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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Driver Diamond Bar, CA 92765 FIRMS
(904) 839.7020 Fax: (909) 86I.3117 Budding Inspection Hotline (904) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION t
JOBSIEADDRESS `'??442 `-'+old f"' deg • ve-
APN LOT TRACT
OWNER
ADDRESSCITY ZIP TEL
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APPLICANT .t7�V�z reV EL1X/R— 44t%_16
CONTRACTOR PutleWk kO(A-WA'f`-
ADDRE StAG£ p
CITY .. ZIP.__..._..__TEL _..Pf 6
ARCWENGMESIGNER
ADDRESS
CITY ZIP TEL
OWNER-MILORSOECLAPAnON
I hneby, affirm War penalty of pap" that 1 am =rest am can Cqm a State Leaned law for the MvWpj
indraod batiw by the deckmakis) I hue peSM nand to Our appeable name) iked= XMIA, Madden, and
Pmtaoia Code, Any MY or mudyMm mumbeas a permit m mmtrac, slim, NndMi dmIA, Or tep*. soft
SaveArre, Prhr bah Iastlalk%6, ad4a r,qulres int aPW1oaN far 11w permilta dopa slpn4tlffial4nwni foal ha a BM
h llnn8ba Oamaenl m Ma Pmvl,lonh N aA9 CamrAGlm'a Otab ucalwa Law ICAs Pim W Cammelwing wMA Secaan
ql ONklm 3 M Vw 0usltlmaantl Profaulowr Cale] Pnmat M1e m 8159 m ewmpi ham Ilcvmure and tlw bade fm
me
No Andual domd SPCAm]0315lyam7 appticwn lmapmnd sualecb th4apDlYamidadiol pertly
d not morn man ass lwntlretl ddlaytSOdAg
U1,as pwneral Me prardlya myemployetsWill wages an Mir We mmpensapon, will m U all Of or purpose
of Me work, and the structure Is not harmed Or aft" Mr sale (Seam 70N Madams, end PafM" Code The
L'anaackre' Slade License Law does not appy M an another Wpm" whop, mmugh employee, m pomunal agM bulldn
or Implaves the properly prev sed that Me Imprvremerlm am nal immded or uttered far We d however, Me building m
Imprevmllem is sok wiMln one yew of completed the Owner Builder will hove the burden d proving that It wad ml built
m IrMy dlmthepu otwW)
L) I, as owner of Me pmpefy, am todudvey cmlhStlng with blamed CVft"=m M Lm5(ru,i tha PIOIM (Won
7044 Resines am Paleswws Code The Cammcmre' Sole License taw, doer net appy Or but Owner of gopedy wnu
Or Improper themen art who, cmtracmtin the Vol" we a hremed Cm = Opposed tam Cpnaaww Suite
I law)
Ut am ¢tempt Adm Hicensuremlder Me Lbntr MVB Stats kcemn law W Ms""win mwo*
By my dgnalum below r atktowlNpe mat except tar my Wdmdhd raddwf[e In which) mast have resided for at oast we
year proem completion of m, mµvuvMnmta ovine, by MIS NMI I cannot kpdy sell a structure Mout I have built man
bulidm Its has non been constructed in AB eoMay by deenmd computers I mamm mthmmopym And ap ikabk
law Section 70a Of m, Business ao Prdesdas Coda is avaeakupen rerymt when mit eP haam 1, sueratud and
mofdbrmgwabsMe htlpYmw bPllreca pcv/calaw aims
MGN
LICENSED CGKR=WS McLARAnom
I others motor per" of WrAaythat l sm seamed under Pmwsms or flumen 9 Fammnowit we, Separn 7WO)
of OMalon 3 of are R,avoss and PMessons Cade. end my lasrse Is in Lill term and Bled
LICENSE GLAi4 US NO `i'�K3 Z.
o. CWfIRACTOP ...............
