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CITY OF DIAMOND BA f stn +rifjrff //1a�}Qgrlirilwil.,
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DEPARTMENT OF COMMUNITY & VELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 8(1-3117 Budding Inspection Hotline (909)&49-7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS u_
APN f LOT TRACT
OWNER VT R�QVI..l
ADDRESS I0Bo 4EL/ ✓LaOFS READ
CITY RI ZIP TEL
APPLZANT tdwM TEL
CONTRACTOR X&YAW
ADDRESS 1 42 At.&
CITY ZIP-,jJ10TEL
ARCH/ENG/DESIGNER ....
ADDRESS
CITY _..... ZIP TEL
UNIX BUpAER DECLARUM
I hereby earn moor penally of bal;ry that I am Idemn frau Be Connote's Stam Li am r law der Ne mamWE)
India a by the eheckms-1,27) I own Di d mit he the appiketim theradia VWCW Tpl 5, Bmlma eH
hvkaelem mm Any city or courdi, tlwf few" a pomtlt for m adrual845 kn0wsa. demolish, m ralelr, my
BaMalmi of to M lau ,, elm requires am appik t 1. fled PBmdtto and, aimed sbwt.1lhmtoasfw
to ntwaed plaauml m Bw ROYItlpNE M Na Cedratw's SasO Lkawa Lew (Wwptr 9} Cmmwrdrq weN SeWbn
nmofoMalen ioidorBu0�es ePro,70315 Dably ndhaldearmmlaelam[dtse atuiparmtlNebpanas
aa: epMgmeaempapn Arcydalaamd Seciton 7087 5 tryenYapdidaM fua permdaubKcm theap�tpdm B dYil 1eI01a
d mtmam 0m ih, amdred (�
U Lasawnd, of am PropatAmm,ert o9e9ewtN wapeaeNar Ewe wmpensmlon,wvn tloore Hero portions
of the ores, am No aGutlure Is No kmptled at offered far we f5mrmn 7044 BLWw end Pmuxle w QW, The
CamWW Sam Imides law does not mf man aware of Property who thmupf,mpWym' w Garsetw Maul. Wiled
a Improver aw pmWta provided Mat aw impNAme" are not Inrovleed ar&WW lot safe if manover the MOOR, of
Ulpmnwd is deb within we M of eirofto aw owner guilder W dere ow burden of po lag that dwas rot adds
or ldsaMad Me the wT of Bale)
UI a owner of Na we",, an MdU** aonpaevno w Ilcenma ralNBamm a ismmat to pmpd f58dWdi
AM" Berbess ma NNeseions fade The Contactor, Stam U6erwe Lew deep not appy In an Manor of Diploma wimp
0imprandatt pan and w he mmmem for to is 'm web alkardWCaratedtoryaroentArea dlRactaa'Stam
Level Law)
U I We nmmpr#an lKenmmsuM% Ne Cwmslates sub uc We as the bllonNP moor*
''..,. By my powmm below I uftMmge that meepl for my pomoft amilme, 0wbeh I must hake mWO ywsthim, we
yep Pea to mnpinm of then mimed by into ppmd l cannot leanly pea B mudum that ltmm bun a a an
1 ownsr#on&0a amMbeen omMCWatApmema by lkensm mstmcW Iw*mWd eat a ropy dineaWcOo
are Saamt noes at an Budnsn and Coda of Btailable upas mal Mst m ads app4ation a nubmiled or at
li the Meant Web site diptaim, legend as 4oklcabwtlaN
SIGN _
UCRiSW ODNMWMT sDECIAMEWp
Iherby aalmr umfor mach of potful, met I am clonal under Daemons of Chapmr 9 Munimarchab won Sudden 70DO
of Mason 3 of the Boom aid Flmessbns Cade Idol on INow is In ba to= ad seem
LOFRE CLASS' Lic No
_�/ft�'L�jC� tbNmacrDR �perx � R.r+�� _
W 'SCDMPENSATIONDECLANATNN
I Nffeflat AFFEiM UNDER PENALTY OF PERAME GNE DFTHE FOLLOWNG DEQAAADONS
I M. stn wB meidam a Car roam m CO.t be See Visual tt ftfoo s Qwgxm tbn, m PmddM by
Sodium 3700of rte Labor Coda for an pw0rmanm of the work for which DM mmlab wow
1 have end not mvTIWorlarh Campenionam Egteame a reWOed by Smbm 370D0 the Labor Code Or
the pefamod ee da,e x27 for Weca this panne is wound MY WOMmb Commmsabon bwurenm farrier are
PpilCl FiIIRIGprdN�� JJ �� /A^�m
CARNER
POLICY NUMBER-
frHeSE=NtAM WBE WMAETEDFNE PBMSFORWE "M DRLARSIMORORLOS}
leas WIR Me PeMWWdmd thereakbr widN Na pedes Diemen I"nAvn"aM palm 0 mynglaEs WOW
b mosso to are Wxion; Cmpweawe tent laws of CaibmD. And Base gm it l 8 bemou suamt O de Wako
CanpaLv�tllm.."Asovd SddM1570Od ad LaRm CapeItlMiOrntady w{091mepmieaa.
_tLfi� Y APRICPNE main, .......� j
MORNING and
Mai m as, up o we
CondM MNam mrempe 1 unlawful and Mon BUbaat m at Me r m mnrayi
mndlaes a p ped up m ane 708 at eWaantl dftsada ¢ 1, sea) In Bold Ares 0 the all p No cornpelmbm
danalm m RmwOm � e acdon 3708 a rho Iebpr mN aitBtNsl sea Ares.
CONSTRu0" Loom AM$"
INmdW idiom under penaltyd papa,ON! Nae b a Cmmudian twdng Na'Ny fa are pwesN dare were fa
Meat MBs twrma 0 wood Sem W97 ON C}
LENOER S NAME
LEHWASMORESS
Hama TO I feta ad Us NaplmaDm and MGM pre e,feta hdamatlm Is armlet I Marek To comply win all pay aM
aNi w W $We laws rusting 0 bul0 ria cmmuNce, and herby &&Me mpm:amanap of this mala to
elder upon are alone msnameG pmpetty to I ini ctbp pufners
C rrLS�aw-�etwa f�
PEPMtyp_E NAM fPJ1E aUj�__. 9I�r 11F
SCINATTEREOHERNATTEE DATE
Em
APPLICATION DATE _ d 4l& P/C#(.� —
ISSUE DATE T — II ..a ICY PERMITS /k/—
TYPE CONST OCC GROUP
ZONING SETBACKS
FRONT RW�..� ❑
REAR ❑
$IDEISIDE STREET ,.,.... .._ RW_ rl
SIDE ❑
PROPOSED USE +!„..-. — VyQ
# DWEL UNITS # STORIES # BEDROOMS j
DESCRIPTION SO FT FACTOR PSF ADJ AREANALUATION
SFFVADDtREM
GermgelCenwrt I.
pj
WLL
PatloMack ........ '...
Poolaspre 1
2
RnRaot
Cammalgmi '
I
Valuation sitACL Area
OUANTRY DESCRIPTION FEE
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1
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CONSTRUCTION iS lED 2 t 2i'
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
._
INSPECTION FEE _
ISSUANCE
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE L'{i Z • 4J
PRE -ALT FEE
BSAF
TOTAL FEE$ y I.l1.32�
COMMENTS
RECEIPT PAID BY VALIDATION ... '
1-0190z,"Osv
WHITE— Dopartmenl Cagy YELLOW—Finance Copy,PINK — Asammor Copy GOIJ 3—File Copy GREEN —AdMlaanth Cop/
CITY OF DIAMCI�' }43AR
INSPECTION RECORD
INSPECTIONe ••
SETBACK/LETTER
140ECTION DATE INSPECTOR
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG PLUMBING
T -BAR
UG ELECTRICAL
INTERCEPTER
UFER GROUND
HOT MOP/SHOWERPAN
SEWER LATERAL
SEPTIC/CESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOL/SPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMING/VENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C ( I
GAS TEST
ROUGH PLUMBING
PRE GUNITE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL
FENCE I GATE/ ALARM
LATH (PRE)
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 1-( ) 2N°( ) LIFT
SCRATCH COAT
WALL BOND BEAM
ELECI RIC METER RELEASE
WALL DRAIW SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO FRAMING PLANNING APPROVAL
FINAL BUILDING
ROUGH FIRE APPROVAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PW
TC of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT. of OCCUPANCY
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE
COMMENTS