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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21910 Copley Drive, Diamond Bar, CA 9176S
(909) 839.7020 Fax. (909) 861-3117 Building inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS as SC3 �1+=+�
APN LOT TRACT
OWNER
ADDRESS -Zt0XQ1 1 6 td L / AO
CITY 41 A%-r` ZIP TEL
APPLICANT % _%�` IF KdA M TEL 71Q
CONTRACTOR f` �? +��t+
ADDRESSwT���Z�� m
CITY r ZIP 'W40 TEL " 2-00
ARCH/ENGIDESIGNER Cr.
ADDRESS !�.* / ►��
CITY Q411 sL ZIP Y24G1S TEL
I bereby aiflrm most ponaity of perjury that I am arernld from titre Caetrador s State Ikbcae taw fa the reason(s)
Indicalsd below by the ch I have Demo neat to IN applicable flem(s) 19ec11iart 7Q91A Brdress and
Prohnsim Dada Any chfy or tourdy that requires a panrt Ioconstraint; aft Improve, dernndlsk or raWr, any
struciae'e, prior m he Isau mm, also MW m the Mildew for the permit to fits o Illinois .talented hnat he or alto
Is licensed pursuant to the provisions of this Contractor's Slats Lkree Low (Chapter s) Commencing ahh Saelfon
7131C0 of lm4sbn 3 of the Business and Freteplop Cade] or Ilia: M or d+a is exempt from ldcanrsure are that bast$ for
dvt edogod o omptiou fury vfoia4al d sKilon 7=1 S by any aPDikani tarapsmul s4ow the sPlificam a a Lrvit penalty
of not more than eve hundred 060 tam
U i as owner of tfa property, or my emplayess **wages as their sold will tm U all of aU ptgyarta
of the wN and the ehlicture R fat Intended or offer ror We (Sec"" -on i094 gvelttess and AOfaSslono CLde The
Coolrsdors Slots Uc"as Law does not aptly th tin armor or pngerty who through i mpktyeae' m personal art, btxtds
or Improves Is properly di wded that the Imlivormadb as not rounded or offered tar sale if tawava, the building a
improvematnt is add within one year of completion the Owner Builder will have the twrtlan of pmvdlg that h was rat bran
or Improved for the WATIM of safe }
(j I as owner of ft laWli y, am exclushatty corltael tg wish licensed Contractors to Pit the project Macaw
7044 Businms and Cods The ConbnctwsStates Lre se Law duos not eA* to to owns of warty who
h didsorrmpmmthersen,andwhocondacffilamapraleclswitha1cseeQContactorIarauaMtrytieCArmaatora'slate
Lk mac Law)
U I am ermpt from fdoneraa under Ire Co lraelor's Stale License cow for the following masome)
By my signature blow I atkrnsadadge final accept for my personal midaim in whitish I must trace raided for at lest one
Yea pnorm camplebohh of the ha maned try ftfiarnattahnot bodiffy sell a ffiru tune tte3l tare huh m an
vatltx-6ttl r d R has not been mra#teted in tit errtfttdy try licensed WirbloW l trrxmtand ltal a tapy# pfl®tIe
few Secmn 70t4 d the Business so ProfesoMarts Code is avallabfo upon rBWast when this appi setlon Ia eesbmitmd a at
the VktAte httpAvwwiegni'caFVfcaLawtdmf
GATE SIGN _
LTMN ED CONTRACTOR'S DECLARATION
I hereby affirm urft persty W perjury fhb 1 am licensed under Xxivisionsof Charier 9 (obmmentdrtg with Section 70001
of Division 3 d the Birldhou and Proteaeans Cot, and my Bserae is In fWl lone and anal
CENSE CIASS 9 LK NO
ATE CONTRACT04
WORKER'S COMPfiMATtM OW40ATION
t HEREBY AFFIRM UNOER P9043YOF PERJUFri ONE OFTHE FOLLOWING DECLA144Ti0NS
I lave and will msk.abt a CaCllcate of Consent to Self Insure far Worlier's Compensation as wWAod t7y
Secfloe 3700 of 4a Labs Code, ter the pa.Yhorrnarce of fie we* for which this permit Is isivol
I here and will mairdatn Woforb Corrgrensadm Insurance as naq€rrad by Section 31M of the Libor Code, for
the, perrarmar isofihaworkins'w10thispermitisisnuadIvyWaltersCompansabotinyurersaCa7'erand
Patty PER
K 'Mom
{T}BS=MNWMNOT IEMWLETEDFINEPf3WlSFOR ONEtsl fitkiARS('i11101piLES%
I cerety dh� eh tlhe paeiatrernee d the wrak his vdtlefe aI� Perrnt s shad I snail rctt emPby any ratsart to eIy mstnw a sa st
become atteerx m de MYldtars Cwpwr mWn Lrlwv d Q*Iornia And agree diSt rt t stautd tetolte subject m Cie Nat irk
Comp Seckn 37DD of WWI
WI rlhrAth comply v Iho a prorEabna
OATS r APPL1CAfTi _!!+a/
WARNAG failure to secure Wiorkzrb Compnaatpn wimp Is tanawful and 00 sub]eet an employer to criminal I
paaahbes and aW flues up to one hundred ftwW dollars tSIOD ODOI In addition to the cold of Cho eompansiW,
dens gee as pmvktad is in secbm 3?OB o1 the later cosy incest and adorney'a tea$
CONSTRUCTION LIENOING AGENCY
I he" affirm under penalty of perjury, diet there Is a Qnstruciiaf Landing Agency for the petb manta of the work for
whm fta$ Permit Is Issues (Sac 3M Chu C j
LENOFA S NAW
iftdi S S ADDFM
I carify that I Have and this applhallm and Gals Cif Ma» bare tsormatlnt Is correct I agree to comply, with an ady and
County ages and shim laws relating to budding construction and htmby surdiam mposardstvW of the county to
e inter uDm Ire abon-marl red pfomnty for inspxtrn xrpoasa
61e s
MMPWEAMnrrEE'-��
PRESS
FIRMLY
APPLICATION DATE /G 1 PIC# l
ISSUE DATE +I bc, i tS. PERMITfy _- --_ _ 1 S — � � 9
TYPE CONST OCC GROUP
ZONING SETBACKS
FRONT RW LQ —
REAR '
SIDEISIDESTREEY AW ❑
SIDE ❑
PROPOSED US M ti!r l
W'
tl
M OWEL UNITS #STORIES Of BEDROOMS_.......
DESCRIPTION
so FT
FACTOR PSF
ADJ AREAIVALUATtON
SPIVADWREM
PatkalQsck
ewe.
Pool(3pa
f9o-f400f
Gf
Conrt=onsdel
Cot
Naluatlo
Adt AnNis
OUANTITY
DESCRIPTION
FEE
' tap
1
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ca
I
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CONSTRUCTION
PLAN REVIEW I
ELECTRIC S '47x ~ b
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE 1_ !
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE _ �LCo es.
PRE-ALT FEE
SSAF L
EI
I
TOTAL FEES �12L
COMMENTS
RECEIPT a PAID BY ,Ig'q VALIDATION �• Fes___ i
WHITE — Deparbnent Copy, YELLOW — Finan;e Cop/, PINK -- Assi asor Copy, GOLDENROD — Fps Copy GREEN —Applicant's Copy
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
CENT. of OCCUPANCY
COMMENTS
CITY OF DIAMOND BAR
INSPECTION RECORD
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL 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 FOOTING/STEEL
WALL STEEL 15T( ) 2'9 ) LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
RO FRAMNG PLANNINGAPPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PIN
FINAL COMMUNfTY SERVICES
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE