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,--- l„ _ CTfY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES CITY OF DIAMOND BAR 4
DIAMOND BAR
JOBSITE
ADDRESS 3108 WTNTINITLI DRIVE
APN LOT 9 - TRACT 48487
OWNER Windmill Estates, LLC
ADDRESS 3480 Torrance Blvd. Ste. 300
CITY Torrance ZIP 90503 TEL. 310.540.399
APPLICANT Ricahrd Goill rl TEL 1 10_541)399
CONTRACTOR .Tcr. (Inn s 1-nirti_cm
ADDRESS same P R cualpr
CITY ZIP TEL.
ARCH/ENG/
DESIGNER R.Gould&Assoc, .
ADDRESS same as owner
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE 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-
TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500))
DI,AS OWNER 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,BUS).
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
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLE-
TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE)
DI.AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO SUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW)
O1 AM EXEMPT UNDER SEC. BLPC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS B LIC NO 671982
DATE CONTRACTOR .1.C.t...: Crcr: el-tc
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 INSUR CE CARRIER AND PO ICY NUMBED ARECARRIER fTtT c
INWILMCG
erliSTl
POLICY NUMBER i(.0 0 4
(THIS SECTION NEED NOT BE(XMPLETED OF1HE PERMIT IS FOR ONE HUNDRED COLLARS(SIP 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 FORTHWITH COMPLY WITH THOSE PROVISIONS
DATE 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
I
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)
• LENDER'S NAME
. LENDER'S ADDRESS
• 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
5 ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES
.31 �
or tetv., A VS .1.-f tr-.
PERM! NAME PRINT)
i2.
cli
) SIG A RE OF PERMITTEE IiTE
APPLICATION P
DATE M.. LI
%ERI /C ti
() ... 1 S-...0 N
UMBER ICI
ISSUE TYPE GROUP
DATE 6- CONST. OCC
I 9... 19....
FRONT SEfBACKS
ZONING REAR
SIDE RW p
0
SIDE/SIDE STREET RW 0
0
PROPOSED
N0.
UNITS
USE
D W EL.
1 New Sing Family Residence
N0. STORIES N0. BEDROOMS
2 5
U)
I-u
w DESCRIPTION SQ. FT. FACTOR PSF A J.AREANALUATION
IA-
(.5
Z
SFR/ADD/REM 5,951 5 9 kis . •-t)
Garage/Carport 748 :/- )56.S.iru
Patio/Deck
Pool/Spa
Re-Roof
5
) Commercial
5
co
Porch 159 Isol
Balcony 70 siLO
e'D'11
Valuation I&?4 ADIAREA
QUANTITY i
DESdRIPTION FEE
-J
<
0
I-
0
w
ILI
0
Z
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M
D
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fa.
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
EkERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
iA 5 :13 ^
, Ok.) .<•t)
6c),cZS
11
�
. •NU/
D.V38t)Le
1 .41
I'ib
...slow.
TOTAL FEES 501.-11
COMMENTS
RECPT. N0. PAID BY VALIDATION
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS FIRMLY
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy
MY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS FIRMLY
APPLICATION
DATE
1 # P/C
/.." PERMIT jsZy
NUMBER
ISSUE GROUP
DATE OCC
1/..71,...4.5 TYPE
CO NST.
FRONT SEfBACKS RW
ZONING REAR
SIDE 1:1
0
SIDE/SIDE STREET RW EI
D
N0. PROPOSED
UNITS
USE
D W EL.
N0. N0.
STORIES BEDROOMS
co DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION
ADD/REM 511A-7
Garage/Carport
Lu
w
u- Patio/Deck
CI
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PooVSpa
Re-Root
5
—I Commercial
5
m
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
<
c.) goo n . *J (A of
1:7
2
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5
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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:
55 7-2.4
/ .--.--*-
TOTAL FEES
COMMENTS 5'63 zi
RECPT. No.qicki PAID BY VALIDATION
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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-MENTIONED PROPERTY FOR INSPECTION
PURPOSES
avvt.cs L kaS•
PERMITTEE N E(PRINT)
SIGN Ui PERMITTEE
DATE
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
�
JOBSITE g mit(
ADDRESS D tAh
APN LOT_91..,,TA FT �I'Vtg
OWNER U.1_„
ADDRESS 3 y TthzdePlAire 134-v-0
CITY R Rii Ale& ZIP 0 50,3 TEL310 9-/0-N517
APPLICANT TEL.
CONTRACTOR 1.- i C.ADDRESS TWIMPITMTEMIZ
CI-NSA/A?I too* ZI TEL A 10-it ogq DESIGNER .,t LP t'ti,IA
ARCH/ENG/
ADDRESS (
CITY ZIP
TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE
FOLLOWING REASON (SEC 7031 S BUSINESS AND PROFESSIONS CODE.ANYCITY OR COUNTY WHICH REQUIRES A PERMIT TO
CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUCTURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE
APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS
OF THE CONTRACTORS LICENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND
PROFESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION.ANY
VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT
MORE THAN FIVE HUNDRED DOLLARS 0500)
DI.AS OWNER 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,BUSINESS 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 THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT
INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT !SS= WITHIN ONE YEAR OF COMPLETION,
THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE
OF SALE).
DI,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE
PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER
OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)
LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW.)
0 I AM EXEMPT UNDER SEC. 13&P.0 FOR THIS REASON
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH
SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS c.-10 LIC. N0.
DATE CONTRACTOR nrc..6
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 THE WORK FOR WHICH THIS PERMIT IS ISSUED.
tel.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 WORKS s'CO PENSATION I SURiZig
CARRIER AND POLICY NUMBER ARE.
CARRIER 190
POLICY NUMBER 2 7.4)pet i 3
mils SECTION NEED NOT BE COMPLETED OF THE PERMT IS FOR ONE HUNDRED DOLLARS(Si00)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
FORTHWITH COMPLY WITH THOSE PROVISIONS
DATE. APPLICANT.
WARNING. FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER To
CRIMINAL PENALTIES AND CIVIL PINES 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,C1V C.).
LENDER'S NAME
LENDER'S ADDRESS
DATE
OWNER
�� �
! GAS A
/-4-erit
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CCCI Est•--8.tv
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LeFtW.°M 6P,ALtINC:i
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ENERGY
PRESS FIRMLY
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&'DEVELOPMENT SERVICES 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE • ej k
ADDRESS 3/O8 e,,..i id—',.... ,//27
APN LOT 9 TRACT 41 e kg/
OWNER
ADDRESS 7 !„)
CITYl,,,..,,,,ZIP 6'SZ37 TEL4P..4�2_- • f4
APPLICANT TEL.
2
#
CONTRACTOR
ADDRESS 1 iE...OZirArirCIAirs'
41"
CITY Li ,M,e., ZIP 9-7,AOTE4,69 42ZZ,-;
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE 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-
TION ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500))
O1.AS OWNER 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. BUSI-
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
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE)
DI,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW)
0 I AM EXEMPT UNDER sec 8&PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS L' LI I'V 7 2
C NO
DATE CONTRACT° tegic/l,lg.4,
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 WORKiRS'COMPENSATION INS CE CARRIER A D POLICY NUMBER ARE
CARRIER
POLICY NUMBER i 47r C 2-C-
(THIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE HUNDRED COLLARS$100)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 FORTHWITH COMPLY WITH T E PROVISIONS
DATE APPLICANT 14,e12 44^45')/7.)
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)
LENDER'S NAME
LENDER'S ADDRESS
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-MENTIONED PROPERTY FOR INSPECTION PURPOSES
49,6e1 hi/T-.P.e)Al
PE ITTEE E(PRINT)
/��1��
SIG ATURE OF PE TTEE DATE
APPLICATION PERMIT .11
DATE i NUMBER #
ISSUE TYPE OCC
DATE CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW o
0
SIDE/SIDE STREET RW 0
4
o r
NO PROPOSED
UNITS Z
USE 1 A A y(AA-c
D W EL.
ww,
N0. N0.
STORIES BEDROOMS
CQ DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFFVADD/REM
Garage/Carport
aW P tio/Deck
LI-
0 Pool/Spa
Z
Re-Roof
E Commercial
5
co
Valuation ADJ AREA
QUANTITY DESCRIPTION FEE
-J
<
E°
I- I f Ir. *T- 6 r".1"e"--
tii
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4,ate <
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CONSTRUCTION
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ELECTRIC
PLUMBING
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INS?ECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
\
ilk WAIII^111111-
v
IIIMMIVIMEIRIESMO 7
, `7eCt?
TOTAL FEES 140
COMMENTS
(-2.) \i C-,.)
7)
24' I
PAID
RECPT NOC( 1 - D BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
- 3
/4-#Y elf-
pt,eiz(9'
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, e Copy,GREEN—Applicants Copy
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JBSITE
%s NO•P wiiilliwr-Ji ir--.
APN LOT*1204,4 TRACT 4.r qi?
OWNER •7t-
ADDRESS
CITY ZIP TEL.
APPLICANT TEL.
A
CONTRACTOR I 9 isnork.) Aft-.a.,,,,r
ADDRESS 3N I C"Cor-tvirt.r 4.4.)
CITY NatThfetik ZIP y5-03 TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031 S BUSINESS AND PROFESSIONS CODE ANY CITY OR
COUNTY WHICH REOUIRESA pERMiT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC.
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS UCENSED PURSUANT To THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7500)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN ME HUNDRED DOLLARS M00):
DI.AS OWNER 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, BUSI-
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
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FORSALE IF, HOWEVER.THE BUILD/NO OR IMPROVEMENT iSSOLD WITHIN ONE YEAROF COMPLE-
TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
DI,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI-
CENSE LAW DOES NOT AppLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON.AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS UCENSE LAW).
CI I AM EXEMPT UNDER SEC. B&P.0 FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7003)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FOR AND EFFECT
LICENSE CLAS.,..
... LIC NO °7 744 s 1
DATE 1 CONTRACTOR ....,:t1E14I1V
WORKERS COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
31<.1-AVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BY SECTION 3750 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
. HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
I
3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF E WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERt,COICOSATION INS RANCE C ER AND POLICY NUMBER ARE
CARRIER ... -.AI
POLICY NUMBER o/j-41
(IHSSECTION NEED NOT BECOMPLETEDOF THE PERMIT B FOR ONE HUNDRED COLLARS($100)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 AKERS'COMPENSATION PROVISIONS OF SECT! N 3,05 OF THE LABOR
CODE, HALL RTHWITH COMPLY WITH SE PRoVi
DATE- 3 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(0100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 375a 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)
LENDER'S NAME
LENDER'S ADDRESS
i CERTIFY THAT I i-IAVE 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
CONSTRUCT!. .AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENT• ED PROPEI:r1;,ELINSPECTION PURPOSES
.4 LI ,i'
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PERM idiEnZWA eII110111111ffpfije,
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SIGNATURE iir RM fif DATE
APPLICATION PERMIT
DATE q NUMBER k P/C,...,../.--
ISSUE ab TYPE GROUP
DATE 41 CONST. OCC
SETBACKS
FRO NT
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SIDE/SIDE
SIDE RW 0
13
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0
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ELECTRIC
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INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
4,
TOTAL FEES (CI.
COMMENTS
RECPT. N0. VALIDATION
F
PRESS FIRMLY
CITY OF MMCND BAR INSPECTION RECORD
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive
(909)140e31115 Fax(909)861-3117 g3r. 91--1 C>
BUILDING PERMIT APPLICATION
APPLICARON
DATE
"'w t 3.0/0 4 NUMBER' 1 a ItP/44440
ISSUE
DATE
OCC
--7/....)i ..),./•—
' TYPE
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
0
SIDE/SIDE STREET RW o
0
PROPOSED
N0.
UNITS
USE
DWEL . it It-2
N0. N0.
STORIES BEDROOMS
CO
I-1.1
LLI DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION
LI-
0
z
SFR/ADG/REH
Garage/Carport
Patio/Decic
Pool/Spa girl,
Re-Roof
6
-3 Commercial
5
m
Valuation 30,C2su ADJAREA
QUANTITY DESCRIPTION FEE
-J .0)/I GvatZt IS+. 1 tra
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0
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11.1
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
Q4=3 Q•er-S
so*. 1 cz.
4- 1. S c)
4-a .sc..
I(DID-coo
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.3 .0
455,4..
ac,I-.QAD sr) Li-. a,,:a 4 3c .-
TOTAL FEES 3183-"s. sal s .a cl
COMMENTS
RECPT N0. 1@ 14 Cr3 PAID BY V)a .D.-0, VAUDATION_ _—
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy
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ZCITY di biosunita. 130oY-ZIP et t 76t-TEL
g APPLICANT z VievarrEL
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• CONTRACTOR C[AAA. ex ADDRESS
0 CITY P014to YLOL ZIP 1 948-TEL in
LL1 ARCH/ENGT
z DESIGNER 13-C.,-,ada/AS
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a.ADDRESS 110,-)-.atter,. e.ii d. pgo V
• an(*IA—4;tosAi- ZIP TEL(919
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I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS Lt. LU CENSE LAW FOR THE
FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR 0 COUNTY WHICH REQUIRESA PERMITTO
CONSTRUCT,ALTER IMPROVE,DEMOUSH,OR REPAIR ANY STRUC=TURE. PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE
APPLICANT FOR SUCH PERMIT TO FILE A SIGNED IJJ STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS
OF THE CONTRACTORS U-
M CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PRO'FESSIONS CODE)OR
THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
8 TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPL/C.ANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY
OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).):
o CI t,AS OWNER OF SHE PROPERTY,°RAW EMPLOYEES WITHWAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF CO PROPERTY WHO
BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OWN
EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT/WENDED OR UI OFFERED FOR SALEJF.HOWEVER,THE BUILDING
OR IMPROVEMENT IS SOLD WITHIN ONEYEAROF COMPLE-
DON,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
L1.1 DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS CC TO CONSTRUCT
THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ULU CENSE 15,090055 NOT APPLY TO AN
OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON.AND
WHO CoNTRACTS FOR SUCH PRoJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS UCENSE LAW.)
CC
Cu AM EXEMPT UNDER SEC. B&P.C. FOR THIS REASON
LI
CD LICENSED CONTRACTORS DECLARATION
DEI HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
• (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
n -MY LICENSE IS IN FULL FORCE AND EFFECT
0
UCENSE CLASS 13, LIC. N0. '5'34
- DATE -30—vet CONTRACTOR C.
a WORKERS COMPENSATION DECLARATION
JOBSITE s
ADDRESS 2' WI ntiivu'I 15 k
DATE OWNER
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. !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-MENTIONED PROPERTY FOR INSPECTION
PURPOSES
OWNER-BUILDER DECLARATION
FIRMLY
rzi LU
-J
cc
LL1
CC
CL LL 1
CC
LU
a CO
co•ct
CO
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1—
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
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' MPENSATXX4 INSURANCE CARRIER AND
POLICY NUMBER ARE.
CARRIER
POLICY NUMBER
(11-OS SECTION NEED NOT BE COMFLETED OF THE PERVIT IS FOR CAC HUNDRED DCUARS($100)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
FORTHWITH COMPLY WITH THOSE P�IVISIONS.
DATE: - 1-99 APPLICANT,
WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS U WFUL,AND SHALL BE SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP To ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDMON TO THE COST OF
COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE. INTEREST,AND ATTORNEYS 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.).
LENDER'S NAME
LENDER'S ADDRESS
PERMITTEE NAME(PRINT)
SIGNATURE OF PERMITIEE
129 y4-A*
DATE
CITY OF DIAMOND BAR
INSPECTION RECORD
�� � 4� .�.���7.
FLOOR JOIST
• !FHA REQMTS
4-
A.
BACK.
ELECTRIC GROUND
S/FORMS/STEEL
SLAB GRADE i
TEMP POWER 4
77.-26-Y,n-,./f , FIREPLACE FOUNDATION s.
ROOF SHEATHING - ' FIREPLACE BOND BEAM
MO HT. BOND BEAM
; . 8 FTT. BOND BEAM
FRAMINGNENTILATION ;, FINAL BOND BEAM r
I
ROOF COVER ' -; PRE-GRADING
ROUGH HEATING , ' BENCHING
ROUGH ELECTRIC ' ' ; ROUGH GRADING
, kw, 4
ROUGH PLUMBING ' . : ; FINISH GRADING • '51*"
4
SHOWER/TUB TEST . i POOL ELECTRIC'i'/ :.
EXT. LATH/SIDING , ,
i POOL FENCING dalt/VAIIIIIIIPP'"-
WALL INSULATION . TOOL FINAL
CEILING INSULATION : OFF SITE IMPS.
; DEDICATIONS .
DRYWALL NAILING ,
, . FINAL ENG.
SEWER ,
SEPTIC TANK . LANDSCAPE/1RRIG.
SEEP PITIL.L. , 'ON SITE IMPS.
GAS AIR TEST !7-.2 a ,I1 I
FINAL ZONING
1 , i FIRE DEPT. FINAL
FINAL CONST. MEM ,
; F
FINAL HEATING 41"4st ' HEALTH DEPT FINAL
;':.A. ; iJ.:C';".. (; .., „-
FINAL PLUMBING
:DEV. FEES PAID
! ; ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE__
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PRESS
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive
(909)2603/95 Fax(909)861-3117€3-3ci. -70
BUILDING PERMIT APPUCATION
JOBSITE
ADDRESS';I De. 1.4.44.htal !Pit
APN LOT q TRACT
OWNER YVtv-3.; 14v5 the-it
ADORES
IP . 0 i
CITY A- .I. i • P/ ZIP TEL ( /I
APPLICANT TEL 8-4-3-4e,r
CONTRACTOR
ADDRESS TWE •i/IMA.
CITY PI•A... ZIP etty't TEL Migiti ,
ARCH/EN
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR
COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE: DEMOUSH.OR REPAIR ANY STRUC-
TURE. PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS DIEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).):
a t AS OWNER OF THE PROPERTY,OR MY EIAPLOYEES VATHWAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI-
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BULDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE. IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING TIiAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CoNTRACNNO WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SET. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT
APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJEcTS WITH A CONTRAcTOR(S) LICENSED PURSUANTTO THE CONTRAC-
TORS UCENSE LAW.)
0 I AM EXEMPT UNDER SEC B.&PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS(3%C-)1,LT-3 LIC. N0. 34 0
DATE ''-9--o y CONTRACTOR
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
3750 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED MY WORKERS' 50114pENSATION NSURANCE CARRIER AND POLICY NUMBER ARE
CARRIER ./"A'4._. futt.
POLICY NUMBER )..747 I'S". -Ycl<f•
(THIS SECIENNEED NOT BE CCCIPLETEDOFTHE PEFIVIT IS FOR ONE HUKORED DCLLAFIS(9100)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 FORTHWITH COMPLY WITHE PROVISIONS.
DATE: 4"" 30-I) APPLICANT: .-41 AI-, a44 f
WARNING FAILURE TO SECURE WORKERS'COMPENSAT COVERAGE I UNLAWFUL.AND SHALL BE
SLIEUECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($100,000),IN ADDMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 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.
LENDER'S NAME
LENDERS ADDRESS
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-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
12,0 4 ZA Y44)
PERMITTEE NAME(PRINT)
et-. 7,,,t4f
02a----fr7
SIGNATURE OF PERMITTEE DATE
�
APPLICApOp
DATE
'4j"' 3c /.., 14... PERMIT n,..3L.-.1 v._P/C
NUMBER""/ay"-' #crre latn't
ISSUE
DATE
-7/-7/g=t 4- TYPE OCC
CONST. GROUP
FRONT SEfBACKS
REAR
ZONING SIDE RW 0
0
SIDE/SIDE STREET RW 0
0
PROPOSED
N0.
UNITS 7.A
USE
D W EL.
..-t
N0. N0.
STORIES BEDROOMS
U)
LU
LLI DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
U-
0
Z
SFFt/ADD/REM
Garage/Carport
Patio/Deck
Pool/Spa
Re-Root
6
...1 Commercial
5
m
K.:2 T-zw- 44 L%-r.--
Valuation 6-t en) ADJ.AREA
QUANTITY DESCRIPTION FEE
c..)
ET
1.-
0 I litsi-M ii-to•Gcz^
w
-J
It? 1,44.13
1 1•4 4495
r.
2
0 13-13-12 a-61 IiAA 7-.4-i .sez
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1 R-RIO S,'IN K
0
z
<
x
0
w
7
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
M ECHANICAL
INSPECTION FEE .8-7
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
7 1-4-la
4-ozzi.So
14-1 -Sc:=
-15 •tYcz.
1 . e...l cli
TOTAL FEES 7 44•YA CP L4-.5 . .1 CI
COMMENTS
RECPT. N0. 1 ),c;44-PAID BY Ilaslot. VALIDATION
WHITE—Department ,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
CITY OF DIAMOND BAR INSPECTION RECORD
Z ��� r�l�����
1 . ' 'FLOOR JOIST
SET BACK -
FTGS/FORMS/STEEL . . . • • FHA REQMTS 1 .
ELECTRIC GROUND ; ---- . • UNDER FLOOR DUCT 1
GROUND PLUMBING ; '; , •
SLAB GRADE- - . „UNDER FLOOR CONDUIT
, FIREPLACE FOUNDATION
TEMP POWER . FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT,BOND BEAM
FRAMINGNENTILATION . : FINAL BOND BEAM
ROOF COVER , . PRE-GRADING
ROUGH HEATING - : BENCHING ,
ROUGH ELECTRIC , ROLGH GRADING •
ROUGH PLUMBING I FINISH GRADING
SHOWER/TUB TEST - : P ECTMC
XT. LATH/SIDING ' POOL FENCING
WALL INSULATION . • i POOL FINAL
CEILING INSULATION . ' OFF SITE IMPS.
, . DEDICATIONS ,
DRYWALL NAILING , FINAL ENG. ,
SEWER . , .
SEPTIC TANK . . LANDSCAPEIIRRIG.
SEEP PITILL. _ ON SITE IMPS,
-GAS AIR TES-T- IF NAL ZONING
e
FINAL CONST N(c. * : : FIRE DEPT. FINAL
.. ..,./.
HEALTH DEPT. FiNA
DEV FEES PAID
FINAL PLUMBING : : ENERGY
COMMENTS . , . i
SEPTIC
SEPTIC TANK SIZE
SEEP PIT1U SIZE
.....,...,,