HomeMy WebLinkAbout26438_ram CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21825 Copley Drive, Diamond Bar, CA 91765
(909) 839.7020 Fax (909) 861.3117 Building Inspection Hotline (909) 839.7027
" BUILDING PERMIT APPLICATION
JORSITE T%�
� .......
I
AODRESSC�
a
APN LOT 1 TR CT V
OWNER ' 6�4r
�.
ADDR S............... ....—
CRY ZIP
APPLICANT TEL
CONTRACT '..
ACITYDORE
. .. ..t......(�1j�y,1
ZIP�igF�
aR/F
��EE !
1
AESIGNE 3
DESIGNER L71i�4'1
ADDR
CRY IP TEL
OWNER-BUADER DECLARATION
i HEREBY NAIRM ORDER PEMLtt OF PERAIRY TMT,AA EXEIM FNON THE CCNTRACIOAS U
CENfiEtAW FORT$FO{,twtvORE 41NI9EC NOT 66uSe4E2su+D PROAES9@NS WOE. AiYOIT+OR
t7UMY WIOOHiIEgARE4APEM1N1T00}18TRU01 ALTE0. YPAOVE OEMODSN.OPR6PAR AMY 6TRUG
TURF PRIOR TORS E. ALSO REWIRES THE APPLMAN(' FOR MH FI MIT TO FRA A YOMEO
STATFIFENT THAT HE OR SHE a LICENSED PURSVANT TO ME PPAYISIWre OF THE Op1TTN.CTORS U
CERYENS PT WTHES SOFTHEBUSINESSWOPR,
MAN, OR HEOF! SHE s IMTi TTHEINPROOE
iEeaSX1s C W EI OR RLIi ME OR SHE re EXEMRi iH EREPROM PNO ME BASIS PoR ME ALIEAED EXENP
fAN AlW VXRATKw OFBECTIOe>Wi SeYAXYAPRHINTFOq APERTIH WBIECTBTHf MPEKAWT iO
AC 1NAF!F XWENJN DRS"TIG6-0II
V LAS OE1YOFOFTYRRIE
D LA601YNER O
TFORMLE(See'MM
THE AE a HORLOYEARWITH OM HME
AND OM EN FOR bA6 e,
WES W TNFORE AND THE STRUCTURE a FAT INTOENSE
U O ANTO OWNEp OF
PRDPFli1Y4mDDUlA9Cq YPRpvEST1EREDN NAIWHODOE96UCN NUIY[WN%LF4RXfR80.F6R
1leMMl(W NIB ORNEHOWH EMfIOYEE9 PIMIYAED 1Mi 61A`N YPflOYEMRl19ARE NDf WTENDEd OR
l%FpIEDFOR9KEIG MWH'ERTNEYA1MlDORINPFGYEMFNim60.D WITF01gN6vFMOf aOAft,E
1KM iNE OWNEflAUEDEfl YIILL RAVE THE BURJEII Of PROWND IIMT NE OR 9HF pW Mi BWLOOR
AIPRDYE FOR THE P V RP09E OF SAIEy
ULABOWNEAa rxE PFAREflrY ANBRPNE ry M:T
CIWR AN PRO &SCRE, TIES CONTRACTORSLI
TONSE.10RUCFTNRT
MIYTO OfAS6AAPROYEBLOMSWDE.iNEES EAMORS
THEREON ATA
CDISE LAW OCEB NOT APPLYTOANOWNEP OPAPAOPEflTV WM8UAp6pR YPART
TO
YMOGOMTMCTSFOR6U W PROJECiB WlTF1AOpifMGTORjejLK{NSEOPURIUANTIPTHE iUNFiUG
1GFm UDENaEuwi
p IAY GT{YPI UFA[R BEC R! PG MR MB/µ'dyZFJ
ME Q A
LICENSED CONTRACTORS DECLARATION
IHMM`f AifNYfMDEfl Pftulma RERAFY THAT IAM L VOISID UNRER PROM OF TER
i IOCNiEtRYB WiMBECFG]FFTpOq OFOMS'LW ]OF TtH BUSBa:68ANpR GEBOANSC�.AIA
LFYLKTiiREre Bi RAt AND CT ia
q�/�/�yyjj
UGENSE LIG NO Q—i��
DATE MORAOTOR
WORKERS COMPENSATION DECLARATION
i NEAE$T MF W N UfAER PEN:LLtt CF PERRIM ONE � TXE FYFLD WIND �QAM,XiNA
_ILMSEAIA WLLMAPITAM A CEATSiCATE OFCONSfN1TE18E1F INWflE FOR WORlERb
G9AWENSApH tS PFpWREp 9YSECTIW TW OFIXE LA60A CODE FOR INN PERRYhANIf.G
OFTXEXUOf FOP WHLH TMS PEANrt W 166UE6
__IHA4EAA YlEI. M.VMAPI NCtRKEP9 COANEHSATIW INSURWCE AY flEONRFD BYBEGINYI
WOF THEIABORCOOEFORiHEPEMANCEOF iNE WOR![FDRYPEWN149
OWED WWRNERS MLPEx IOWWRANCE OLLYNUMSE. ARE
CARRIER
�Y''L✓ ____
FOLLY NUMBER 1� ^
(11®9ECYW FEFD WTaEQM.Ri1F0i aF THE PEwArBaaCNENMPEO WI1NSRiWIW LESA
1 CERTIFY THAT OWED I
$1Vyy NDi FNPWYM'/ PE0.5fN W ANV YA.YNERepA3 iO6EfL'AIE SUYEGT TOiNE
WORNEA9 tONPFN6ATMJN Uw80f GLIPOPNIA,AAAOREETMTIFILKRJLD SEWN!
