HomeMy WebLinkAbout16-2723t}(,1 OND 11,i .
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
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21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fox (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www,cityof°dtamondbarcom budding@diamondbaren gov
JOB SITE ADDRESS ' r ��' ik
APN LOT TRACT
OWNER ° L
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CITY IP14—yi/erb—, ZIP TEL y/ +' $f
APPLICANT it +w, Wl 1 TEL _ C1v }
CONTRACT C -t
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CITY V 1p 0 TEL Q
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ADDRESS
CITY ZIP TEL
OWNEft-9UIIBER DIC1J1,11%] iN
:I 95nn under pmuo4' d perprry DO f 4m exempt from ma CorAtuber'S SU"�1.1wr a Lary for the reatan[s)
nd ated below by the predmmrkW I have plued nW to n BppIcabrt I1 rwtia r 70.5, Boom = erg
Pic! leme Code, AM c4' or mum that regneroe a Worot to cametruct ejW, Immrere, , it l i, k w ropefr, any
etrrcwre, prior to Ib , Apo nqurres fore otmlaant far Mw I W fik a tiigmrtd stadameM total bt or aim
is warned pwvmrrt to vwvho hobs of fhe Cwdrx *es bt mt umm taw (Char %connooKin morph socwn
of Bwrsmn 3 of ore Busmass rrd wadaeakare Gate] or that he or shy to exam from Wansure and the basis for
the alleged exemption Any violation of Section 70315 by any applicant rev a pomdt nublocte the applicant to a cMT penalty
of not more than five hundred dollare ($500)
U 1, as owner of the property, or my elm with wagon as owr Sale wmpCnn ltlon, vao do U no of or U ponlorrs
of the work, and the strimm to not trended of ohored Mr Sale (rSeeft 1044 Bus rm and Pagesslamt Code The
Contradore State License Law dean not apply to an owner of property who ihmogh employees or personal emorl wires
or improves the property, provided that the irnprovenots we mot ttaoded or offered for sate U however Ure oaldirrg or
Improvement is odd whNn am ymr W corrpletIm. the Owner Mar wN have the burdem al promeg lhal If vras not ruin
or emprued for the purpose 01 sal)
U I, ea owner of lore Property, am exalu000 oeMracim0 with iimororsd Cordeordhrd to ooaftci Cre pro)ed won
7tr44 &Wness and ProiesKm Cork The CartCactans' Stab WOW Low does flat epph'tn avn owner of Property 00
or trnproves tneram and wftawath Ilteft projet a wtm a paroled Ccntra x Sa rWA to the Corftctors' State
UM-fttaw)
C # t am eaampt from Mansura under the C(mmoea State License Jaw for the Ngtow" nano a)
on
ev ray *rmn below I ajurwwwp that, SCW for my par'Sdrw In widCtt I OW torus fwded tar at �Mw cvu
yews Wto, compfegonofMtrmottowwadivyCrispertnitICarriat W03yONatin ethatIhmbUT11huan
b er t it has no beam in fat omtksatS' by, kansed aeauxtara I W03tand Roan a crpy d tie
tMikaft w Sown 7044 d Bhe i5osk 94 no RatesAm Coda k avabble um mMw when 11tia appamalee Is
&broad or at IN web so t TWft vw kgtmiu ca goaci0aw t d
LEVISED CO TRACM S IDEO"TION
I atfmst undo Panay of pa oy drat f am keased ww> praWsorw d Chagas' 8 foomm g *0 5ettrem t0W
of Ow4w 3 d She and Proiesst 4Cd*$ and on Urrrm is % 0 f mS W eff"d
UCEASE CLASS� LIC NO l 2 a g 3 4.
