HomeMy WebLinkAbout15-1803CITY OF DIAMOND BAR to
DEPARTMENT OF COMMUNITY & bEVELO APMENT SERVICES
21814) Copley Dnve, Diamond Barr, CA 91765
(909) 839-MO Fax. (90) 861.3117 Building Impection Hotline (909) 839.7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS: `
APN GOT TRACT
OWNER
ADDRESS
CITY i x tuff n�.,f %fin A" ZIP L
APPLICANT TEL
COWPACTOR l
ADDRESS 1.102VA
CITY . 1 ZIP Fib fi �o
ASCWENWDESIGNES
ADDRESS
CITY ZIP TEL
TtEGt"11%
14onflf, +gym wular is *ty of pe" VW I am exempt wam the ODft= sr's State L= me taw foor the rpo$WV;}
N1dio tr,! beiuw by ti+t 0000UrMW I have 0=0 read to the Wicalcle oamb# Mac twi 7=A Bouilneae Md
Code APY"a Q=l; t octet WWWrss a pemrd to *Wsbact, attar, nrrprowq, ilarnoush, of ra"If, crow
prior to is tots xas, sdw lcptdrsrs the appHWrRtbr M 0"K m tte a oigmod eta+otrrar o than its w afro
Is howaad pmogto tltio Memreskans oTttw tkrstredm s Stadg tltwt es tow Mhsptsr 9) Comerierictag wilt Saction
?W of DhOslmx 3 of Mrs lualrraos and Prafesslon Dada] or ilat no or she to exempt hm le6neum end the basis for
the a I*W exorn0or; Any Yfulabon of Ste. 70315 by any appIUY, fir a permit oub^ t the appliCant to a CMI penally
of M more flow five hundred dollars {SSOOI
Lj Raals dwsraraf the prowfl%or my employ s+trah wages es their Sole Componoation, will de t j all of at 0 parldans
of tee work, and the owns is not boended or drered for Sale fSocuon 7044, Buatnesa and Wessofas Colo The
tkantrtctdm" SMaht Dense Law does not apply to an owner of property who through omployaos' or pmrmpmtl ow holds
or droves ills VWr"I pruffl6d "t the improvements are not Intended or offered for Sao M howsyst tow bulling flu
Improvement Is sold within one you of cwvlubon the Owner Builder will have the btrrdon of prov'Ag that R was not ou:It
or Improved for the purootae of sale)
U I, as owner of oho property am exdush* coott cting wUh licari d Cairawlefe 0 otmAruct the orollod tuber
7044 Business and Pminxslons Cude The Oarorvcrtne' Smt6 Lteerrs6 taw deal not apply to an aff"or of oroearty wire
bulldsorimproves thoreanand who cartr> for the fxgecswith ahcwasedContractor pursuartt*tre 'Bata
License Low)
U I am exempt tram doom under the Contractors State License taw for totewirrg masw*)
.................
By nry" sigRallum below t whet, etsRpt for my garsond rrsrderras in wNch t mom toes resided fur Liu hW anti
year pea to mmptir M of the knpatwomams Corered by this permu cum ixtphy sell s Slarechrre that I here to a an
ovwmrbur,*itithaec0bwcons!rUcaudwIts eno"off, f)oansadmntractrssl undiffeWW that Acopy orttniapprrarpEe
law Sechon 70" of the wanes aw Rvemione t *0 Is a4labte Lpcn request whar Se appf3ct n Is suhmittad or at
tors f flawing Wet atfef, hephwew W ca awPmtawr trttru
GATE $3iN
ILICENSW CONTRACTOR'S
f hervory of wder penalty of perjury btat I am kcatsed h6lder prowok= Of ChWsr 9 foommencing with Section 70001
of Omaxt 3 of ttwt SuslAms aad Psofssalons Code and my of" Is In full farce and affect.
tJCEttE3E CLASS UC NO,
DATE 0OWI RACTOR
I OWAI'S COMMSATION OEM MTION
I NUERYAMPAA UNDER PF."TI OF PF.RNRY ONE OF THE FOLLOMS DECWiATIONS
I Nava and wLi audntaln a Certluata of Consent to Self Insure rot Worker's ComponsatW off proWded by
,r' Swben 373B of 1ho labor Codo, for the peftma too of the work fer which tnN pemaR Is 10ad!