SUYFGi TO THE WORKERS CtlAPEN6M.ONWYI415 �6ECT6Y WOF
CWE 6NML MYERSgW LY WITFITHO6EP
y�
DATE APFtAANT Fi
WAFARMI FAWRE TO9 CLNE WDPXERb COMPENSATON LOVERK£19:lN.R4FUL ANO &1ALL SE
'... eUe.1EG(IN ENPIOYER iO CRMWAL PFPIALTIE8 AA9 CPh RNE9 JP i0Ot£MJIAIRIXl1MR18MA
'... M%LAfSRrW WD}41AWITCNLO TXECaBTOF fLNPEN9AKYf OAMAOESABPI}.'I'J,OEDFORw
I SECTKml aiap GFTiEttSOfl CpDE 6YTERE6i AWJATi0iP1EYSFEEB
CONSTRUCTION LENDING AGENCY
INEREBYAFFRW 191DER PQI,YTYOF P£MF41'iHM iHFAEi6AC9H5TlNCFKKit&AW6AiE1KY
FGRIHEPEOf THE WpRKFORRY1i0i iHtfi PEAYrt 49155UE0(6EC T1AT G4 G}
Lo�RSHAAE
LEFRBADORE64
I CERi4Y TNN iHWE REf➢itbSMP(IUibNA:O SLME RUTTXF MFOKNMKW"o"AOW
4AGREF TO COI.TWfiFiAll GSTY RNOCOWitt OPONANGESANk ELAWS pELATW6 TO@UAtEHp
GDNSTl4ICTAN AAA RMEOV AVTHOROE RFPRE6EMMIYEBOFT kTV 10 FNYERVPOHTHF
ABQWe MEN,OHAA ER HyIIN GN ER
PEiYRFEE i t
BNgiANPE OF PERMRTEE DATE
PRESS
FIRMLY
APPLICATION
PERMIT
DATE ` /
NUMBER '
ISSUE
TYPE
OOC
DATE
CONST
GROUP
ZONING SETBACKS
FRONT
FEW ❑
REAR
❑
SIDEISIDE STREET
RW ❑
SIDE
❑
PROPOSED USE
NO DWEL NO
NO
UNITS STORIES
BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAIVALUATION
SFRIADDIREM
N
OEnBUCelpon
lu
PAINOeeM
UU
U.
..... ._
(9
z
RaHwf
0
ConunerNel
'..
ED
Vd,IeiMn
ADJ AREA
OUANTITY
DESCRIPTION
FEE
cc
F
w
IS
'2
..................
._
Q...............
Z
CONSTRUCTION
PUN REVIEW U
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
�r.
ENERGY on
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
TOTAL FEES
COMMENTS
RECPT NO BY
VALIDATION
WHITE—rMmeRt Copy, YELLOW—FManm Copy PINK —Assessor Copy GOLDENROD—FIIB Copy —App eMs Copy
INSPECTION RECORD
law
SETBACK
FLOOR JOIST
FIGS/FORMS/STEEL
FHA REOMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
WATER SERVICE
FIREPLACE BOND BEAM
MID HT BOND BEAM
ROOF SHEATHING
8 FT BOND BEAM
FRAMINGfVENTILATION
FINAL BOND BEAM
ROOF COVER
PRE GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUBTEST
POOL ELECTRIC
EXT LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
- ------- - --- ------------
OFF SITE IMPS
DRYWALL NAILING
SEWER
- - - -----------
SEPTIC TANK
DEDICATIONS
FINAL ENG
LANDSCAPEARRIG
SEEP PITIL L
ON SITE IMPS
GAS AIR TEST
FINAL ZONING
FINAL CONST 7-11&4
Ito/
:FIRE DEPT FINAL 1
FINAL HEATING
HEALTH DEPT FINAL
FINAL ELECTRIC
FINAL PLUMBING
DEV FEES PAID
:ENERGY
W
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE