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;( � CITY OF DIAMOND BAA
� � '- DEPARTMENT OF COMMtJNITY&DEVELOPMENT SERVICES
_ � 21660 E.Copley Drive Suite 190
- (909)860.3195 Fau(909)861-3117 PRESS 4
�'��'� BUILDING PERMIT APPLICATION FIRMLY
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� DESIGNER � �60��� f'�SSOG NO.DWEL. NO. NO.
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p� OWNER-BUILDER DECLARATION SFR/ADD/REM �.��r
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TURE,PfipR TO ITS ISSUANCE,/�LSO REOUIRES hIE APPLICANi FOR SUCH PERMIT TO FILE A SIONED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 70 THE PROVISIONS OF 7HE CONTMCTOHS LI- � .
CEN9E UW(CMAPTER G(COMMENCINO N7TH SECTION 7000)OF DIVISION 3 OF THE BUSINESS M1D PR0. POOVSPB
FESSIONSCOO�ORTHATHEORSFIEISIXEAIP77HEREFROMANDTHEBASISFOR7HEALLEOEDE%EMP- (�
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� ACML VENALTV OF NOT MORE THAN FNE HUNDRED DOILARS(f5o0).):
O �4�aN1EROF7HEPROPERTV,ORMYEMPLOVEESWITHWAOESASTNEIRSOLECOMPENSATpN, 0 COmRIBfCl81 . � '
� WILL DO THE WORI(AND 7ME STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a1,BU54 J
� HE95 AND PROFESSIOHS COOE THE CONTRACTORS UCENSE UW�OES NOT MPLV TO AN OWNER OF ? � � ,
PROPEHTY WFIO BULD9 OR W PROVES THEREON.AND WHO DOES SUCH WOHK HIMSELF OR HERSELF OR
� 7HROUGH WS OR HER OM7J E►IPLOYEES,PiqVIDED 7HAT SUCH IMPROVEMENTS ARE NOT RfTENDED OR m
OFFERm FOR 3ALE IF,IqWEVER 7ME BIAL.DPI(i OR a1PROVEM@!T 13 SOLD WfTMIN ONE VEM OF COMVLE-
Z �'TqN,iT1E OWNER�BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� UIVROVE F0(i THE W RP0.4E OF SALE�
W ❑I,A$OMMEROFTHE PROPERTY,AM EXCLUSIVEI.Y CONTMCTWO H7TH LICENSFA CANTMCTOq3
Q TO CONSTRUCT 7HE PRO.IEC7(SEC.7w1,BUS�NES9 AND PHOFESSIONS CODE:7HE CONTMCTORS LI- VelU9�lOn qp�,pqE,q
W CEHSE UW DOES NOTAPPLY TOAN OWNER OFA PROPERTV NT10 BUNDS OR IMPROVES THERE-0H,AND
� MRqCONTMCf3FOR5Up1PROJECTSWIh1ACONTMCTOR(S)LICENSmPUHSUANTTOTHECONTfUG pUANTITY DESCRIPTION FEE �
� 70RS UCENSE LAW.�.
� ❑1 AM D(EAIPT UNDER SEC. B.6 P.C.f-0R 7HIS REASON � � �OD ►' �C�I V L Gd� �
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� DATE OWNER � � Z�Q iVt �'Jtl �c
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LICENSED CONTRACTORS DECLARATION w
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� I HEREBV AFFIRA/UNDER PENALTY OF PERNIRV T11AT I AM UCENSED UNDER VROVISIONS OF CHMTER !
