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`---��— CITY OF DIAMOND BAR
DEPARTMENT OF COMIvIUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��%�M�� BUILDING PERMIT APPLICATION , FIRMLY
� JOBSITE �' Z S L APPLICATION •� ����ERMBER���#/C
o ADDRESS DATE O� �''`'(JT1
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENAL7Y OF PERAIRV THAT I AM EXEMPT FqOM THE CONiMCTORS LI- G8f8J0/COfPOfI
W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.68USINESSMlDPROFESSIONSCODEANVCITYOR (n
U �pUl�1T1'WryICHRE-0UIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� w
w TURE,PRIOR TO ITS ISSUMICE.ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w PeIlO/DBCk ,
� STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO iHE PROVISIONS OF THE CONTRACTORS LI� �
� CENSE LAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISqN 3 OF THE BUSINESS AND PRO- POOUSPB
� FESSIONSCODE)ORTHATHEOFSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (�
TION.ANVVIOLATIONOFSECTION7031.6BVANYAPPLICANTFORAPERMITSU&IECTSTHE�PPLICANTTO Z qe-Roof
A CML PENALTV OF NOT MORE THAN FNE HUNDRED DOLl.ARS(5500).�:
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Z WILL DO THE WORV(AND THE STRUCNRE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7oa,BUSI� J J
� NESS AND PROFESSIONS CODE:THE CONTRACTOFS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTY YVFq BUILOS OR IMPqOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTNqOUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVERTIIEBUILDINOORIMPROVEMEMISSOIDWRHINONEVEAAOFCOMPLE-
Z TION,THE OWNER�BUIIAER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVEFORTHEWRPOSEOFSALE).
w ❑I,ASOWNEROFTHEPROPEFlTV,AMEJ(CLUSIVELVCANTRACTINOWITHLICENSEDCONTMCTORS
Q TO CONSTRUCT 7HE PR0.IECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:7HE CONTMCTORS LI- V8I118SIOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOMIOWNEROFAPROPER7VWHOBUILDSORIMPROVESTHEREON,AND
� NM1iOCONTRACT5FOR5UC}iPRQ1ECTSWITHACANTRACTOR(S)LICENSEDPUFSUANTTOTHECONiRAC- QUANTITY DESCRIPTION
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� ❑I AM EXEMPT UNDER SEC, B.6 P.C.FOR THIS REASON �
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DATE OWNER F
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� LICENSED CONTRACTORS DECLARATION �' w
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I HEREBV AFFIRM UNDER PENALTV OF PERlURV THAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINE S AND PROFESSIONS CODE,AND Z
��� MV LICENSE IS IN FULL FORCE ANO EFFECT. m
� LICENSE CLASS� `�'� LIC.NO. '� �
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� WORKERS'COMPENSATION DECIARATION Q
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� I HEREBY AFFlRM UNDER PENALTV OF PE0.IUFV ONE OF THE FOLLOWING DECLARATIONS: Z
�Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUqEFORWORKERS' ¢
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COMPENSATION,AS PROVIDED BV SECTION�70o OFTHE LABOR COOE.FOR THE PERFORMANCE U
Q OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED. �
QW 1 HAVE ANO WILL MAIMAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SECTION
3700 OF 7HE LABOR CODE,FOR THE PERFORMANCE OF iHE WORK FOR WH�CH 7HI5 PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER M!D POLICV NUMBERARE: CONSTRUCTION
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Z I CERTIFY THAT IN hIE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL
C.�} SHALL NOT EMPLOV ANV PEFSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION 1AW50F CALIFORNIA,AND AGREE THAT IF 1 SFqULD BECAME INSPECTION FEE
� SU&IECTTO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 37000F THE LABOR �
CODE,I SHALL FORT}I ITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
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p DATE: Z APPLICA� SMIP
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"'� WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C '
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�y SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(flao.000),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PqOVIDED FOR IN
� SECTION 3708 OF THE UBOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: '
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THATTHERE IS ACONSTRl1CTION LENDINO AGENCV
FOR THE PERF-0RMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.J.
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� LENDER'S NAME
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� I AGREE TO COMPIY WIiH ALL qTV AND CWNTV ORDINANCES AND STATE UWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTMORIZE REPRESENTATIVES OF THIS CAUNTY TO ENTER UPON THE
Z ABOVE�MENTIONED PROPE R INSPECTION PURPOSES. COMMENTS
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� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—AppllcanYs Copy
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SET BACK FLOOR JOIST • �
FTGS/FORMS/STEEL FHA REC�MTS
ELECTRIC GROUND ^ UNDER FLOOR DUCT
GROUND PLUM6ING UNDER FLOOR CUNDUIT
SLAB GR,4DE FIREPLACE FOUNDATION
TEMP POWER �y�L �i+ FIREPLACE BOND BEAhA
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BbNQ BEAM
FRAMINGNENTILIATION FiNAL BOND BEAM
ROOF COVER PRE-GRADING � `
ROUGH HE,4TING BENCHING
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBItVG FINISH GRADING
SNOWERITUB TEST POO�ELECTRIC
EXT. LATH/SIDING P�OL FENCING
WALL INSUTATION POO�FINAL
CEILIIVG INSULATION OFF SITE iMPS. �
DRYWALL I�IAILiNG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAI�lK LANDSCAPE/IRRIG.
SEEP PtT/L.L. - C]N SITE IMPS.
GAS AIR TEST F1NAL ZONING
FINAL CONST. � , FlRE DEPT. FINA!
FINAL HEA7ING r� HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ENERGY
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SEPTIC�'ANK SIZE
SEEP PIT/U SIZE
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