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CITY OF DIAMOND BAR
4WDEPAR MENT OF COMMUNITY& DEVELOPMENT RVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax• (9(k9) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMITAPPLICATION www.cityofdiamondbarcom buddinga@idiamoodbarca.gov
JOB S(TE ADDRESS 410A H 0 w,?II t D r' S.
APN LOT TRACT
OWNER_T�R h
ADDRESS T..Q')j H .4Yr!'l.t �?r
CITY ZIP TEL Z. �,}�
APPLICANT r TEL i _ ;�
CONTRACTOR r
ADORE S
CITY 21P L O'
ARG ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNEi 4tgLom DECLAImnoN
I hereby aMrm upon, paeby of "jury Net I em eampa tan Ne Conanway's Stye utane Lew for OF manna)
Indkead below ey Ma chaNurerplE, I have R9md real or tine applicable larval Pearson 70311, &pimp am
arae ml p Code Me l tlmy w"y s ui repairs a pmndi m pwwl, e#m,a slow, damNeN.t boor"
is Ui ,pawmneIpm�M mj ontlwappNmhdtwsle pwmlt m fileasgmdeaaromaswihaores
biOof OMurn3 of
f the bto
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she Moment
lt on
7909 a OMelan 5 Miss Bea#sae ami halenbea Cade] a L'ai M m aha la exempt ha-� ilunsum are Ma bad9la
are ateual esmpUon Ary vwacn Of SKUDn 70315 by any BRALKA tr0 Mat 31,01 a the app`onaa M e Do Minority
of ml mon man are hundred dukar, Iasi
I,) i, awo ma a Me properly, a my am uppo s aft wapp a lhwi cmnpeimsm. Bela m W an of no Li paimn
W the wait we the srucnim Is Bak Married By onewa for ale ISuenm ID" Rusraa 9rx1 Paawtoe ibde 1Me
oxyma has' Sao Llmme Law ores naep a, meso mw of property won, aeagh am mew By plemai go M, chat
a hrf(Xoss are pmPewl pradtletl Md sa krArd+MirmrnM em mdlmemtaaaolfemd to 98te ntgwevet Nah9"a
ImpmmUrem $area Wmpn am yar a rCmpadan,Me Ower $Wier Mp reins$ bm�Uai $$Mair that n wn ret sat
a I mplmwd to Me Repose of ale )
701, pown$oe Mepmpary, am 8 The
ormcurs'SgsIM limned ameractaaplmnW, ca er pmjnt rsy who
7044 9uanns enn ver, ne Cede 7n CParpur ro Sate LtaMa Lew nn not apply to rt aver or property who
or improves MdmoU, bad who mmwde t r ton prpJeea *Mn a Ila nptl Conlrecior psmam M she Cdem4fom' Saa
uprla Law)
U I Mm mamptit= Iirn upas the Gom"o"rra Sate Daimler to far the fabrainp
mu Sign
9y AV$Daae t am l MctNMetltto d4 e%agtm my oemai malva Inwooft lfrom ""Monet to at aptcaw
ym path tosm#eftnof the paemtl by this pemeGarea apaly en a strudus Mail Mow boor par an I.
MATIN plateau d n hon not been caWU W M he Onrety by Renard mnebaa I UWMtU l son a miry d ane
applicable law, Sechmi 70" of Me B -Ai wt Profession; Code Is MOW Upon rt9uea when ME; apdkuyva a
9ubmGMdw alma td6aymg Web sae ht4YwWw CB.DJv/reaW mel
(ICBM CONTRACMn DECLARATION
I hereby aflnr under pansryd Injury that I em 6wisd weer provision of Chepts 9 gamnari *let Sedlon 70)
at Drvalon 9 of the Dude we Pompon Cade, and(myy pM ams
r}, /e in full tomo M
Liam UC ND d _Q �f 4
M DATE E� CONTRACTOR
WMUR'SCOIAPENSATtOU 7mm
I HUM AFFIRM UNDER PENALTY OF PERNfly OME OF THE FOLLOWING CECLAAATCR S
I tem WIII na m„a n o CPmOalae M co al aSan-maws W sank$ a Compan80a, be WoAwd by
Ins :9700 d Ma LOW Coot. forst mdormenm a Our woe tawhkM Ma pwm t a aemtl
odil malntmn ykrkera CmnpMwft Maumee as remind by Sec W 3100 of me tofu$Coda, AN
Ula an of aware lavmth 4dH mom(tlaaamtl ley Wakae @mpe'maon aNnncM Ceme'am
CARRER or 3
POLICY NUMBER
MfSMCTIONMEDWrBECOMKM FII¢PFAktiaf#f ONE HUNDRED WLLAG 5100 OR LESS)
ImMysal t Me mdam-raerPSWwescfa wlxa Mapwnttaiasad ! NSlrotempaW $,#pane tmry UlamaramM
"erne aaaamDa Whivde tnmatattam-anaerp ala dLaW7bem+w aNe`dmmaWthks'a
[gnps¢eson praisarlaaSecren370Ddsw LNaCada ISIaOIadImOlGpahMrwimDdae praAWma
DATE APPUDW
WAR)MG Psum to mourn Worker s CatpareeWn m"mge is useyho Mal shall subject an employer to Seminal
mretat any CSO area up to aIe humreatl Uawt tlwl9m ($10) COOT m adotlm to the ms at Me cmnpeUwatn,
damepaes proven iiia $whin 970$ d Ne abet i9dP, Imeres, enort4anaye'eee
OOFrJT WTMN LENMNO ASPECT
I hareby dlim mater penalty of perjury Ms there Is a txlnameban Lending Agency W sa pedcrmanra of the wok iw
Me parent a $sed ado 9097 Civ C I
LENDER S NAME ..... ....
LEMERS ADDRESS
I on" Mai l Use moo dear a M Met treasurer mferourame steered l Marini mmpiywlM ON any mad
pe 8m1 l&nretatiig m bupdhg WMUUMMf end hasty ewipdm alM MON iso
Baer bcve mamlmetl pmpstytr mprnmpe
PERMITTEE NAM �R pal
SIGNANRE OpPeaffmE OvIr
APPLICATION DATE (
ISSUEDATE -7/11 119 PERMIT#
TYPE CONST
,_ PIC#
f' 1.7 .- QCF .11:
COO GROUP '..
SooPe of Work o a,
rrtn
D0- '711
#DWEL UNITS #STORIES
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C04(
#BEDROOMS.....
DESCRIPTION SQ FT FACTOR PSF
ADJ AREANALUATION
srwAnoraEM
l9wagarGatEham
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PatloiDaclt
u.
i4MOYSPe
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Ra-Roofas
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Commercial
d5
Yatuetlwr
Ai. Area
QUANTITY DESCRIPTION FEE
3• S 7aan
r -fZ
Le L0 o far,
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL-
1 NIS of 3
INSPECTION FEE
ISSUANCE
SMTP
__
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
4` Ou
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
197.3 aS
PIC PAID 6Y ♦ VALIDATION _......�
ReCEIPTb SSII-3i, PAUOBY VALIDATION _
WHITE —OapartmoM Copy YELLOW—Finance Capt' — Cap/
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTIONDATE INSPECTOR
INSPECTION DATE
INSPECTOR
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
POOL/SPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMINGNENTING
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 / GATE/ ALARM
LATH (PRE)
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 1sr( )2ND( ) LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ 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
T C of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT. of OCCUPANCY '
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE
COMMENTS