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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION wwwcOvolidaamoodbarcom budding@diamondbarca.gov
JOB SITE ADDRESS 2 6 w b Q l K iC.v10 I i
APN LOT TRACT
OWNER
ADDRESS 2 KIM> v_
CITY Cl (010nQ�'+�L' ZIP TEL 0 i b - (:AO
APPLICANT ��.I> -'.. SC1 i A:Q 1N TEL 18 83)7"12- t-71(a
CONTRACTOR 1' ?19, - F L'.a 3-�
ADDRESS i iltit�
CITY �c►5 A.'l��tt'_�. ZIP *:Oi� TEL g10-A q('0
AACHIENG/
DESIGNER
ADDRESS
CITY ZIP TEL
01100-BI m DECiARAT1611
I bed Weer wider penalty of pertury fat I am mrnp, his :a Corn=r a State License Law for to reason(ai
Micatod below by the chKIcymuk(s), I heva pWad sari W the app!kats itsm(s) (Ssepon 70M.5, BeMlness and
Pro:lmaiorp CA* Any 94 of pa * prat rerprwe a perndi to ecieri rw'1, elver, Imp—, dew of repetr, any
abuRwe, twbr b 1 s Isstslrpo, efw requlraa tMa applipant Mr pre pemR to file a dgrred atammxrt thel he of ae
N ptamlattesiM of tillst�trttneeTor'eStabsflossesLaw (Chapesr9)CormrwanrblgwMhSection
70M of Obtains 3 of tivr Business and Ral+ewlora Cade] or Olaf he or Rho as exono from koensure and the bail for
to atteped emrt puns Any v QrW of Section 70315 by"applIcarf for a permits r4ects the apptiram to a civil penalty
of trot mas Ugn fire oundmJ dollars 0001
(j1 asowner ofthe prolip",ormyamptoyessvft*spasae$I*sole mmperisal will do()all oforUpori d
of the win#, and the sttucbae Is one Intended or offered M sale iSectim 7044. Business and Prolesalona Oode The
Conracrol9' Site License law does rat"to an over of promortywho through employees' a personal effort builds
or improves the Wvperly, provided that the Improvaments; era sat Irtlended or offered for sale d have eor, the building or
Improramem+s sold MMn one year of completion, the Omar Builder wtil have the burden at proAng thel h was not brill
or Improved for tit purpose of sees I
U I, as owner of the property, am exolUSlvafy contracting with licensed Contractors to construe the proles (Sedan
7C44, Business and Profoulans Coda The Contractors' Stale Lcense, Law does not appy to an owner bf property who
buLdo or Improves Mellon, and who contracts for the pro]odowM a licensed Contractor punt to the Cortrut i State
License cew )
LJ f am axompt horn ikansure under the Corrtracsor a 511eDs Uperise saw for the fallowing nsasomM
Daze Sign
By my signature below I eclavotedgo &tat, except fir my pl rvenal re9i0 m in which I mO hwe nodded for at Nast one
year prior W ecmplydon ail the 'snprovvesents covered by thb permat Cnot icy sel a structure >fsat I have bait as an
owner bustler If It has not been c mbmctad Hits arhlrey try k4ntmad antraCmrs f understand that a copy of tiM
applicable Law, Sacdon 1044 at 00 &aNness and Protseda a Coda 13 avaltabia Vison reQcraM WfM Otls applimon IS
submitted or at iris epliaehq Web she hry *WW 14* ce Wksis a hunt
UCEMS ED CONTRACTORS OECLAAATIM
I tat" afbmt wrier penalty of *ory = I am Items rr4ar provislorii at OwW 9 (counmencing whfi Section 71XJ ))
of Ifvlcon 3 nine BUSLva aid Protesekos Code orb any kimas N or full forts and effect
LIC94S 0-4s G 3 (0 LID No1-7004 (o
Exp OATS 3 • A I 10 CONTRACTOR
it ORKERI TEND TIBN
I HEFIESY AFFRM LENDER PEt STY OF MI IUiiY ONE OF THE FOLLOWNG DECLW7IDNS
I have and w& malef n a CarGllegs of Consent to Soh m9xv for wafer s Cwnfcansatlan, as provided by
Section 37M 0 thr Labor Code for ^w perfolem mk of doe work for vi"O tNs pamd Is issued
X I have, and vO Wokv'e 4Aompersatbn k a, as r"Ared bySactlon 3700 of the tabor Code for
Ore perPormar" of to work for wfarit We permit Is Issued W A"r's Commmabon Insurer" Cartier and
Policy Number are CAPJWR 5Wf.• lf4 403"71
PDM N NKR I-waL—in
MaS SECTION NEED NOT BE ONPLEWIF THE POW rS FOR ONE HWDRED DOLlM SIOO OR LESS)
I tartity7et In tN gaifomrarxe of the waklbr wMch This pw= Is Issued, I NMI not employ" peram in any manner so as to
OWN 4UW. t 3 the Worker a Or peaoation Laws of Lbtllbmla And agree that If I should become wbjw to the K'a'frar's
ComperaMlon pmvMhu of Sect1w, 3700 of the labor Code I mall fothtMth oomph' with amit pmNsiam
DATE APPLMANT
WARNING Fogure to aecure Worker s Compensation coverage Is unlawful, and shag sAact an empvnr to criminal
penalties end chill 8nu up m one hundred thousand dollars (3100,000), ih eddidon to ate Coal of -Is Xmiril$man,
damages as provided for In secdon 3708 of the Our code, Interest, end attar oy'o tees
CONSTRUCTION LENOpiO AGENCY
I hereby affirm under penalty of y>*ry sisal mere Is a ConSM Oon UndkV Agency Pon the performance at the work to
which this permit Is Issued (Sec 3097 CN C )
LENDER S NAME
LENDER S ADDRESS
I me* Olaf I have raid this goication rub stain brad N etas Information is direct I"to comply with d co sea
comity ordrances and ataba Was relating to Wilding oontstNtdan and hwavy acanonto of the caurrty to
enter upon the above mentioned Property for inspecdm w4aw
aIIC.0, Sa! a 2 a
PEAMI� {PApIT! t
SI TUREDF?ERM[T7EE DATE
APPLICATION DATE * « t�PIC0
ISSUE DATE - PERMITri
TYPE CONST OCC GROUP
Scope of work ,;1 'e Yl tl'
Z �- Y.ial lxel ? h • I� b+l b1 _
k DWEL UNITS 0 STORIES 0 BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ ARE/WALUATION
SMADDMEM
t3erege/GarpM
inPatlo/Deck
rL
Paol/Spa
_�
Ra-Roof
Commercial
m
VtBt1e+A�oir
Adi Arm
QUANTITY
DESCRIPTION
PEE
c9
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUM13ING
MECHANICAL
INSPECTION PEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
r�
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
/ C
PIC PAID 6Y p +� VALDATION
RECEIPT r _�. PAID BY _� d T VALIDATION _
WHITE -- Department Copy YELLOW — Finance Copy PINK — Assessor Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
------------------
INSPECTION
SETBACK! LETTER
DATE
INSPECTOR
------------------
INSPECTION
TRACT AND LEDGER
DATE
--------------------------- -
INSPECTOR
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG PLUMBING
T-BAR
UG ELECTRICAL
INTERCEPTER
LIFER GROUND
HOT MOP/SHOWERPAN
SEWER LATERAL
SEPTIC/CESSPOOL
. .................
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
PGOUSPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMING/VENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( C
GAS TEST
ROUGH PLUMBING
PRE GUNITE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P-TRAP
'DRYWALL
/ GATE/ ALARM
LATH (PRE)
-FENCE
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 157( ) 2N0( LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTIDN
RO FRAMIfdGPLANNINGAPPROVAL
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
T C of OCCUPANCY
CERT. of OCCUPANCY
COMMENTS
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE
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