `
ROUGH ELECTRIC j �` �� --�''f�'�- �--� � ROUGH GRADING
ROUGH P�UMBING ' � FINISH GRADING.
SHOWER/TUB TEST POOL ELECTRIC �
EXI: LATH>SIDING POOL FENCING
WALL INSULATION POOL FINAL.
CEILING INSULATION OFF SITE IMPS. ;
DRYINALL NAII.ING s �i DEDICATIONS
SEWER ' 8 ' FINAL ENG.
SEPTIC TAIVK . . __ � LANDSCAPE/IRRIG.
SEEP PIT/I�.L. `" ' ' ON SITE IMPS. '
GAS AIR TEST FINAL ZONlNG
FINAL CONST. FIRE DEPT. FINA�
FINAL HEATING HEALTH DEPT. FINAL
FINAL EL.ECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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