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CITY OF DIAMOND BAR
DEPARTMENT OF CO UNITY 8E DEVELOPMENT SERVICES
21810 Copley Dr9ve, Namond Bar, CA 92765 PRESS
(909) 839-7020 Fax. (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
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BUILDING PERMIT APPLICATION
................
JOB SITE ADDRESS I>fLVIC) S j 1 It /2Y\ (711th Pi
APN LOT ThACT_................
OWNER f, A R I
ADDRESS �3 e n
CITYDJ _ ZIP9 1-1 U TEL 1"_
APPLICANT AA �1'j TEL 'l �
CONTRACTOR /T�r/ d a\0`f?- `N OLiP " Y" I�I e-CIi�"�.Y C
ADDR SS 2R'%�GS'C %�DYI� S">✓ �_I_Q�"`�D
CITY n C) Q. ZIP 07 13 S TEI,� S 7
ARCH/ENGrDESIGNER
ADDRESS
CITY ZIP TEL
OWNEP WLM OB3APATM)N
I hereby amtm Pool meal Of PO4M ml I an sweet Iron me Consumrs Ease Losses Law to ih010i KS)
I"MN below by aw Checlonaat4) I have Placed all to the emleabm deme) ractlar IWIA, RU Wn and
Re ares Cooke Any all a tasty C1Be remlev a alms b mnsbucl, aft, hrWave, demises, or vain#, my
Wutt", PW Is to interim, A"xmaes Cw appeicand ar Cw permit to ft s saws staHmmi Out Ma aw
N ikesaw Pegwdb Cw POwIaP ofCeC RNWwft Sam Ikase law (caper 9) CMw mini wO SenWt
70M of DtWam 3 of the W*A and Pra7esame Carol lgets he so was a" sea from li[8nsms am the bald for
W aid wmwW Any vWetlmof Seam 70315 by was asseimirt to, a permit M*t NavolliM a"mofy
ofnMn aim No fvnsll(MM 185011
{JI stevmerlmePrawttA amt erNlovaeswahwmesasReal mmpensatbn,wl9 oot.JaaIXijp9raam
of the work, lW the Sterols Is rot mtmWW a offerai for ease Matter, 7044, Business silo fttutm Case The
Wntrmba8' Sea Lam taw me not apply mm mrs,or Ptsent aro Crime BmplOyaeS' a p0remet val bases
or Imemol tin MR", ladled Dart the ansmem els to rot intended l offered Ru 8318 a mossoof to kMr4 a
mlmisl Is aatl write an, yet of cmomba,, the Owns Boom Wn hate, as bmaPA Of PmymO roll A was rot NA
a improves YIX the puryse or stye }
U L as owner at an purports: am arrommery mnhectm0 wit females Canrecmrs to mnamat the pm)aat Isamst
7094 BUS.mS mid Cam The Camacmis' Sam urea taw me, Iwt appy to an atmst of prop... who
x mmrammwewymd wtmmnb'mtafa the Plc7acnwm eikeread C WreuaMbaa CmbaCWB Ste
Ltl to.I
U i ml eonvnPtwere kpl marAwma ConamalState Uelwe Now IN Else A oMrp mamra9)
Byfnysigm:ae paipxi mat 0aceptAy my pemaapi tamdlmemwtwdti mtattax re:Ad�tIX a[Ieantlw
ywor pdato alar lmpepa{marsws.ad Mamparzall mnrulapaby mEaswLttre marl Fax buikasan
w9rlw aAtdwaatwe nNtwltCIXwmmiOpin mmbretY btiaenfetl m+NtesSa I uMeremnd Mata mpyni}map{Ak4#b
law $anlPf 7O44Nfhe &ISIBs4 erd P5a1a54iat14 Cada bat3ltaG6 Wm regPea[wt6ri tlH9 epptaadon ISepb'ACIAI IX of
mesiNkairq Web Oita aDRrwwsY foOmfo Ca PWtgbWdms
DATE SIGN
LICENWCDNMADTDP'6 DECLARATION
I Iwre6YMCvm urYfor penal(n plJmythni am Ilssed miler pseaanyor paphr9 (mmmonn^p arta Salm 700Pt
n D+bSm3nme Duanen and PmtantiamCoes mW my km4ewm NyE�m mm erten
UCENSE OJ LD LC NOl � .�3• 1-P g�
CONTRACTOR f� fl A-)) A AA ---.P
WONIM'S COW OSATtDN DECINNTtON
I HEREBY PFR IA UNDER PMlIY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
