HomeMy WebLinkAbout18-335835
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Far (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www cayofdlamondbarcom bulldaog@adumondbamagov
JOB SITE ADDRESS field
YDr•
APN LOT TRACT
OWNERy
ADDRESS
CITY ZIP TEL
APPLICANT TEL
CONTRACTOR C.
ADDRE S
CITY ZIP O EL
ARCH/ENG/
DESIGNER
ADDRESS
CITU ZIP TEL
OWNa m aOECI TWH
I hereby aMrm under poetry al penury, Nat I em ona l had Ne fdbecora Stete Umme tmv for the reavNel
had and bend by Ne rNerdanartlal I hen paced next m Ne amlabae Item*) ISeaUm 10311 lame. and
Pmehvvw Cada. Art, of, or many Net noshes a pemd To construct, name. mean, darndldN, a darer, sN
ebuabn, plo o Ib hamente ebo the eppfran Aad the ymmno Rb a stood ebmusca Nd da a ala
On
euenl othel.a.ssland NeWmetodelobLomelw RlmpbaCOommerco0Nea9sdan
10000 OMdm3othe Gahmendnn7U3lmCob]orNdhfor NerendohofloamytM Nebeartem
7DWaff Ohm
Needdese AAyvbalbnalSaclbn7ml SbymyarllaNhmammXsoryecb lhearpXwhhmacMlmaM
an Me
o M mm men flue Aunddnd dalere (f5001
ULaownnaltha prgmrly punyensloyemwdhwapaatheeab,curn dmllm MDda Umoo L)MM
M Ne was and Ne abucNO b at Mendnd or ohdnd for rub (Sedan 7D44 Gu lneb and Proambna Cade The
Condaclan' Soo Laeme tmv they rot adopt, to an owner of woody was Nmuph em romans' or mrmmd effort budaa
a Impronlf the promrN, proAdnd Nd Ne Imm"enb ab rot imentet hr ohrO lor ale X hhweser, Ne WIIXIm or
dmpmnmonl Ia wid Wlthdn Ona mrof mmpleUon Ne Amar -Ra herwl tare the bunlen at pmdnp Nal it" not Wilt
or Improved lor Ne purpose ata* )
U I of awns of Ne properly m exclusively NnbeMp way bcmmtl Commodore To mnebu t Ne pmleol (Smllon
7049 Bal and findamom Coda The Commands' Sole license tmv does rot appy to an owner of propend who
buldsorimpmvestheban and who contracts forte pmleda WM abromeed Conmacorpu9mnl home Conmacore' Sate
U ea9 taw)
U I m suempt from Handsome under Ne Cantraar'e Sita Licnda law far Am topusing rmmn(e)
Dan Slln
By my asdnome babw I eceeowkd9e UNI second for my demanded meammNe In whith I mud tare rased for at Teed one
Year heard minimal M the aprowemerhb arum l by this mmn,I aunty lapaB/ and a strum n, dot 1 Nn Cray M an
owner Wdaer X N half M been matrawl In Ite endrely by assumed on,low m I undameand that a al of tam
arpfiaae New Gotham TOM of do Bimmev end Pfisama Cade is readable van dequarl when Na Mohamed b
sobmmnd or at Ne bNahng Wend Are Nmrw'wwr alotu as lerfp Arms
LICENSED) CONTRACTORS OECLARAnON
I heroby alfmm under, middle of pedlury that I am Fedmtl under poewfam M Charter 9 (monend#M war Srremn MIND
f 3 of tam Bueiabd R
anota>nodo Coand mE
Code y mnx m n M1A oda and eXxt
1off Dwas
O _TLj(V2
J
MTEEXP CONTRACTORN
WORW.SCOMPFNSAnm CIAMnaI
IHMYMMMUNMRPFNAWOFHFAIIW NEOFTNEFWEOWNGDELTAMTWn
I lav, and will headed a CAnlflale of Conxm to SelHdnm M Wilier a Compensation e9 prodded b/
Section 3700u1 the Labor Code for the pedtudmaa pt Mo work orwhlch Nr roma Is Issued
I hen end wn mbnWn Wa r'a Commnadon Imumnce a required by Seaton 370041 fle dawn Cote, for
NB pnomemco of NB Wrkbr MIO Na pamal a laced My WOMre Compenatan Insurance Carder and
PoIIcy Nufbyprp-_kM �L,MSM �
CARRIER VL�L�L%� W „
POUCYNUMBERit —
EEEL NEED NOT GE mMRETEDFTHE RJUlTE FOR ONE HUNDRED DC1AA5 1 OR
I matron In the arameme of the work Carwhsh thismrmAr lamed, I she! rahemOtryndvmom Mail' manner a bo
berme wbjw a the WOMere DempsmWd Wn of CaINmW Mtl almost pet X I shard became abject to db Worker,
Commission pr aibpmof Seton 3700 of the Labor Dade I ala fuNraM mmpywlN Ore proalso .