� i(COMNENCIN(1 VATH SECTION 7000)OF ONISION 7 OF THE BUSINE55 AND PROFESSIONS CODE,ANO Z G -/ JvL � � •�, . _
W LICENSE IS PI RAL FORCE M1D EFFECT. /,
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V DATE �� V� CONTRACTOR_�.J L� � L. •l - J -( S�
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� WORKERS'COMPENSATION DECLARATION �
� I HEREBY AFFlRM UNDEH PENALTV OF PERIURV ONE OF 7NE WLLOWING DECLARATIONS: Z
� _I HAVE AND WILL MAN7NN A CERTIFICATE OF CONSENT 70 SELF•INSURE FOR WORKERS' _
Q COYPFNSATqN,ASPROVIDEDBYSECTION370oOF1HEUBORCODE,FORTHEPERFORMANCE U
Q /OF 7HE WORK FOR WHICH THIS PERMIT I$ISSUED. �
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� _I HAVE AND WILL MNNTAU!WORKER9'COMPENSATION INSURANCE.AS REIXIIRED BY SECTION �
Q 370o OF THE LABOR COOE,FOR THE PERFOfiMANCE OF 7HE WORK FOR WHICH THIS PERMI7IS
ISSUED.MV WUR.K{ER-S'COMPENSAT NSURAN CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
j CMRIER �1 C�l�� �lJK�� PLAN REVIEW Ti1�ll '13
� � POL.ICYNUMBER 2Z�v'�OQ �O(��jp ELECTRIC � '�u�
p (naSSEcna+r+�r�oreeoa.RErIDOFnEv�.r�swnoNeMro�oaurs(Stoo)aa�. PLUMBING /�
Z I CERTIf'Y 7HAT Pl THE PERFORMANCE OF THE WORK FOR WHICH TMIS PERA/1T IS ISSUED,I MECHANICAL AI f i II 1 � 111
C,� SMALL NOT EMPLOY ANV PERSON W ANY MANNER 50 AS 70 BECOME SU&IEC7 TO THE � � • -'� � -
y WORKERS'COMPENSATION UWS OF CALIFORIJIA,AND AOREE THA71F I SHOULD BECOME INSPECTION FEE y�� ►T
SUBJECTTOTMEWORKERS'COM7ENSATIONPROVISIONSOFSECTION�7000FTHELABOR �lI X U���ll��l�l�v��1
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"o OATE: APPIICANT: SMIP �LJII..DINCi AN ��'��
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� WARNINO:FNLURE TO SEWRE WOFiKERS'COMPEN9ATION COVERAOE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECT/W EMPLOVER TO CRIMINAL PEIULTIES AND CML FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLAFS(5700,000�,IN/�DDRION 70 7HE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 370!OF THE L/iBOR CODE,INTEREST,M!D ATTORNEY'S FEES. �
� RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE•ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERRIRV TFUT THERE IS A CONSTRUCTION LENDINO AQENCV � • �
Z FOR THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,GV.C.).
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� LENDERS N/VdE . . .
H LENDERSADDRE35
w ICERTIFYTHATIHAVEREADh11SMPLICATqNNIDSTATETHATTiE�BOVEINFORAIATqNISCORRECT. TOTAL FEES i� '�•
� I AGREE 70 COMPLV N7TH/�1.L CITV M!D COUNTY ORDINANCES AND STATE LAWS REU71N0 70 BUIIDINO �
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF 7HI5 COUN7V TO EMER UPON THE
Z ABOVE�MENTqNED PROPERTY FOR INSPECTION PURP0.5ES. �
Q .�, COMMENTS '
� GLYVI.�s �.. r 'bv e�
m PERMITTE AME(PRINn � ' ' �
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� sw ua F PERMf1TEE °A� RECPT.NO. PAID BY �VALIDATION
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SET BACK � FLOOR JOIST
FTGS/FORMS/STEEL' FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CUMDUIT �
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWEFi FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. 80N0 BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING ,
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING �� �"' �� � FINISH GRADING
SHOWER/TUB TEST � POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL.FINAL
CEII.ING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL EN�.
SEPTIC TANK LANDSCAPElIRRlG.
SEEP P!TlL.L. QN SITE 1MPS.
GAS AIR TEST FINAL Z(?NI�lG
FINAL GO{VST. � � FIRE DEPT. FINAL
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