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CITY OF DIAMOND BAIL
PARTMENT OF COMMUNITY & YELOPMENT SERVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax- (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIR�LY
BUILDING PERMIT APPLICATION w .eflyofdYamondbarcom building@daamondbarea.gov
JOB SITE ADDRESS 1? T a W )' Ia&1 ", Z
ER•••••••••••• fhb
APN LOT TRACT
OWNr
ADDER IS t
CITY inNi— zip 9r7& TEL Y09— _celf
APPLICANT 'r-ff TEL (oe, 71e
CONTRACTOR
ADDRESS 70tW Mo.{+� yG-e • Y
CITYEi v.Vi t ZIP TE Ca Q S"Y'4
ARCHIENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWW WJRM DECLARATION
I Randy alflrm under Amddy of leal gnat 1 am exempt tram tne Cordwta"s Sam Lkew tea He the wall
mdma, below N Bw wramrrkiq, I have plsaed rade m th8 NORIANe Imo(s) robber tan A, &Ahem and
RMaaom Code, Any ay or cow* Ow requila a 9enMt m mtatod, after, Impose, dwwllsk an "Pon, any
ate�ure, pier k BylnnM rho require, the appieant WtU PMTW Wide a Showd ek OW he or SM
alkauW Pp MM Raw afthe CondeCOM's StMUMMe Lew(Ohrpler lD COMMMe,4 Wb Salon
MM M woolen 3 of fie BuWMee WIO ProMemdor Codas ort -be he wane is normal from 11mayo a aid ma Caw mr
ihteaepa 8xempUM My Nhemot Sattmm703i SbY MYaieilmdbxaoawtabyda ma apalwMtPeCttiBpMSIry
of rot mare Stan Bw hundred duan; (8500}
U 1, aS Member of The property or my offaillyaws, with wages a then BPm woradonallon, win do U as of In U pro"
of the woos as the AWCMro a nd mbmded or blared for ole (War 70Aa, Sween and Pmfesaaw Code Do
T011pepfMs$atelkaMe law wenMaaYmMRanMINpoPedY YAq throupA empopm WPM MOIK
or NOplova the goody, Pmaad met dw impmYemeniaare not IMOMed M Rarer to sea tthowever ma dii&ng a
ImPmwmed orad wTmObbl yaM d wmPktlon, Cbe DtlTar BurtlM will t®ve alta Mn1ffin Bf Wa1ng tlmllt tMbrot bat
ulmpmaforma dela)
UI'm broader d the posseray.Mn aduelrelywobscmtgwml lig edCe*ut okwwOuttha podded (SadM
7044 Boa" Mai fv*W m Taw The Comwers' Std UOmae Low doe not Angry m M owner propmty %to '...
1 bons Mlmpwoa bmam,"Wldmrmada IN the pidlkn win a OMAW Laommor prdeara moo CRdlrdare'Sam
tae Law)
U IIN, examrt ban Ikaaum w 00 Contux oe Bab Lka kw for sea foRamg mamma}
Cam Sign
By my barn I aoev+top Det e=W me, my Renew red001tte In w1kh l ami nave raMded kr of Me aw
Year alta in MV90MOf the hrom" netlm Conrad by dile Pe1md Imbed reply sal a Amotum mats hars am are an
sember-bodoor 0 i my, 1V1 we 4MNnXta In Re adnry by Ik0m0d owacters i uMalemnd Ihat a MR d IN
apPa dm IMv. Ssdkn 7044 of the BW" and WOwne, fade Is "OWI MIN madoet when this ap s cheat ie
submwi n etih8 todgrarp Web after hCpvwwx kDnm mpwlmleW ntmi
LICOMP CONIAACTO1111 DECLARATION
I remain, amrm ulilkf wertyor pepury Ind', em I cMeed umc provNmns of Chapter 9 nom aingwM sonar 70M
ofDNNIon3orMeM"?wdPmmamnsCode and mylkeme4:nbull tome MdeNa't
LIENSEGASS �% JC NO ?Cas r w"
EXT' DATE �`� CONTRAG- f2/fir - .deY"P
WORKER'S COMPEN&ATfWt DECLARATION
I HEREBY AFFIRM UNOER PENALTY OF PERAPY ONE OF THE FOLLONNS DECLARATIONS
I Save and will maNmin a CeNoate or 000,1110 SON two for WakM's COMPOnesdan as pmmad 0
SaCOn 3700 d the LearOaM 1m to PowMmMCe of the work IN widen ma Permit a I.cued
__itastl aMwlli InelnWm Wata(s CooWensOCM Ineurorvm wNFAECeySwtkm3700dthe: Coda,me,
bin PertamMa40 d thBwP1k fa wmkh Byspertnft IahpuOd Aly Wmw0r9 GMnpasa0n lnsuronm CMIMgrd
PNky NunmOr Me�r 1 j� /
CARRIER UI 7O i''d/ tae, �._
POLY NUMBER twlc 7 fa 3f 5`a�b 2 f Or H
(LIS SECTOR NEED lar BE COMFUTEOFTIE PEWS FOR ONE RINDIEB WILLAAS $100 OR LESS)
I candy hat In die pedomanm of the w for whol mm para is ismBd, I owl act Mvide, ow Pbewnkarryiaawtm Mm
aeowm dallied to the ftWt Oa� Lowe of Culloada Nd IOCma d I dedd News, sere to me ftri
CmlpMaakn peal ens of %ftn 3700 or the Labor Case i sallfamwMl M"Yom goat prwMos.
aaTE APPLICANT
WM'kWa Federe to pace WhrMb Cwwmuw map to vurniiW, am Meal dUAW an aewmyW k vilwal
PMe Bu are came, nae w k Ma hummed UDUS&ld Allam 4100 am In mkABM m the cwt of me mmexemse+som
damages as Nodded for in aapa 3708 of Oe abbe ode, media, as a.'mmy a Las
OOIiSiR =GX LENOOM AMM"
1 away also omen pmtyof adury led Beta is a CamWCbn Lending RoMxy far IN performance d M way M
ma PMMt m Isvad {SAC 3097, Che C)
LENDER S NAME
LENDER S ADDRESS
o,bbthat nameradhos Name rwonmm0 ullire[me dove iM&M hInela wthem!agreek tlptt Ai meiloltyMd
curdy o:dmMweantl amM e»s reweng m buddl�p cMapudion, and Hereby audonp Malamnmbrcs or LNs county m
aaeruPMthe same memmrad MWa^l'Y me, trapedlM PUPoma
AbIZ, I,d EM `7G e-'ls
MFNEd"" ^T— 1E`I1
E MATE
APPLICATIONDATE �jl'111 �1 PICA,_...
ISSUE DATE 151 T� FERALUED S Sp
TYPE CONST OCO GROUP
Scope of Work �! tjG'1,8�
A DWEL UNITS #STORIES
o VL' /W
aBEDROOMS
DESCRIPTION SO FT FACTOR PSF
ADJ AREANALUATION
SFPoADDtREM
Caarepa/Capao
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Patwowm
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PgatSpa
Z
Re -Pod
9
Canmerda'.
IO
Vale bon
Ad] Area
QUANTITY DESCRIPTION
FEE
(A.7 r r
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMTP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PR&ALT FEE
Com%
BASF
PLOT PLAN
ZONING CLEARANCE
TOTALFEES
COMMENTS
AJC PAHO BY VALIDATION
RECEIPT# �,S'�{ a PAID BY 'qI. VALIDATION_
WHITE— Department Copy, YELLOW—Finance Copy—Aseeaar Copy
minaugs 0 0
jlL*Jjnl,
INSPECTION DATE
INSPECTORI'
INSPECTION DATE
INSPECTOR
SETRACKI LETTER
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
UG PLUMBING
COMMERCIAL HOOD
T -BAR
UG ELECTRICAL
INTERCEPTER
UFER GROUND
HOT MOPISHOWERPAN
SEWER LATERAL
SEPnCiCESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOLISPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMINGNENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C (
GAS TEST
ROUGH PLUMBING (Z(cf r-tJC%r)Ce
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 FOOTINGISTEEL
GAS TEST
WALL STEEL lsT( )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/ PIN I
ITC of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT. of OCCUPANCY
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE
COMMENTS