Er t)ltT€ .I ry ^ �f�l% CONTRACTOR v - �
WOBIfEB'S CNI MSATiON IN:C AIM
I I HEREBY AFFIRM UNDER Pf34ALTY OF POLIURY ONE OF TIf FOLLOANB DECI.ARA IONS
I have and will f Wntaln a Cerbikela of Ct Met to SA Insure for Wbdrar'e Compensation as provided by
$Kdm 37M of an Law Code, tar the ptrin m=a of Ore work to MNCh Ids Pau IS tsatted
I have and will maintain Workers Compensation hlsurenee, as required by Section 3700 of the Labor Coda, for
the performance of the work for whiCh W permit It Issued My Worker's Conpimsot5w tLsuranee Carrier and
PclkT Number are
Ck9RtER
POLICY NUMBER
(TIRS%ZM NEED kV BE CUMPOU w Tit PEFW IS FOROW RR&1*if =LAM SIM tit LES%
f odttr ti In the perfdrmerlm dtw work furvAch this prmrC Is tasured I Strad net BrnIM 1 Irvy t>e loamy rt sn a in
iong to the WorWn. Compensaaan Laws of Caloorda And agree that h 1 shoLfd b@rorrre s olsat rp no WOft'a
C.prnpwsstYgn munepne. of SpOon 3Rt0 of the Labor Cade i ahat formkth cornply with SMw pror4,f m
APPLICANT
WMIENB Faaue to man %WWs cmrAgS Is "wht, and 0a sun]aC1 an tmpWM to alff
wrtafhoe tNt alvii noes Up to owe hrrxtrad Ian" d ftus (81ct0,lttttlj, Lt addifim to am Cent of the cornpan edam
damages an WeaNded for in BB M 3706 of go labor aide Warest and aternays fees
t CTRttOTIIHt LENDWS AaOXY
I Weby xflhtn wder pity d Pansy that own is a Construclon Lt€ &g Ar tar tt of the worIA Far
wtriell do "" is thw (Sec 31w, Ctv C t
LENOR S AA
tkWER S Ate
I suety tout I tuna rsW We appfleahan and state that the 21500 Irnotrramn is Cnmet t I agreo to carnpry with 91 hats amd
34aawea and state taws releft to Wading orwrrvm end tax" aut ice repof tdie MOYI Yf
xft Won the Pop" fa r� Wow
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SdONA OATE
APPLICATION DATE f< <f' 41;9 / if PIC#
rSSUE DATE 1 �/ ��IPERMIT# 1;1 (1V
TYPE CONST OCC GROUP
Swpe of Wairit lea, —
0 DWEL UNITS s STORIES # BEDROOMS
C F-SCRIPT)ON
SO FT"
FACTOR PSF ;
ADJ AREANALUATION
SFFVADagEM
G�aem'Carpat
w
Palvo/DoCk
ut
LL
Podmpa
z_
Fie Roof
Cmmemol
an
an
rr,�%lrit� Ati1 Area
QUANTITY
DESCRIPTION
FEE
a
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE ^!
ISSUANCE 4.
SMI P
ENERGY P/C
ENERGY PERMIT
RETENTION FEE oo
PRE-ALT FEE
BASF
PLOT PLAN
ZONIW3- CLEARANCE
TOTAL flee ,jLodi
COMMENTS
P/C PAID BY VA.UDATION
RECEIPT ► RAU_ PAID BY S VAt,IDAION
WHITE—DepartmenlCopy YELLOW--PimanCe Copy, PINK —Assessor Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION
DATE
INSPECTOR
SETBACK/LETTER
FOOTINGS FORMS
SLAB
UG PLUMBING
UG ELECTRICAL
UFER GROUND
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
SHEAR WALLS EXTERIOR
SHEAR WALLS INTERIOR
FRAMINGNENTING
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C ( )
ROUGH PLUMBING
INSULATION WALL
INSULATION CEILING
DRYWALL
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
T C of OCCUPANCY
CERT. of OCCUPANCY
COMMENTS
INSPECTIONDATE
INSPECTOR
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL HOOD
T-BAR
INTERCEPTER
HOT MOP/SHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOLISPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P-TRAP
FENCE I GATE/ ALARM
FINAL POOL
WALLS
WALL FOOTING/STEEL
WALL STEEL 15T( ) 2NO( ) LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
RO FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH OEPT
FINAL INDUSTRIAL WASTE