MI 'SCOW FISAMNIAnON
I HFAEBVAFRMM UNMER PENALFy OFPERJURY Ott OFTHE FOLLOWING Mo AdVIONS
—Irreversibility
ma.'daln a CmiF®ia m Conspnl to SeR Inwre for Wmk¢re Ch. `xamabm, pfdNkd by
Section 3700 of the Labor rade Its Me mfimmmae or sop wins as worth Mo pound o Nsad
...t.�.___. I leve and w0 maim Worker Canpenplim MSXara, as returned by Scotian 37OO of Me Ism Col, fop
thaty War wink krwhrcA Ae�pwmRkksuaa kat steam ktWMcelLrrrrimM ad
Pl Morro Wme s-k1�Fe w
rARWER
POLICY NLA`HH
(Cd1S SEE "NEEO NOT BE WIPEt® IFT8E PERAT ISFOR ONE HMO O(UM aIM CR LEM
Identify adhft edmm g,upwmk AaatlftpmmAshv¢tl IawmnplwaWNwypwwannnhwwmwmwmhath
aemrw atged 0War Incident rmmpwoodon laws of Ethernet Ara a l small avmre VeNne b she weapon
renes Sack,, 3709 dtvtswcpd9 ie asYf Mass. bop
I PLIC
WARM%t Fuum to deco, WakerEComeame trewmai� i and spew sound err mpiayer o caused
poals opo dd$ ffre, m k war two 9oumnd AaSo (3100004, In a to thou chat of She campen:daon
domino W mmnum far in Saturn 3M at the i hada, Worrast, and a ssai nloec
tFtiOOLGAGEINT
I Monday team code OWAR, of fdrpd y 00 Mas is a Cor4tm wn Looked leaned for ft uncommon of 9u wank for
width Mss pwmd is away dSn 3097 Or C)
LENDER'S wadi
L04MRSAODFOS
I ceey Hut i Aavr odds M and and, Months dome wmom Is Server i agree to arFlper area dl copy and
admwema mrd state laws re0pgm WWQ and hereby � regeremmwea of ea, cmmym
mem arm to above mMOW PnYAery for thpeocan pWeades
PEA6MTIEEpaiak>a 10. 4 e,3
9i PERbgTiEe.................................. GATE
APPLICATION DATE
ISSUE DATE ] IL.
TYPE CONST
/ PIC#
7
+ PERMLT'rPiz- t ` t -?-1 Z . L
GOC GROUP
ZONING SETBACKS
ONT ............ RW ❑
EAR ❑
FR
IDElSIDE STREET RW ❑
SIDE ❑
PROPOSED USE
N DWEL UNITS
p STORIES If BEDROOMS
DESCRIPTION
SO FT FACTOR PSF ADJ AREfWALUATION
SFFVA004REM
...............
Qmalialcamorl
W
Panolcock
W
Pool/Spa
2
Re Roof
Commumlal
m
Valuation
Ads All
QUANTITY
DESCRIPTION FEE
N
to
x
g
CONSTRUCTION
PLAN REVIEW
............. .
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
..........
SMTP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
..._
BSAF
..__.....
TOTAL FEES
COMMENTS
III
RECEIPT #PAID
BY VALIDATION
WHITE— Department CoPO YELLOW—F.S.Oop, PINK —Assessor Copy GOLDENROD— Fde Copy, GnE£N—Appik ants Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION DATE INSPECTOR " INSPECTION DATE INSPECTOR
'SETBACKtLETTER
iTRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG PLUMBING
T -BAR
UG ELECTRICAL
INTERCEPTER
UFER GROUND
140T MOPISHOWERPAN
'SEWER LATERAL
SEPTICICESSPOOL
MAIN WATER UNE;
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
ROOF DRAINS
! FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOLISPA
i SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAf INGIVENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C ( I
GAS TEST
:ROUGH PLUMBING
PRE GUNITE
INSULATION WALL
POOL PRE DECK BONGING
INSULATION CEILING
P -TRAP
' .............DRYWALL
FENCE I GATE/ ALARM
LATH (PRE}
FINAL POOL
LATH EXTERIOR
WAS
LATH INTERIOR
WALL FOOTING/STEEL
WALL STEEL IST( ) 29 } LIFT
GAS TEST
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL GRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO FRAMING PLANNINGAPPROVAL
FINAL BUILDING
,... ROUGH FIRE APPROVAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL'
FINAL PLANNING ...
FINAL ENGINEERING/ PW
FINAL PLUMBING
FINAL COMMUNITY SERVICES
TC of OCCUPANCY
CERT. of DCCUPANCY
FINAL HEALTH DEPT
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