HomeMy WebLinkAbout15-1542M
n
s�
a
n
A
z
— ' `• CITY OF DIAMOND BAR''-� �--
DEPARTMENT OF COMMUNITY & VELOPMENT SERVICES
el 21810 Corley Drive, Diamond Bar, CA 91765 PRSS
` (909) 839-7020 Fax. (909) 861-3117 Building Insertion Hotline (909) 839.7027 FIRMLY
BUILDING PEKMITAPPLICATION
JOB SITE ADDRESS 4A
APN LOT TRACT_
OWNER
ADDRESS A ;Q 12 , AtE&W Ro f t" V /3 64
APPLICANT TEL
CONTRACTOR K4 — 1 t Y
ADDRESS alas i5 t°i'1
CITY Pk,"_ ZIP 9r > 3' TEL(-902 2 � :'� 'p
ARCH/ENG/DESIGNER
ADDRESS
CITY ZIP TEL
WNMR1.11f11M DIMUMATIONI
I ?wrety X*rn under penalty of perjury that I am awlel hsm I'm Carttraattt'a Sknto Ucensa Law tar the eerie doh
Wi ated Mlvx by the checkmarkjst I face paced next to the Wlaablo I 164com MI 6; Lyrahheae rsed
Pirthuharel Code Aory M or eararty Mal rmwires a fAerndi to rmahud attar, hnuave, du wlW or mpaty arty
w1ucttea prbr is Its N.sanarm aloe rawa es Ore apialkanf tar Bon parM W the a Ogned etaNint at #M he or she
isIlculeadpramuantvia fiap€lyfe4hsofVia MvWckes+ UmmLaw (Chapter 9 Willa Seetim
st Dwaldn 3 of Ile 8t idri cal and pmItasaillow &XM or he or she Is aaampi hwr kersys and Me bad fW
the ameasel azemptgn Airy yogdon of 5eadon 7M 15 try any awmant for a pastnk auboaveltAf apown to a va pvwty
rd mp+s � t toindred rtdlaes {SSOi7}
Ut,as cow of theyCp fterrrWempftmwAtrwagesasthmr We canWasabofi,will doUall ofcropert
of the wort, end the arichn a not Intended or dkmd tar sale 0xilm 7Da4, ksipm and Cade The
Can State L dense 8 nw dues nrA apply % on mmner of property who though empionem, or persorrat eNart bi Ids
or irrtpmm the pmlorty prarkied that tiro tmprawaneats are od Inhanded or v*W her We t howmr qa building or
hetpnwemehi is add wttan anal year d mmpleban the Owner Oulder will ham the barmen of preyN that n was net bull
at lmpmw w for lire pumose of sale)
U i, as owner bi the property, am mmius vely cantratUng with Ikensed Wndrastare to construct the paged Oeclton
7D44 (3uom= and Professions Code The Carhxloors' S= UDm 4aw does fiat ap* to an owner d property who
x Impmvees thereon and who canhacts for the projects with a licensed Camractor purauarn tothe Cmteicton' Stara
License Law)
i, I am exempt cram Bcensure under the Comraciloes State Licence law for the faliamft raaton(bh
By my lagrtaWre below I aCkhaayMile that anoept to my porsonal re,�idenoe in whICh I must haMl re*W Mr of latest we
prior to comp ilum of the Impruvamems covered by this permit I cannot legally sell a shucturo that 1 have NO as on
owner-baNder it t has fiat been constructed in Ifs entirety by Ikenged eontralbi I urdaesrand that relay of the appikalda
law aecOm 1044 of the Business and Nutt w a Cede is available upon request when Mb appllantlori IS a* sited ar st
the taimMngWall seta httplwwwleginfocagovicamwhbnl
SISN
----------------
LICEW CONMACTOR'SDECLAAATION
I heretN ONM under pe ultty of perjury ft t am Faerelw seeder prwvslorss of OnAN 9 (ae'rk7len0v with 500on 70DW
of Drwsare 3 of the Uunn eas and CIS dada wo my kcense m m kg two seal ei-
tLye 40
W NTAACM
WOROM COMMWTtcm DECUMT1081
I kill' AFi%itNrt IWOR POWlY Of PSLOW ONE 6F RE FCLLflRM DEMARKMi Is
t have a ah wrq mamtars a OwtificaW of Ca colt to Self manes htr Warier a Canpetwbon as frmed by
town 37M or the Labor code for the prifarr ram at the wart for wtitch him mmd a ism
_......... I ham am conk =ntan tttarki r s fbmlaensatwn Insurance as moused by Setlw VW of the Labar Cade ter
Me porlormw= d Me work hr which Ids permit Is issued My Wbnter a Cornpe+re bon Inaorarme Car* and
MKY NUMben are GAi ( EA A►4 A �lStrt� A
PCLICYNUMBER +�
L
jW 8E=N NEED N0T I$EM++FLf0 FTNE PERW IS FOR OW NL>!etDRLR DU[ LAF1S M001 OR LES51
I coj" that Inthe pert rr arras of tits work to varrrh that pain d s msum I shall ml en0ay arty person in any manner was b
beanie aublsct to Ida WcvkWa C mpareiagan taws of Carfare And agree that d I Maur become subled to the Worker's
CoaVensahon padamre of 5achon 37M at fie tabor Cade I stall tatrram campy vft those prmWmL
APPUW
WAAMNG Failure b secure Worker% Compa wbon cwerap Is urdawhd end spat subleci an walla r to criminal
penalties and civil Ones up to arm hundred Moveaid dollars ($tOOOOOI in addhon b the coal of Or corrVansaWftI,.
danages as pmvrded tar in secbmr 3M of the labor code mtie gist. and Morneyk iras_
COt SMIICTia# LENDING AGENCY
I hemhy afftm ender panache e(pultiq Eat there IS a C%Manichan LeAlK Agency for the oullahr of Ile wtrk tor I
wroth thw permit is wcW (Sac 3rJ91T Chr C )
LFIVOER'S ftANE
ILDWSAWREM
I Wf* that I have rew ft appitcation and golaigllithe ttll " irft7r is gear i agree to rurrrpt willh 0 coy ami
armwees and sib ralatIng a try aut3OLM anpregrawm d that =Pttr hr
ender upon Ere above vieftoead pr000h r for
fr{e�c t J
i OF 6�
1111E
APPLICATION DATE �� � i �k'S ?iC# �... I
ISSUE [SATE -7/ 1 1 % ,,S PERMIT# _M_-N S —
TYPE CONST OGG GROUP
ZONING SETBACKS
FRONT RW
REAR ❑
SIDUSIDE STREET RW EI
SIDE 0__
PROPOSED USE-- .I
i
# DWEL UNITS # STORIES # BEDROOMS
DESCRIPTION
$Q FT
FACTOR P SF
ADJ AREAiVALUAT1OPt
SFWADD/REM
.7►
w
t3stlolt?eck
OR
SOL 4a re;
LL
I oovspa
i
z
2
iC°rlrsm
Re-Root
Valuation Adl Area
QUANTITY
DESCRIPTION
FEE
<l
m
a
142
P1P—XV4A(1(<;�T
CONSTRUCTION
PLAN REVIEW
ELECTRIC +
PLUMBING
MECHANICAL
INSPEC77ON FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTNON FEE
PRE-ALT FEE
BSAt= coo
TOTAL FEES
COMMENTS
RECEIPT R �—a" �— PAID BY CiNr VA UDOXION e—knn, ,,,
WHfNE — Deparhnent Copy YELLOW — Finance Cagy — Asso low Copy GOLDENROD — Ole Caps, GREEN — Appllcord s Copy
r
CITY OF DIAMOND BAR, , .•+-
INSPECTION RECORD
SETBACK/ LETTER
FOOTINGS FORMS
UG PLUMBING
UG ELECTRICAL
UFER GROUND
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
SHEAR WALLS EXTERIOR
SHEAR WALLS INTERIOR I�
ROUGH MECHANICAL
ROUGH ELECTRICAL 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
T C of OCCUPANCY 11
GIRT. of OCCUPANCY
Le
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL7
HOOD
T-BAR
INTERCEPTER
HOT MOP/SHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOL/SPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P-TRAP
FENCE / GATE/ ALARM
FINAL POOL
WALLS
WALL FOOTINGISTEEL
WALL STEEL 1 s7( ) 2ND( ) LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
ING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE