HomeMy WebLinkAbout14-2348ULVIOND ILu:
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley DEive, Diamond Bar, CA 91765
(909) 839.7020 Fax* (909) 861.3117 Building Inspection Hotline (909) 839.7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS
APN LOT TRACT
OWNER
ADM S
CITY r ZIP M TEL
APPLICANT TEL 32"5--V-3 -'i5a2__
CONTRACT R _ .......... _
ADE dR71P
V,.
P 01
ARCRIENGIDESIGNER
ADDRESS
CITY ZIP TEL
DWMR OWLM DECLARATION
I hemby Offln omen penalty, M perlur Nal I em wane tam Ma Cmbncmr'e May, dogma Law lar No reatiANE
bdkaNA mbw by ire dsona,1051, I leve placed rffit 10 me $Robbie ROM (settme =A mmNMa and
Pnmssmns Code Any city a cmmty tbal squires a penNi w arvahwk alley imyws, Olovetce, or malt, eNy,
pNamlleTR e, alae MgdmefM epTdlcmi
her ow WN+d WNmaefped NaLmeni maiMabaO
m acmabgtaa9uaMm WgevtgpnaotiMCanbaclu'e$mmtkq�teW tGeaplar8j Wb SacUpn
8t NYmIPM13d ma DUdlrea 01d Pmi86amM GdeJ ama! ie IX ETd D Baemplimm Itenafle mq m0 �a iIX
NB Bompldn MYamlaamot Secaon 7IXii 5OYBnY epAMaMtara(NmdaDlecmmeapgkartNa WYPeidOY
d rot mpaNNSDveAundretl tldiw9 }
U Lacwlalthe pvoporp amyaropipyeawa5wegeae9 IfteoveawayroaffloovaNdOUaa dwUpwoone
of me wam, and Ore abumm N not marded or oaoMd w me ISecVon FMC Mains, ed polesJmIl Codo no
ConbazbB SMmtKmMn Low dcei not BAY m an miter d OroPorty wDo, tlaaph nmplayoa' a pp�M nttart,mDrD
e Improves me Poorly, OmMod Nm Del oro not invaded a dfOmd Wsate Il mwm+e We k" N,
MSpmvemeat In ON eiNa on Year of op MvIxr Ne Omer Ruddar w10 have me bbMaS of pang met D vat OF bum
e Impomq lar OroPOTaadM sale 1
Lj I as error M me property, as ftolasYrep caebar 0siva Dareetl CanmeabmtotowiMma Om pro)ad IStcNn
Al" Duamas and Cade Me C ,.Foew Slam UUMN, Law con m1 apply IN m mane til pop" no
amgaora6 VWM wd en, caft" for the prcloa'IX vdm a WAVW DalbBCta ps&uaMM McGodacb9 $We
LeanN Lan)
U an memot Dan ken mo wdg am Conbecmfa Sam Lkwew and N ae Idmwhpmrsorr(sp
DY my dOaAee 40bw I ACNIewiC�NM, a=aap for rnl peOelW MOMMce MMadrl mal bare felroBd ON d May ae
year one bmmp lb, of Me lmplaenpl6 covered by My pandi yammt m9Ny, 01 a Arucbae matt tela NOR NO w
miter-bNarKO Na nA bw coewo fid m of al " by 1welef wealays RnOeaUm weotpydtle awkcayea
mw 5edbn 7044 ofthe DusbuYee mtl Rohan, code m Ram" "ON to est wave ddt appOmtlm Isamoaded a ay
me NdoNb "S*htlpMwwmDiMapOmttCatdw Niml
SON
uCEMgD CIXtl/GCIM DECWiAWN
I afirre unci ja ato of Wgwy del l as lkerad Orel prawaam of Depict a taeeueaapwMl Subm 10001
d IXvisll ] dihe augevaa tad Rtltsmms CoOe mtl my bcemdbat �hd{I�a'lC^a�wlaetTia[!�
L%EL6f QAe8 !�
—_ f.ON17NLLON 1 I d- 5plar
WMU S COMPENSATION DECtNUTLON
I HEPEEN AFIDIM UNDER PE UTY OF PERAIRV ONE OF THE FOLLCWfNCi DRIAR IONS
ad'Aitl makddn a rmtlOpm d CdlSellt b 5aa FSmB mf WIXhar 9 QanpenSalim a pnmbtl ly
Salon 3%m of the Labs Cal bt Mperfemenrx of mawark inrMNch mispemtR Bimwd
thoahrmoan,ofMe vi, la, aMa, oft aNUMlla.asy tgonEnade, lemeoce cin oke
the DemmeKad mB vMk IIX wla.N ddSp�d M (Sued MYtYIXAat fAeryforealm lmaance Grua ad
fFAlmbmeraT y, (j+ x„1
CAtw$R T►A�l�''GQ {�
-11
POLICY MAOM '121A� — _ _- ' -
OTCSSEDRUN ISO NOT BE COMnETm ffTif fEMR E:FOR ONE MJNDOM ODUARS E100I OR LESS}.
I dwldYNaloNe ONalnmueMNBwavlaMwMd)La pemNokdietl lahm rot Ey mYPelam @: anYmmlvf 80 alb
iwmrc mibjeU m NaMakes Gm�L'
amio And I mal bacane sulawltoNeanikes
WPL iMse pmytipa
APPLIG!Fallen b SMrcO M4aaraga is whmful ed "I subject an em plarl IF rnmlaw
peMONs ed dei May up b an0 NI&O Ma mad doll= (SIDDD M M addlbee M me cast dare connowwan
dmdgo5aspardGd Mrin axum 37tH dGd robe coda IMarnd,ed etMtney=fees
CONSTWJCTION LENDING AGENCY
I at&m once, pmNo d peduM w "We, Is a Canwatnl LeadroepwSq Mr me d Le w,N to
wnv0 ahs pemadkadtl {Sa 3D97 DO C}
I S NAME
LENDER S ADDRESS.
I mile* reap Ode eppwaidn am dem and LMabPla m(mnatlon MNanact ogBemweelYwMm blYaNd
armneces antl amtIMn yMaonq m LVNmgaaeNAmm entl OfOOY mSOavke Iepeaettaaye=d alt muntyb
=der=Yt, c...) � r
E t ...- t.. ....... DA
AE OFP EE DATE
APPLICATION DAT P','���'�,,
ISSUE DATE
TYPE CONST
.
! P k JJi`
PEflMITg ae
OCC GROUP
ZONING SETBACKS
FRONT
REAR
SLD E/ SIDE STREET
SIDE
RW ❑
0
RW ❑
❑
PROPOSED USE
/
A OWEL UNITS
JrL ij sk
I
N STORIES A BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF ADJ AREANALUATION
SFWADD/EM
vy
w
PmbfLleck
LL
PooVSpa
7
2
Re -Roof
9
Caroms dei
m
Valu3lKxt
Adl Area
OL3APIDTY
DESCRIPTION FEE
'K
rr
x
CONSTRUCTION
PLAN REVIEW
ELECTRIC
All
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMTP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
BSAF
f .�
TOTAL FEES
COMMENTS
RECEIPT a
PAID ByVAUDATNJN
WHITE—Depoetment Capy YELLOW—FM vuca Copy,PINK—Aese=Bar Copy GOLDENAM—Ede COW, GREEN— ApOICNAN Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION DATE INSPECTOR-
INSPECTION DATE
INSPECTO-R ,
'i SETBAW LETTERTRACT
AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
'UG PLUMBING
T -BAR
UG ELECTRICAL ''...
INTERCEPTER
UFER GROUND
HOT MOPtSHOWERPAN
SEWER LATERAL
SEPTICtCESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
',. ROOF DRAINS
FLOOR SHEATHING —__—',
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOUSPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMING/VENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C ()
GAS TEST
ROUGH PLUMBING
PRE GUNITE
.......................................
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL
FENCE / GATEt ALARM
LATH (PRE)
FINAL POOL
LATH E CFERIOR
WALLS
LATH INTERIOR
WALL FOGTINGtSTEEL
GAS TEST
WALL STEEL f 9( ) 2X0( ) LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO FRAMINGPLANNNGAPPROVAL
FINAL BUILDING
ROUGH FIREAPPROVAL
FINAL MECHANICAL
................
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PW
ITC of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT of OCCUPANCY
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
COMMENTS
f -v
.acGr G CERTIFICATE 4F LIABILITY INSURANCE °"'�"M "Yrn
�+'y 11/14 (2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the policy(his) must be endorsed N SUBROGATION IS WAIVED, subject to
the term8'SOtheondYtiDRS of tha_odlcy certain policies may require an endorsement A statement on this certificate does not cooter rights to the
certlNcato holder in Ile° of such andorae�aVME
Robert Harris Insurance Agene C.�? ,,, ,n 1711)619-#450 (f Nm It 14)
btc. #0216736 'ae marvel1 i_eharria.com
3150'#-etoi—et:_A_Stlite 200
OREEIRVIRS)AFFORmX6coVERAGE NAxa
Costa Mesa CA 92626 WWWRABartford
INEREEO INsuReSsAartford Property & Casualty 4690
Via Solar Corp INSURER
INSURER D
19175 Fernando Road ma ER
'Sun Valley CA 91352 INSURER F
COVERAGES CERTIFICATE NUMBER I3-14 Master Liabilitv REVIRNTN NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INTR
OF INSURANCE
ADDLJSUSRTYPE
0 NUMB
U FF
YEXP
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ❑ OCCUR
2SUAP2396
1/1/2013
11117014
EACHOCCURRENCE S 10000001
S 100000'
,INFO EXP M mEpenon S � 5000
I PERSONAL& ADV INJURY S 1000M00
GENERAL AGGREGATE S 2000000'
GENLAGGREGATELmITAPPLIESPER
Fj POLICY PROSIprft LOC
PRODUCTS COMPIOPAGG S 2004 p0M
S '...
A
AUTOMOBILE LIABILITY
ANY AUTO
pS � x AUTOSSCHED
X MAALL UTOS
AUI`
78BE1�P2396
II/l/2013
111/2014
COMBINED S EUMIT 1000000
}
Y¢aREiY(Pe aWaeN}
B(peRTYCAMAGE
S^— �
S
UMBRELU I"OCCUR
EXCESSUAB
CIA MS'MADE
EACH OCCURRENCE a
AGGREGATE $
D D RETENTI
S
VpORRERS COUPSNSATION
Alai EMPLOYERS'LIA ILI
ANY PROPRIETORIPARTNERIEJ(ECUftVE�
OFFICEWMEMSER EXCIUla
M Nm
II d-1" eeImr
OMRIPTA OF OPERATXINa ONp.
NIA
3736
7/172013/17/2014standmPy
R VNC STATU- O R
ELEACH ACCIDENT S 11000,000
EA EMPLOYEE S 1,000,000
EL OIBEASE POLICY LIMIT 3 1,000,000
IRTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaach ACORD GOT. Adt"M M RNnaka SchNmM, amara apace la meWMQ
CANCELLATION PROVISIONI 30 Day Notice/ Except 10 -Day Notice for Non -Payment of Preoium
freddy6viasolarcorp. cam SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
*Evidence Of Insurance ACCORDANCE WITH THE POLICY PROVISIONS
AUOWNZED REPRESENTATIVE --%-
M
ACORD 25 (2010105) 141950-2010 ACORD CORPORATION All rights reserve,
INS025imim"m Th. Af r1Rn nem. onA ia.rrn ore rnnivfa.A muALa e f At non