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� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
W 21660 E.Copley Drive Suite 190
(909)8G0-3195 Fax(909)861-3117 - PRES$
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� ADDRESS ZONING SETBACKS
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Q ADDRESS Sib� W. S.�pt�THFCN V� . pROPOSEDUSE 30(D aELOCp�'rEp OR AOD��
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1L TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICAHT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMENT THAT ME OR SHE IS LICENSED PUfiSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
� CENSE lAW(CHAPTER Y(COMMENCINO WITM SECTION 7000)OF DIVISION 3 OF iHE BUSINESS AND PR0. u- PooUSpa
FESSIONS COO�OR 7HAT ME OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR h1E ALLEGED EXEMP-
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� A CML PENALT'OF NOT MORE THAN FNE HUNDRED DOLURS(i500).):
� ❑I,ASOWHEHOFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial �
WILL 00 THE N'ORK,AND THE STRUCTURE IS NOT INTEHDED OR OFFERED FOR SALE(SEC.70//,BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
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Q THRd10H HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OH m
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Z �`TION,THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALEJ.
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Q TO CONSTAUCT THE PRQIECT(SEC.1Wa,BUSINESS AND PROFESSIONS CODE:THE CONiRACTORS LI- V81U9110� DO� ADJ.AREA �
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� � WYq00MRACT3WRSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
� 70HS 110ENSE UW.).
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� 1 MEREBV AFFIIUI UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � .
d Y(COMAIENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PqOFE5510NS CADE,AND Z
X MY t10EHSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS `A� v LIC.NO. � ��b�� j
V DATE 1% �O � CONTRACTOR C�CSCC �1�RO'r� a �
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBY AFFIRM UNDER PENALTV OF VEiWRY ONE OF THE FOLLOWING DECIARATIONS: �
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0 IHAVEANDWILLI.UINTAINACERfIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' 2
� COMPENSATqN,AS PROVIDED BY SECTON 970a OF THE LABOR CODE,FOR THE PERFORMANCE �U
OF hIE WORK FOR NM1IICH THIS PERMIT IS ISSUED. � � � ��� � .�t��
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w I HAVE AND WILL MAINTAIN WORKEflS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION �� /� �-��
Q 970o OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS • ' � I
ISSUED.MY WORICERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTIO ` 11�1 f����nh�.w
� �pq�Ep PLAN REVIEW `7�L .L ��L. �
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� POLICV NUMBER ELECTRIC �T �
� (1V96SECf10NNFIDNOTBE00AFLETmOF7FfrPEFAYTISFi7ROMEMNDRED00L1Af�S(f100)ORLESS�. PLUMBING �.d - --------y• � �
w MECHANICAL ��
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I
(�J SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE , `,
N WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE TMAT IF I SHOULD BECOME INSPECTION FEE v
S SU6IECT TO THE WORKERS'COMPENSA710N PilOVISIONS OF SECTION 3700 OF 7HE LABOR
CODE,I SHALL FORTHNATH COMPLV W17H hIOSE PR VISION . ISSUANCE �
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p OATE: /� /�QI APPLICANT: SMIP � �o �
� ENERGY P/C �
WARNiNO:FARUHE TO SECURE WORKERS'COMPENSAtION CAVERAGE IS UNLAWFUL,AND SHALL BE �
LL SUBJEGT AN EMPLOVER TO CHIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT O �
DOLLARS(i100.000),IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF 7HE UBOR CODE,INTEREST,AND ATfOHNEV'S FEES. ' RETENTION FEE:
d CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
� I HEREBYAFFIRAI UNDER PENALTY OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR h1E PERWRMANCE OF THE WORK FOR WHICH 7HI5 PERMI715155UED(SEC.3007,CIV.C.).
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� LENDER'SNAME
F- LENDERSADDRESS � ^ �
w ICERiIFYTHATIHAVEREMTIISMPLICAT10NANDSTATE7HATTiEABOVEINFORMATIONISCORRECT. TOTALFEES , �L�S`�
d I AGflEE TO COMPLY N7TH ALl CT'AND CWNTV ORDINANCES AND STA7E UWS REUTING TO BUILDING ���
CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF 7HI5 COUN7Y 70 EMER UPON THE
I Z ABOVE-MEPRIONED PROPER7Y FOR INSPECTION PURPOSES. COMMENTS '
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� RECPT.NO. PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW-finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicent's Copy
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GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER � FIREPLACE BC3ND BEAM
WATER SERVICE MID HT. BOND�BEAM ` '' ' � ' �'� �' '
ROOF SHEATHING � ' ' 8 FT. BOt�D BEAM. � � �. �
FRAMINGNE�NTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING � �
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUMBING FINISH GRADING
SHOWER(fU6 TEST POOL E�ECTRlC
EXT. I.ATHlSIDING POOL FENCING
WA�L INSULATION POOL FINAL
CEILING INSULATIOIV OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAR1K LANDSCAPE/IRRIG.
SEEP PIT/L.L. - ' - - ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIfVAL CONST. FIRE QEPT. FINAL �
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ENERGY
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