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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES �..f
21810 Copley Drive, Diamond Bar, CA 91765 PRE, "
(909) 839-7020 Fax, (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PER.Mrr APPLICATION
JOB SITE ADDRESS A_g-3�..... 4 V Pit
APN LOT TRACT
OWNER
ADDRESS +�
CITY ZIP TEL
APPLICANT TEL
CONTRACT
AIDDRES, AkAlbo RN01 AN C_
CITY--- ZIP TEL
ARCHIEN IGNER �l..
ADORE
CITY IP EL --- "-
LitpNFJI-ffiEtlLti itEG1 RATION
I hereby af0rm urriv pan* of permy that i an, exempt from `-a CorIrWora Suds Lice fot "to reasai(s)
Indicated below by dire ct€epurar .s[ I have placed raid to the aVlcable ii. [Saatttxs MI Whose and
hiahosions 00a Any 4* or iniai tat reglukee a pormlit In sonsili RIW. imprm or repair, amp
ekwativ79,pdarto Its $asulancoi,aftmWimtheepplimitforthep to file a signed stribuireed Wheershe
N lammid puteuatittrs it* prowWarmat Wte 1 autrechsr a LWem law ICIi 91 with Section
713011 ar Dhilawn 3of thaillhadiriew aid t+rahselons Godel orttert he or she is exempt tray i .,ensure and to boats for
tea d emphonAgvndatsroat SectrwMl5byay aibra�rn.".auhJor thasp® �Aecwlparalty
of rust more thau five h mor% doliam (SSM
(-)I as ownsi of ft proi ar rejerrilibyeaswithwedsustheirsafe esnnon,will WL)allrfFC.7Woes
of the work, and the sbusturs is V Sri or VNred for safe ,%ectsm 7944, Husness and �mfessims Colo The
Sofia Lloanse Law don °mt t* to an owner ul VrWerty who i intuo enWoyeeV or perwasi ~ Wds
or im s',,a inndaq pmt Aded ttistttw briprowerrarts are not rtended oraffored far sale if hmwisr, tailftg or
improverre rt Is erdd wittJn ono yeartC the Owner ti Word l0 hmme Wdon of proving that4was rnt butt
or Implaired forttts;,aposa of sale I
L) L as DSYrtat of this pmportp, am ftMiaWht cant acUN With hewrsed t } traelaB to mristruct the prejed {C.-kL^tkrrt
7044 Mom add OnAssiors Cate T a 0aftarpter State lumnse Law aoas not apply to an owner at a mny w!*
bulds or l,iaziroaes triarean and whocorh fs krthe tx a wfm a hcens%cartracle, pursuant to the Co reu^ s' Site
Ucense Lew)
U I am exomptfrm f aansure under os C xrbneta s State Liren&s law ter the ioiiawisrg reason(&)
8y my sign uira beWw, I acksoo loop that ea t he my pariiwadasldarcii to wtn:h I m st have ratted IN et least oral
year pnor to ciwr hdrr of the nrtrovemoots comas by dta mmft I cannot iegly wo a smictgo tit I hove built as an
ewnor bolderif 0 aMbiraeconsttudodiri risentivy by kenwd cordractors t urldmb ad tfral a copy tithe oppkala
low Seullori7U440ltta3e oossnf:dPTanwfiorraCode isavWzWeruponrequestwhenthisappiaoin tswbmiiorat
the tdlow ng Web rAW ttdoheow log ON ra gsvicWawhtmi
DATE NN
f.IMSED CIIINTRACTORIS DECLARATION
I haraby aff rm under penalty of ouri that i an lianud uri ptMisli ire d Cnaptsr 9 tcammarnxN wRh 5a0en 7000)
of OWWR 3 d the Cos ness and - na Code and y 11nse is in hdl'orce and effect,
E tit P ��� FBI
�NTRr1CT'aR �
COMPENSATION DECL41110JIM
I FER BY AFRRI+P UNDER PEWCY OF PSUA W t)FTHE FOLLOWING eEGIAAAiTONS
[ terra and will maintain a Wkil a of Consent to Sett b>sae for Woft,a ComperWw, as prooded by
Smarm 3700 of the Labor 00de, for the parfr anee ui Ga wok fig whir the permit is muted
I ttwe and wIF maintdln Workeft i•4rr lrsalhon insurance, as raointel by Section 3700 or the Labor CWft for
the rt&'Tnanceofthework forwiichfiisissued My1A r"sCo€aparaatonlnsuraremC,a:rrierar
Relay N nntar are q
PEiik'Y t�iii�Tt
{SfdS L?tl7ti t D fi(ST l2E CAf f� FT P T S FOR DNE Fh W0 LABS (S1M OR LS%)
IcatfythatTntteperbmvmoitPewotfN wfirci thispemitis awed, shallnitampvrarypesalinanymannerofasth
baaome subW to the VilorWs Compersa0on Laws of fi filyva, Ard agree that d t should iadat tau t %ihs Worrert
ar70TEWxDATE
YAM�a
dth de I rh vhtt
1.
