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Home My WebLink About15-1110 (2)z y 3 J a �l x i z z M 3 i zz x z z x 3 f x a ' CITY OF DIAM( BAR - ' DEPART IT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS „� (909)839.7020 Fax. (909) 861-3117 Building Inspection Hotline(909)839-7027 FIRMLY „raw - BUILDING PERMIT APPLICATION JOB SITE ADDRESS / O I %6 APN LOT TRACT OWNER ✓A/ D E ADDRESS / CIN ZIP _Yj_29CrTEL9sp s1 APPLICANE-,il-11 ,nTEL / CONTRACTOR A16eyba> 1'lwil kf " ADDRESS Sl ZS N CITYLO�aCao ZIP Ci TELT 3Y ARCH/ENG/DESIGNER ADDRESS CITY ZIP TEL OWNER-BUILOER DECLARATION I hereby affirm under penalty of perryry that I am mampl from the Competitors Stale ll¢ree Law for the reasnys) indicated below by to chedmards) I haw placed next to the applimble Ilemis) [SecBon 70315, BrNinese and Profeanicre Cade AM city or cooly Nat requires a pemdl to ceneNrct, alio, Mora , dominant, or repair, any ebuchoe,priorlottalasl, ataorquhwtieapplimrritwtepumpto RMatigmd-MWo Nalheorsly ts Ilcemadpugantto0epeNslumatt*CahbactoYa Sly Lk law(Chapterg)Camm Wng WMSedw of Division 3 of to Buchman and Prebendal Cade] or that he Or she Is exempt from licensure and the basis for Me alleged exemptlon Any viplaflon at Sutlon 70315 by any apparent fare perm, gWects to applicant N e Mid penally of nd more Nen Me hundred a glare ($BW1 U 1, as owner of the property, or my employees with wages a their tale mmpenswon will do U ell of or U potions of the wok, and the sbucagre s rot Intended or offered for We (Sanbon 7044 Business and Rdms Cade The Lontractae' S'tete Ucame law dean not apply t an owner of property who trough employres' a personal effort builds or Improves the propend prodded that the Improvements we not Intended or offered for We T however the bulli ing or Improvement is mid with, are year at completion the Owner Builder will haw the burden of proving that 0 was nal built or Improved for the purpose of wale) U 1, as owner of tha property am elcluslwly eOnbecting with licensed Contractors to construct Me project Becton 7044 Buvinw and Profession Cade Tire CnnOacNre State limn law does rat may to an Omer of property who xlmpmvesttiumn anal wrormbecb for to projects wit a dcanged Contractor pureumatotle Contractors' Stale Losing law) Iamexempt Iran licensure under the Contaciofd State Umm few for Ne following bonsa wap By my signature below I acknowledge that, except for my personal reddence In which I must have folded for at Inas one year pdo to completion tithe Improvements covered by this omit I canal legally will a structure that I haw built a an hdlder If it has not beers oarehMed in we anbeh by licensed associates I understand tate ropy of to applicable law Search 7D44 of to Busiman and PraRnbm Cade Is mouleble upon reeued wh n n application Is submitted or at the following Web site a0#Awvw leginfo to goy/caaw girl SIGN LICENSED CONTRAC fl'S OECLARAnDN I hereby an under penalty of pehury tat I am Ilcemed under pmviNuns of Chapter 9 (commencing with Search 70001 of town 3 of the Business and Prolnseom Cade and my Incense as in NII force and effect LICENSE CUSS — 3 G UC NO 4 7 9 J6 9 CONTRACTOR (QS�nejj WORKERS COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I here and will margin a CotiBcate at Consent to Self Insure for WarMu's Canpensamn as prodded by Boost, 3700 of to labor Cade for the performance of the work for which this pend If Issued I have and will nwnWn worker%Campenwatlon hreumnce m rqulred by Section 370D of Ne labor Code for to performance of the was M which this parted is Issued My Mar ver's Canpensmon Insurance Lamer and Policy Number are CMWER POLICY NUMBER OHS BECTON N® NOTBE W WLE7ED #THE PERMIT IS FOR ONE HUNDRED DOLIA s(SIOM OR LESS) I mri#/tlul N 0e f erhnnNne ofthewnk for when tt permit Mea 1 shag noemplq any wason h nary naircr ecanto became subject to to workera Cooperation laws of Callfomla Ad agree that d I should became subject to the Working conceOe�tin� provisions ��of Satlm 3700 of to labor Cade I mall MUmMh mnpp Wt d® pwoba W PI " PLCAIR WARNING allure t secure Worl Corporation coverage Is unlawful and Mail subject an employer to criminal Honduras and pull tines up t am hundred thousand ddtsrs (5100 DDO) In addlbun to the cnsl at ore cpmpe m damages as provided far in suction 3708 of the Taber carie intrist and a emeYe tons CONSTRUCTION LENDING AGENCY I hereby atirm now peralty, at anhury, that there s a Comemardon Leading Agency for the pufarmance of the wok for wagon this parted Is Logged (Sec 3097 Cw C) LENDER S NAME LENDER S ADDRESS I certify that I here mad this application and este that to Owe Informatlao Is correct I gree to comply with all city and county ordimrces and stere laws resting t building consfa cdon and hereby aWnme reoesentetives of this county 0 enter upon to range manherei property for Inspection AmdgWs �,i 4 vee rc SIGNuilmoliffinigMEE 7E APPLICATION DATE ppS 11911 S P/G# ISSUE DATE �P�Y�r� C PERMIT#t r- I t 1O TYPE CONST OCC GROUP ZONING SETBACKS FRONT —RW—[L- W❑REAR ❑ REAR SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE # DWEL UNITS # STORIES # BEDROOMS DESCRIPTION SO FT FACTOR PSF ADJ AREANALUATION l SFRIADDA7EM Garage/Carport W PWio/Dmk LL Poo/Spa Z Re-gool � M Commercial I M I Valuation Alt) Area QUANTITY DESCRIPTION FEE I a� G I as I gg 6 I f CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING c O]-_ MECHANICAL INSPECTION FEE ISSUANCE f SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE PRE -ALT FEE BSAF TOTAL FEES COMMENTS RECEIPT tly7 PAID BY -//011 VAUDAT10f� WHITE — Department Copy YELLOW—Finance Copy PINK —Amesgo-Cam GOLDENROD — Flee Copy, GREEN — Applicants Copy CITY OF DIAMOND BAR INSPECTION RECORD FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG PLUMBING UG ELECTRICAL T -BAR INTERCEPTER MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT 0E OHION ROOF SHEATHING I ROOF DRAINS FRAMINGIVENTING '.. ROUGH ELECTRICAL ROUGH MECHANICAL ',ROUGH MECHANICAL ROUGH ELECTRICAL Wt I C I I , , GAS TEST Am. * Tm LATH (PRE} LATH EXTERIOR SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION ROMW14G RANMINGAPPMX Fa m" WaTt-w7m, �IIIIIIIIIIIIIIW FINAL PLANNING 111-W, 10 FINAL ENGINEERING/ PW T.0 of OCCUPANCY = COMMENTS