i+ ,,, I have and wL7 mufflaln Workers CAmpeaeadon irtwrante as required by Sadist 37O0 of the labor Code for
the tutor mute of the work for 40 dds permit Is Issued try workers Compass om Ifrsurarm Canter and
Policy Number are
CAARICP
f
PDLJCYN6'MBM R_
ms5ECRONKmNOT sEWM?LEft )IFTH;Pmyrrt,FOROoERwa0011 OR1150
I tErtrty tlrat br dre pertartwrro d rho wuk kir wtrdr,ttrs ousts[ le ussared I shag naterr>p tenYt r m y mat Moto
hemne subject to the Wurl a Comporsasbn Laws of 02mrda. And Wee brat d 1 afrotdd become rautifact to doe
Lmrnpenaadon ptavBlorls o1 Socdan 37OD � rho Labor � oomph drape �+'
DATE 4>t"Atfr2 ar7A
WAMNG nature to secure Worrkssrs Co a�an cw is u , and Al 5 nWt an ompD W to Omerst
Al
p4haPr..ae and o M$ fhtos up in omt kr*ed dsa+wnd doltsra (5100 OW in addftn to the root of the campe,"'...on
damages as owideld for hr section 37M of Bhe tabor code kftM and arBrmay's loos
iX WITIftMN tfcTfB A AGE V
I fro" affirm mder pity of Wj€rty that Zfw w a CoT;autnon tBrding Agangr lor the pyre of the work fur
cYhtm Ns pawnit lo issued rAec W97 Daft C )
LENOEA$ NAM
TEN M S ADOR "
I cc" to I have read ft appkt n 9rld an that the above hrformahon Is correct I agree to comply with all sully and
county ordnancee and =%tawm relardrn W buldReig co so<uctlon and hereby authorize representatives at this courtly to
r pan the mentioned property for inspection pirposev
v
,�
PERMmt{riRl
1t ""�--
f
SIGNATURE OF 10M11V DATE
PRESS
-�r FIRMLY
APPLICATION DATE 7- 7_19 "� l� P/CfF PPai�"'x j1��i►1��
ISSUE DATE ter# rF ��t IJPERMIT#t P 1? /1'
TYPE CONST OCC GROUP
ZONING SETBACKS
FRONT RW Ci
REAR ----- Ci �
SIDE/Sff STREET RVV ❑
SIDE ❑
PROPOSED US
1-
A DWEL UNITS fi STORIES 9 BEDROOMS
i
DESCRIPTION
80 FT
FACTOR PSF
ADJ AREA(VALUATION
ADD)REM
Garege/Carpod
w
Palio?Deck
car,
Pool/Spa
Ref -Roof
0
Cornmerciet
V ehsaftertAdjArm
QUANTITY
DESCRIPTION
FEE
I
i
m
I
+�
i
CONSTRUCTION 0-1 f.1
PLAN REVIEW —ISIS
ELECTRIC..
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP t'
ENERGY P/C I
ENERGY PERMIT
RETENTION FEE
PRE•ALT FEE
6$AF
I
.............
TOTAL. FEES ri-i 'St
COMMENTS vj
f GEIPT N AW— PA M HY �J VAILIOATIC H
WHfT'E — Deparitr&M COPY YeUOW -- Frnarwe Copy PINK — Assoosw Copy GOUXxfT — Elie Copy GREEN — ApOn antis Copy
CITY OF DIAMOND BAR
INSPEeriw RECORD
SETBACW LETTER
FOOTINGS FORMS
UG PLUMBING
UG ELECTRICAL
LIFER GROUND
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
SHEAR WALLS EXTERIOR
SHEAR WALLS INTERIOR
FPAMINGjWN'TING
ROUGH MECHANICAL
ROUGH ELECTKAL WI k 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 INSPEfTlqN I
FINAL BUILDtN99W0
FINAL IVIECHANN
. . .....................
FINAL ELECTRICAL
FINAL PLUMBING
T C of OCCUPANCY
CEffr of OCCUPANCY
COMMENTS *0-f 0#4V
TRACT ANO LEDGER
SWITCH GEAR
COMMERCIAL HOW
T-BAR
INTERGEPTER
HOT MOPISHOWERPAN
. . . ...........
SEPTIMESSPOOL
HERS REPORT RECEIVED
.DEMOUTION
ROOF DRAINS
ROUGH CONDUIT
POOUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH ME CHAN ICAL
i GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P-TRAP
FENCE / GATE/ ALARM
FINAL POOL
WALLS
WALL FOOTING/STEEL
WALL STEEL V-( ) 29 j LIFT
WALL BOND BEAM
'WALL OMW SEAL
WALL FINAL
RD FTWING PLANNING APPFOA.
. . ...........
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERIN61 PW
FINAL COMIAUNITY SERVICES
FINAL HEALTH DEPT,
FINAL INDIISTRLAL WASTE