Criminal
PRnWes and civil We LP to me taberad dwusand dal t$10110001 rr addition to the Meal of to rxmperuaUon I
damages as provided *err in sact on 37L3 of the labor coda irtHreiit and &anpy s tees
6M RUCTNOFF LEND= AGWY
I timothy e*rm under penif t.y of perfm tfraf there is a CPnstratfion Lansing Pugency for the pert maxim alibis work for
sv6;h"permit is issued (Sac ANI N C )
LENM S NAME
IENDMSA€ RESS
cr-tfly trek I ha"mid this app[and stafe that to above Infarf'gdoi N rterrect I agree to cem* woh al criy and
rauntr niftiarim a,-d state laws f#abng to €uddktg atnrbbon and henry represertattsd `h's Wunlyin
enter won the awvemenHoned proper£y pur;-%
PER4TIU E{Tile0 � � t
-
* W—ATUIE IIF PEFltt!
APPLICATION DATE 1 � 1"a ..........
ISSUE DATE PERMIT#�s
I
TYPE CONST OGG GROUP
ZONING SETBACKS I
FRONT myI— [
IAR C
SIDF SIDE STREET RYs p
SIDE —
PROPOSED USE
# DWEL UNFFS # STORIES # BEDROOMS
DESCRIPTION
SC FT
FACTOR PSF
AD.3 AREA/VALLIATION
SFFVADDAPM
Gerega/Cergort
r0 PattoMack
1
;PooU3Pn
--� ` Commrrroal
23
Wusiftn $- -----t Adl Area
QUANTITY
DESCRIPTION
FEE
l
CONSTRUCTION�t._
PLAN REVIEW
m
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP�
ENERGY P/C ------
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BSAF
:TOTAL FEES
COMMENTS
3 RECEIPT e PAID RY TSkiei VALIDAMON .._
wIf %— Del a `one st copy, YELLow --- Fb€ nce ccpy PINK — Asses% rC:opy, GOLDENROD -- Ii Dopy, CIREEN — Appilcant's Goes
CITY OF DIAMOND BAR
INSPECTION RECORD
SETBACK/LETTER
FDDTINGS 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
FRAMING/VENTENG
ROUGH MECHANICAL
ROUGH ELECTRICAL W( J C
ROUGH PLUMBING
INSULATIDN WALL
INSULATION CEILING
DRYWALL
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH CDAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
TC of OCCUPANCY
CERT. of OCCUPANCY
COMMENTS
INSPECTIONDATE
INSPECTOR;
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL HOOD
T-BAR
INTERCEPTER
HOT MOPISHOWERPAN
SEPTICICESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P-TRAP
FENCE / GATE/ ALARM
FINAL POOL
WALLS
WALL FOOTING/STEEL
WALL STEEL 1-( ) 2N0( ) LIFT
WALL BOND BEAM
WALL DRAIN! SEAL
WALL FINAL
RO FRAMMG PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE