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�� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT�������
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020• Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
�4'TM' BUILDING PERMIT APPLIC TioN FIRMLY
o� JOBSITE \q O� \I�� ,J APPLICATION PERMIT / p/C
ADDRESS V DATE NUMBEF�Q%O 1i I
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DATE CONST� d� GROUP
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
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0 I HEREBV AFFIRM UNDEH PENALTV OF PEiLUHV THAT I AM E%EMPT FROM THE CONTRACTORS LI- GflfB B/C8 OR
W CENSEUWFORTHEFOILOWINOREASON(SEC.7031.5BUSINESSANDPROFESSqNSCODE:ANYCITVOR (n g �
C-� COUNTVWHICHREWIRESAVERMRTOCONSTRUCT,ALTER.IMPROVE,DEMOUSH,ORREPAIRANVSTRUG w
W TURE,PRIOR TO ITS ISSUANCE.ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
� CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PflO� � POOUSPB
. � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP-
TION.ANV VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof �
A CIVIL PEfU1TV OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
0 ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COfI1RI0fCI81
Z WILL DO THE WORK,AND THE S7RUC7URE IS NOT INTEN�ED OR OFFERE�FOR SALE(SEC.7a�,BU51- J -
N NESS AND PROFESSIONS CA�E:THE CANTRACTORS 110ENSE LAW DOES NOT A7PLV TO AN OWNER OF ?
PROPERTV WF10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q iHROUGH HIS OR HER ONM EMPLOVEES,PROVIDEO THAT SUCH IMPROVEMEMS ARE NOT INTENDED OP m
Q OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIAIPROVEMENTISSOLDWRHINONEVEAROFCOMPLE-
Z TION.THE OWNER�BUILDER WILL HAVE THE 6URDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE VURPOSE OF SALE).
�yJ OI.ASOWNEROFTHEPROPERTV,AAIEXq.U51VELYCANTRACTINOWITHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V91U0SIOf1 ADJ.AREA
W CENSE UW OOES NOTAPPLV TO AN OMMER OF A PROPERTY WHO BUILAS OR IMPROVES THEREON,AND
� NSiOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)UCENSEDPURSUAMTOTHECONTRAC� pUANTITY DESCRIPTION
TORS LICENSE UWJ. FEE
� O I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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� DATE OWNER �
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F¢ LICENSED CONTRACTORS DECLARATION W
CL 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PqOVI510NS OF CHAPTER �
� 9(COMMENCIN(i WITH SECTION 7000)OF DIVISION 3 Of THE BUSINE55 AND PROFESSIONS CODE.AN� Z
OMY LICENSE IS M FULL FOFCE EFFECT. �� � �
LICENSE CLAS LIC.NO. �
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� WORKERS'COMPENSATION DECLARATION �
� I HEREBY AFFIRM UNDER PENALTY OF 7ERIURV ONE OF 7HE FOLLOWING DECLAFATIONS: V
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� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEIF-INSURE FOR WOqNERS' _
COMPENSATION,AS PROVIDED BV SECTION 370o OF THE UBOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICN THIS PERMIT IS ISSUED. � W
� �
w _i HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: N TRUCTION
� CARRIEH PLAN REVIEW
� 70lICV NUMBER
dZ ELECTRIC
0 (I}ESSECIqNNE�NOT8E00MREfmOF7HEPEAIMISFOHpNEFIIR�OfiEDDOLLAiLS�tlao)ORLESS) PLUMBING
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Z I CERTIFV 7HAT IN THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERM IS ISSUED.I MECHANICAL
C.�} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SU JE TO '
[/� WORKERS'COMPENSATIONIAWSOFCALIFORNIAMIDAOREETHATIFI L COME INS ECTIONFEE
= SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION THE LABOR
CODE,I S ALL FO THWITH COMPLV WITH THOSE PROVISIONS. IS CE
� `
p DATE: N Y�PPLICANT: M �
w ENERGY P/C
� WARNING:F URE TO ECURE WOAKERS'COMPENSATION CAVERAGE N UL,AND SHALL BE
� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES 11P TO 11NDRED THOUSAND ENERGY PERMIT
DOLLARS(f100,oao�,IN ADDITION TO THE COST OF CAMPENSATKKJ,DAMA AS PROVIDED FOR IN /
� SECTqN 3708 OF THE LABOR COOE.MTEREST,MlD ATTORNEV'S FEES. EN N F /�(J�
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O CONSTRUCTION LENDING AGENCY p/1�'J/�
� 1 HEREBV AFFIRM UNDEF PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINa AOENCV '��
FOR THE PERFOqMANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUED(SEC.3ae7,CIV.C.�.
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� LENDER'S NAME
� LENDER'SADDRESS
w I CEFTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT 7HE ABOVE MFORMATION IS CORRECT. TOTAL FE ES � //� /
� I AGREE TO CAMPIV WITH ALL CfTV AND COUNTV ORDINANCES M!D STATE LAWS REUTING TO BURDINO
� CONSTRUCTION,AND HE B AUTHORIZE REPRESENTATNES OF THIS CWNTV TO ENTER UPON THE
Z ABOVE-MENTIONED�R R FOR INSPECTION PURPOSES. COMMENTS '
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� SIGNATUREOFPERMITTE pq7
2 RECPT.NO. PAID BY �oZII1— VALIDATION
` ~ WHITE—Depertment Copy,YELLOW�inence Copy,PINK—Asaessor Copy,OOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST � �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT • ` � � '
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUf�DATION , . '
TEMP POWER FIREPLACE B�ND B�AM
WATER SERVICE MIO H'T. BOND BEAM
ROOF SHEATHING � • � � �I � ' 8 FT. BOND BEAM • '
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB 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.
SEEP PIT/L.L. � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COIVIMENTS
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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