1 nave 01 web memnfn a CSNOcan of Consent Is Sett Insure for Woolb Controls wn ore Created ay
Giant 9700 0 to Ober Ones, for the pe#amance of the work for welch iris permit is issued
I have and will maintain Worker Competition Instant ore n rwred by Section 3700 of not labor Code for
the performance of the work for wnleh this poria Is sed My Worker§ Compmxllon Isurence Cooler mtl
Policy rr�p01 10 �q
CARRIEn,LLia N P Gn (} f-12 e y v e c+
POUCYNUMBER ���-'eI"
OHBSECTION NEED NOT 9ECOVIREFT0iFT4 PERMIT l FORONE 11hai DOLLARS,aiDCT OR tEM
lampeat InceperWmuxaorthewak mrwLmof mmabsad riseato d I shimycen iumymmNdm®m
become s;b#Ct th W WOraY6 CorrpawaCtn. Lmof tWkWra.. And lose Dat d i shaid fanvre ro boo Walmfe
CvnoauaSP ol%ctm3700orme Lubin fandi mn!vath ravrC..wine prahhm
OAT] --$. m"JCANT A�(i�
WAR INO kine aryls Worker§ Compensa mange n ureswhe, and shah sublet an tries st m limbal
penaim am me am up to are hulked ft and dA" (610000% in aiidlor or me mit or Ere compenaa0m
dmngas as provided far in a bon 37% of ON nW more orealt aw ofkerml Am
CON6TPUCT= LB10RYG AGN"
I"by Miner wWff Will n omNay mM Cie ba mossecom Landa9 ARM for W permof it work for
wpkthika pmmttn la6Uat {Sl 3067 OR C)
LMERSAAW
(EIDER BAOIXbESS
I mttlty thetlmse�iNs Mor rose hw[theWma mmamtlagrepmmrepty MarM"Yana
mmkti mdimncm oro aMars rMMmg to mofomg mmaunkw vm harm,m0md. wrommocalvas minty m
anmr Pon ba Mum milled M" Wmme
PEWATFEE LANAE{t9yNij(i
SGNANIE OF PERM I€ DATE
APPLICATION DATE ri g/SI�/� P/CC#
ISSUE DATE PERMIT#
TYPE CONST OCC GROUP
ZONING SETBACKS
FRONT RW
REAR
REAR
SIDE/SIDE STREET RW
SIDE
[a -
El
❑ —
❑
PROPOSED USE
# DWEL UNITS # STORIES �' # BEDROOMS
_
DESCRIPTION SO ET FACTOR PSF ADJ AREAIYALUATION `
SFR/ADO/REM
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Gla0elCerpal
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Pstipngck
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PODUSPN
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ZRa,
Roof
cmromormor
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Ad] Area
QUANTITY DESCRIPTION
FEE
4563�,e21101-1
tD C
f
I
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
ia�ie2
MECHANICAL
INSPECTON FEE
ISSUANCE
SMTP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
i
BSAF
I
TOTAL FEES
COMMENTS
"'-+4
E.+ p
RECEIPTB 320 a2'+ PAJDBY S6S VALJDATION
dL
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WHITE — Oopartrnarr Copy YELLOW — Flml Copy, PINK— A4.sem er Copy GOLDENROD — Flie (bay, GREEN— APPUC VY 9 Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SETBACK! LETTER
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
POOUSPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMING/VENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C O
GAS TEST
ROUGH PLUMBING
PRE GUNITE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL
FENCE /GATUALARM
LATH (PRE)
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 7"( ) 2H°( I LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAW SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO FRAMING PLANMNGAPPROVAL
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