DATE APPLICANT
WARNING Fields b aNme Workers Compensation meeaa a unfawfd ad shad! ailed an employer to mlmlaH
peaoee ad nMl Imre up to tea hundred thousand do0ars ($tun 00) lin sudden to Ne mal of the canpenamn
deepen o povand for In swWn 37DB oNe MuMe lftrvA and atmmey'f tea
CINSMULTION 113W M AGENCY
I hereby dam undo pn*yht m" dot Nem r a Cmaplan tanaar Almcy toil Arm mdhyrranm M dew work for
which tem mmA m Bawd fSea 3097 Dw C)
tFNDEA5 NNIE
LENDFRSADDRESS
I mNy Na1I ham maul ern arpaatlpn and dao thd Ne adore edonralbn is mrme0.1 aprm to Campy wed al ay end
muny odNnema and Lora Area reading to buUAbq mrdtlmdM and hereby soroAte mepmnbOna of Nr county to
enterurn Nelehnmen paderty Inacts-mrasee
I
.
PFA NAM
NA EOF ERM DATE
APPLICATION DATE
ISSUE DATE
TYPE CONST
PERMIT#
P/C#
fVR %S' 326S8Z
OCC GROUP
Scope of Work IL Arr,
#DWEL UNITS
(n
#STORIES
- wn
#BEDROOMS
DESCRIPTION SO FT
FACTOR PSF
ADJ AREAIVALUATION
SFR/ADD/REM
OarapwcC n
w
Pelio/Dmk
u_
Pool
Z
Ra Floof
O�
Do
Do
Va#euatlon
Add Area
QUANTITY
DESCRIPTION FEE
Ca
CONSTRUCTION
PLAN REVIEW
a 5 g
ELECTRIC
PLUMBING
MECHANICAL
-IS 4a
INSPECTION FEE
ISSUANCE
SMIP
$ O
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
S• Ov
BASF
O7
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
1
a S A S
P/C PAID BY
RECEIPT PAID BY
VALIDATION
VALIDATION
WHITE— Department Copy YELLOW — Finance Copy, PINK—Asmalfar Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION DATE
INSPECTOR
INSPECTION DATE
INSPECTOR
SETBACK/ LETTER
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH BEAR
SLAB
COMMERCIAL HOOD
UG PLUMBING
T -BAR
UG ELECTRICAL
INTERCEPTER
LIFER GROUND
HOT MOPISHOWERPAN
SEWER LATERAL
SEPTIC/CESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOFSHEATHING
ROOF ORMS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOL/SPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMINGIVENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W C
GAS TEST
ROUGH PLUMBING
PRE GUMTE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL
FENCE tGATE/ ALARM
LATH (PRE)
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTINOTEEL
GAS TEST
WALL STEEL Ir( 2r°( ) UFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RD FRAMMPIJWMNGAPMAL
FINAL BUILDING
ROUGH FIRE APPROVAL
FINAL MECHANICAL.
FINAL FIRE DEPARTMENT
FINAL ELECTRHAI
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERINOf PW
T C of OCCUPANCY
—
FINAL COMMUNITY SERVICES
CERT. of OCCUPANCY
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
COMMENTS