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PIVAI
'CITY OF DI MON BA U DEPARTMENT OF COMMUNITY&D VELOPMENT SE
BUILDING PERMIT APPLICATION 21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
PRESS
1,-1 FIRMLY
JOBSITE--5-2 kv 4G ow--/-72-OlAl LA-Ale ADDRESS
APN LOT TRACT
OWNER mf--'A'AATZ-S I L.Pr'S LA ci I, (2-'51
ADDRESS /2-5-c31 .---VO ArCT 1:310 TR_P)LTA.
CITY O1 ik-"*-154•5 tI ISr15112--ZIP91 i' ..0 TEL.
APPLICANT 5t L--./S Gicit,--12-g I TEL.9F er'-'8. 2-49-r-tIYC
CONTRACTOR -4°--C912-
ADDRESS
CITY 12--A-t-rj 0 ZIP 412-1 6 TEL1E)*�61-0^4410
ARCH/ENG/
DESIGNER prt.f...45-N DES t t^)
ADDRESS I 6 iV5 1 (.9-).-.1. •.[&,,;
CITY PNAA 1344D ZIP*in TEL.ff-y-
OWNER-BUILDER DECLARATION
CI I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
LL CENSE LAW FOR THE FOLLOWING REASON(SEC 7031 5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR C.)COUNTY
WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC,
Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED CU
M STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
gCENSE LAW(CHAPTER 9(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. C.)TION ANY VIOLATION OF SECTION
7031 5 STAN?APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO tz A CIVIL PENALTY OF NOT MORE THAN FIVE
HUNDRED DOLLARS ($500).):
LI DI,ASOWNER 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 7044,BUSICO 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 Cr THROUGH HIS OR
HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR 1-1-1 OFFERED FOR SALE. IF,
HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE.
CI TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE
PURPOSE OF SALE).
ILI
O1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS CC TO CONSTRUCT THE
PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LILLI CENSE LAW DOES NOT APPLY TO AN OWNER
OF A PROPERTY WHO BUILDS OFI IMPROVES THEREON,AND X WHO CONTRACTS KA SUCH PROJECTS WITH ACONTRACTOR(S)
LICENSED PURSUANT TO THE cONTRAC.I-- TORS LICENSE LAW.).
le CC
DI AM EXEMPT UNDER SEC B&PC. FOR THIS REASON
CC
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DATE OWNER
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102 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING
WITH SECTION 7004)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND
EFFECT
F-LIG NO-7 i 7("2,--
C)LICENSE CLASS 4ir.
1.—.1--'
0 DATE t2—.L L ew CONTRACTOR
1.1.1
WORKERS'COMPENSATION DECLARATION \
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF.INSURE FOR WORKERS'COMPENSATION,AS PROVIDED BY
SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE,
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE
CARRIER AND POLICY NUIpRE
CARRIER c-49----tp•,9"--,Ais•
POLICY NUMBER 493
(THIS SECTION NEED NOT BE CCMPLETED OF THE PERMIT IS FOR ONE HUNDRED =LARS CO)OR LESS)
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON
IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I
SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL F
FITHWITH COMPLY WITH THOSE PROVISIONS.
Ner-72--
e APPLICANT
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($100,000),IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
CONSTRUCTION LENDING AGENCY
I 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. 3097,CIV C)
LICENSED CONTRACTORS DECLARATION
0 el
DATE.
LENDER'S NAME C-44-1---• LENDER'S ADDRESS "79-7\*I
-C tEC)GA-
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY
AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTKMED PROPERTY FOR INSPECTION
PURPOSES
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DATE PERMITTEE NAME(PRINT) )
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SIGNATURE OF PERM/TTEE
APPLICATION 1
DATE MIT .2- P/C
NUMBER Ci #
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
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DESCRIPTION SQ. FT. FACTOR PS F ADJ.AREA/VALUATION
SFR/ADD/REM 5.w,IF 'Z. 75-
Garage/Carport 1-2,0&pr-r ts. �213
co r
IA Patto/Deck 1
LLI
11- PooVSpa
0 Re-Roof
z
5
—1 Commercial
5
co
Valuation ADIAREA
QUANTITY DESCRIPTION FEE
c.)
EZ
I- rAc-4,/) c;;7) p t—,4 c, 1 67.q D
2
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE.
PRE-ALT FEE.
0, tiel t1;36
Cf e7 c. 7,06f
I f?...5—. (71_, r Li
1 en)• BD p LI t c-i 0
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04 . 06X-
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4 J .,...1..,
TOTAL FE S
COMAIL t ,
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t ORMITAMIIMPIME11111" •
AI
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RECPT. N0.v 11P1-797. 1kIIL
WHITE—Department Copy,YELLOW--Finance Copy, PINK—Assessor Copy,GOLDEZIROD—File Coq,GREEN pplicant s op piiue
I tik,t>-jvyti,,,,,4-
CITY OF DIAMOND BAR INSPECTION RECORD
.
4I.• •
• • • ,41:!
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. • . • 7 .• 21.. . .
SET BACK , . I FLOOR JOIST '
FTGS.,FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
UNDER FLOOR CONDUIT ' .
GROUND PLUMBING
SLAB GRADE FIREPLACE FOUNDATION . .
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE 700• MID HT. BOND BEAM
ROOF SHEATHING vs I 8FTBONDBEAM �
0 Eti
fiJ
FRAMINGNENTILIATION ly mow A I FINAL BOND BEAM , .
Ki r t 0'
A
ROOF COVER ,.;1111111111=111 I PRE-GRADING
An.,41 I BENCHING
ROUGH HEATING �
ROUGH ELECTRIC
I ROUGH GRADING
ROUGH PLUMBING • FINISH GRADING
SHOWER/TUB TEST I POOL ELECTRIC
EXT. LATH/SIDING I POOL FENCING
16 first.,02,
P00 FINAL
ALL INSULATION OFF SITE IMPS.
rr-57/ 1 DEDICATIONS
/0 06/1W01
CEILING INSULATION
DRYWALL NAILING &IWO
SEWER 1 FINAL ENG.
SEPTIC TANK I LANDSCAPEJIRRIG.
SEEP PIT/L.L. _. .. . _... ... ON SITE IMPS. .. ..
.ni\iAll HEATING
-+------- !
FINAL ELECTRIC
1
1 FINAL PLUMBING' 1 1
-,/--7-t-tc-. 5741104)ifr 0 b : '6
./ t:)1 •-
HEALTH DEPT., FINAL DEV. FEES PAID ENERGY
c,:g.;',:t...•:.3;;:7;:•.: • %.
COMMENT'
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/A.)forn—ro hia:,6-1: 0 0 ti)a^-] C ea
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e o . 1)o-It
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SEPT C TAI\IK SIZE ,t
SEEP PiT/ii SIZE
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