HomeMy WebLinkAbout13-0977�, CITY OF DIAMOND BAR r a F 731 "
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
' r 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
r (909) 839-7020 Fax (909) 861.3117 Building Inspection Hotline (909) 839.7027 FIFTHLY
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS
APNLO D �n TRACT_ ...
OWNER_ - t/
ADDRESS 2�-$ t'N.DiMft
CITY bj4,4Md_.t_r ZIP a& TEL
APPLICANT _...__ TEL
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCWENGIDESIGNER
ADDRESS
CITY ZIP TEL
OMM SURM DECLARATION
I hereby aysm Olde pem0y of pndury but I ew Ewa from ma Conoecmre Sbde Liam law for Me reasulpl
mahotBd belew by de chK*Oiuum I Mn avow wart m to applicable Imndal pecom 71301A. #ashen arW
Proleaakrm CM* Any b#ymmady WMT MgWns a permit An Wabml litM MVMK%doMfth.w repat mq
Isftmi p# Lm of
Om Contraction,
oeppion, S tlepam Low
BlgAaBemmr NgWO pf1W
MMof 11dpumoel#ft$Wtw Wowalan PmtCim CQaSmYtkern 00 exeneu menlommemmg MN SeeanBn
70001 OlMelon b lEta NWyend Promwmem Code] mint he w the In enmO brow Iimmum a^d M bads for
theaL'epedesBmpdo+ Any NdolapODW SWAM 7031 S M 6lryapplE2nthN0 pamRBllgbyt9meapWEeam ma CNII penally
1�Ua.,w''e Imre #ran five hulut'W daAo4iSb001
UM, a owner of theprnpelty,orB7amWByeaewim wegesas 9r s* omgreamm,W11 OU Oplowu partlons
of it wall any the sMOOe to NO IOWded or OMmd ler sal I&cMm 700, Oakes CA hd=bn Code The
Cothmdma'Gmm Npenae LawdOOnplapplp loan axnerNWopert/xim thra9h ampleyarrI ar 'lldt boli¢
Or ImOoma me property. Pneand dent Aber kRNwommm am net Intended a Mien l for sea f Mwa.IX M buimOp Or
kTmrmamo+t m cpm wNdn me yes Mmmpa{bx1 the OwnO 8ddww10 have the burden l pmdnA Nflt d was rot bUlit
or lmplmee by M poi of Baro)
U Las mewed the property, am amhoh" cermun ng w#h Iii Quantum To =Mot the Aman MMOM
Tac Sunhemay and ftaM*n9 Code The CominkI Stam Uce1se law dam ml appp Or m nearby Of Wttetty wdu
WIM ar bmpran9 b) W,NOupon Wllba4 mrMepmorom Mth a Eased CaMecmr pumuod N MCammcme'Std
Lkame tow)
U I per eamnpt ham ncaneum under the bermormrs State Ucause law for by, fllowhm raeeanfai
By my sinaaaa Daiwa l ukruwmdge that eRa[N for my peroral Moen; in wiam I mann hays fund my at unit any
year prephr Worrialaw lthe lmprunm9M Warred by I pamuU smut Wit, Am a BWp¢d9 Debt l Mea Wit a a an
owner-bWdOifftNO, fail Ogen pMrebucmd in Ss altlre7by HWnned mdreclm l finis Way l theapplklde
low, Sectbn7D44ath,&W:u and"=DmCademeutsabu but repuest wixm pis aeon is pubmMed Or at
Ne fulbxdng you d'siigt�+mwm obbeo Ce hma
DATE "' ..........._ Sam D
UCRNSEL COTPACMI DECLARATION
Zal amfm under p&uDYof opium M l oro mutual u pcmmure of Chun, 9 expromemerytivelfth Settlor 700th
Of Woman 3 of Ne Wompre ad Pen ns Code, and my human is -n full brce and Ludt.
LDEdSECtASS ........... UC NO
DATE CONTRACTOR
WOMER'SCOMPRMATO# O'OARAAON
I HEEE)f RW ONOEA PENAtTY OF KUM ONE OFTIf FOLLOMNGOEt(PPATIONS
I here and we monam S Ceff am of Capitol to Self kaaa9 for worker's Comps , on prowdad by
SOObn3T001 Na Ln�Com # Na parroma'xaPtha wmkPocwhxh thu permp m
i bare erId w01 msOae Ytmiare Cmaransatkn Inmrana oureOsad ay Semban 3T00af teetatw Cade for
hwperlamanm l the M>Pk M'whkti #Ye pemO19LRWd myWmkerbCanpeak¢Bm hau9nm Csdmand
Pd�tAmenma
Ck%W
PODGY WMSER _
MOSSEGTAkEIES) NOT SE93WUTW *TNE PMW M FOR ONE HAMMDQLAM(3i0D)OR LESS)
Iartlfymatp:ttle WwtArtthewwklon Lmohgbml3NOm Idia9 rote1yWWXpo�mO or Tormesm
bemired�w-tto I*Vor Sent
Of t.awCDE II smi AMagreeput d1npoo WO&A sm#ctmlie N'atmrp
Conlen�IM WwtybnsUSbybm 3700 U pe Iabo Calk, INrtlifatlnwth pam#wAh d�Ambims
DATE APPLOW
WARNING RI in mare wWar'e CompenaaWn op romper is nawful and &W subject s employe I criminal
PermOw and dye Ores up t7 oat nomad thaeantl ap0at9 NI99 0001, In addkon m the ms of dw compensmtlm
ponies as Pound Wr in MCUen37TMl the IWprnoaa Mmre51 and allmyl trop
COaNIRIT.apNt9y0OG AC4NCY '.,.
I hereby mom Oder perearyet poetry cut there ma Comment, timing Agency for to temmOlW l the work On
»bear the Dumb is need (Sas 3397. Cly C)
LENDER S NASdE
LENDER SMORM
lardty Dot Nun read NbaWeeat(W erd elm Mtthe about Myamabmlemn IaW bcmWywMapolyand
mmryarthnaxesand elm saes r�dm m GAdthA consWNm and ham' mCndnreWeuamm�veaUmw Wady m
d+w pmaoan-meObnM Popetty tar map mpuroV9eu
LCt� 4
NA4E{ /
-mor y
y ...
5 TREE DATE
APPLICATION DATE
`�J PIC##_ ....-.'7
ISSUE DATE _
TYPE CONST OCC GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE7SIDE STREET RW ❑
SIDE ❑
PROPOSED USE RGI tl r
�ir^y#yy �L
# DWEL UNITS # STORIES # BEDROOMS
DESCRIPTION SO FT FACTOR PSE ADJ AREANALUATION
SFR/ADD,'AEM
!'
Garage/Carport 1
r/}
PatlyDeck '
LL
PaaUSPz ........._
2
Ra -Rol
J_
CORneerd81
iD
Yaivati0n AdI Area
QUANTITY DESCRIPTION FEE
W
'
i
w
O
CONSTRUCTION Ct J
PLAN REVIEW
ELECTRIC
_...............
PLUMBING
MECHANICAL
INSPECTION FEE f,F %jJa A2,20
ISSUANCE
SMTP
ENERGY PJC
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
BSAF
I
_
I
I
qy
TOTAL FEES 14 All, try
J
COMMENTS
__
RECEIPTS_ PND BY d-9 VANyoxioN
WHITE — DoparmterR CgpY YELLOW — Finance Copy, PINK —Annual Copy GOLDENROD — File Copy, GREEN—Appikmd's Copy
CITY cAW m 6ND BAR
INSPECTWIN RECORD
SETBACK/LETTER
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG PLUMBING
T-80
UG ELECTRICAL
INTERCEPTER
UFER GROUND
HOT MOPISHOWERPAN
SEWER LATERAL
SEPTICCESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANDUT
DEMOLITION
ROOF SHEATHING
HOOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
SHEAR WALLS INTERIOR
POOLISPA
ROUGH PLUMBING
ROUGH ELECTRICAL
FRAMINGf
ROUGH MECHANICAL
ROUGH ELECTRICAL W(
ROUGH PLUMBING
INSULATION WALL
ROUGH MECHANICAL
US TEST
PRE GUNITE
POOL PRE DECK BONDING
INSULATION CEILING
P._TRAp
DRYWALL
J CATE/ ALARM
LATH (PRE)
-FENCE
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTINGISTEEL
GAS TEST
SCRATCH COAT_WALL
ELECTRIC METER RELEASEf rT ww F
WALL STEEL 1 rj LIFT
BOND BEAM
WAIL GRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO FRAMING PLANNINGAPPRUVAL
FINAL BUILDING
ROUGH FIRE APPROVAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
FINAL ELEUMICAL
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PIN
TO of OCCUPANCY
FINAL COMMUNITY SERVICES
CM of OCCUPANCY
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE