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`��T' � C1TY OF DIAMOND BAR
��ITF I I i � i DEPARTMENT OF COMMUNITY&D�VELOPMGNT SERVICES �
������, ��.�. "� 21810 Copley Drive,Diamond Bar,CA 9176� pRE��
� � 909 839-7020 Fax: 909 861-3ll7 Buildin Ins �ction Hotline 909 839-7027 �
, � � � � > g P'• t � �o�'���'° �t FIRMLY
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� � �'"'�'�"�" BUILDING PERMIT APPLICATION
� APPLICATION DATE: S I 1 S I��} p/C1t P'C'Z \�^� -�S'�,
oc JOB SITE ADDRESS R . /'
a ISSUE DATE: L.- a - a r��y PERMIT# � y' �1����
z APN LOT TRACT �y— �`
o OWNER�To�Q. �onl'cYIYhQ �tf[a�]CfiL TYPE CONST. ! � rt� � OCC GROUP:
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� ADDRESS
� CITY ZIP TEL. S a. OI'$7S ZONING F ONT KS RW ❑ I
a APPLICANT TEL. REAR ❑
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� SIDE/SIDE STREET RW ❑
o CONTR,4CTOR ��� � �in�' h ���% 1, r SIDE ❑
oro ADDRESS � l7 �J . " � G PROPOSED USE�(TO DTt�IXEl� nen��l'�CtY1�f1Ci [Xlt�f�lCdL dhC� (.IbQ7QC�
i � cirv�.�(CC.i���'► ZIP TEL. 6Y���-7x�'o ����,,}�om-b huncli�n acce.ssi6le.►�e�{n�,rr_
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" ARCH/ENG/DESIGNER� S�VC IA�1L T
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o ADDRESS I$�LO3VlI�A LI47�S� #DWEL.UNITS ' #STORIES #BEDROOMS
z CITY � 21 ZIP TEL. ab 9I2 3
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
OWNER-BUILDER DECLAflATION
¢ I hereby amrm under penalty of perjury Nat I am exempt trom the Contractor's State License'Law for Ne reason(s)� SFR/ADD/REM �
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p indicated below by the checkmark�s�,I have Dlaced next to the aDDlicable item(s)[Section 7031.5,8uslneu and Garage/Carport
o Profeuions Cade:Any city or county thal requires a permit ta construct,alter,improve,demolish,or repair,any
z structure,prior to its issuance,also requires the applicant for the permit to file a signed statement thal he or she � Patio/Deck �
a is licensed pursuaM to the provisions of the Contractor's SWte License Law(Chapte�9)Cammencing witb Section W
W Pool/S a
� 7000 ot Division 3 of the Business and Professions Code]or that he or sbe is ezempt hom licensure and the basis for � LL P �
N the alleged ezemption.Any violation M Sec6on 7031.5 by any applicant tor a permit subjects the apD���nt to a civil penalty; �7 . . �
� of not more than five huntlretl dollars(3500). � . ZQ Re-Roof � � .
o (,)I,as owner of ihe property,or my emptoyees wiN wages as their sole compensation,will do(�all oT or(_.)portions � Commercial"`` % g� �
0 01 the work,and the sWcture is not intended or oNered for sale(Section 7044,Business and Rofessions Code:The m
� Contractors'State License Law does not appty to an ovmer ot pwperty who,through employees'or personal eftort,6uilds '
� or improves the property,provided that the improvements are not intended or offered for sate.It however,Ne building or
� improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was nnt buitt
p or impmved tor the purpose of sale.). I
� (_J I,as owner o1 the proper[y,am exdusively contracting with licensed ConVactors to construct the project(Section
z7044,Business and Professions Code:The Contractors'State License law does not appry to an owner of property who Valuation � � Adj.Area:
� buildsorimprovesmereon,andwhocontractsforiheprojectswithalicensedContractorpursuanttollieContracrors'State QUANTIN DESCj31PTION FEE
Y License Law.). - u �
p am exempt hom licensure under the ConVactor's State License law for the Ioliowing reason(s): a .
I � � ; w '
zBy my signaNre below I acknowledge that,except for my personal residence in which I must have resided tor at least one W
� year prior to completion of the improvements covered by this permit,l cannot legalty sell a strucWre that I have built as an w
� owner-builderitithasnotbeenconstmctedinitsentiretybylicensedconhactors.lunderstandthatacopyoitheappliq�le �
Q law,Sec[ion 7644 ot ihe Business and Professions Code is available upon request when this application is submitled or at � '
X the tollowin Web site:htt `�
g pAwrw.leginfo.ca.gov/czlaw.html. Z ��/
w DATE: SIGN: � ��"� �
0
� LICENSED CONTRACTOH'S DECLARATION � � '" '
H a
w I hereby aBirm under penalry of perjury that I am licensed under provisions of Chapter 9(commencing with Section 7000) ' `
m of Division 3 ot the Business and Protessions Code,and my license is in full force and effect. J , D�
y LICENSE� LIC.NO.: _T�CJ rS`"1 z
/,�`�� a
o DATE: � CONTRACTOR: _
Z U
a WOflNER'S COM .ATION OECIARATI N g ,
� I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLAflATIONS:
oI have and will maintain a Certifirate of Consent to Se141nsure for Worker's Compensation,as provided by CONSTRUCTION: '�J'4�o • �O
� Section 3700 of the Labor Code,for the pedormance of ihe work for which this permit is issued. p�qN REVI EW: 4'�G�`- 51
� �I have and will maintain Worker's Compensation Insurance,as required by Section 3700 ot ihe Labor Code,for ELECTRIC: �7 ��
� the peAormance ot ihe work for which this permit is issued.My Worker's Compensation Insurance Carrier and — r
a PoliqNumberare: PLUMBING: ��y--.1..�p�
� CARHIER �C�`te.��(��� �� J�U^lr4�L- MECHANICAL: .3`l.,P�A_
Z POUCY NUMBER A 7j��r. �7.r0 INSPECTION FEE:
c�r --
� (fHIS SECf10N NEED NOT BE CAMPLETED IF THE PERMff IS WRUNE HUNDRED DOLLARS(5100)OR L.ESS�. � /p
� ISSUANCE: I ��e�
o I cerlify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to SM I P: ���
0 6ecome su6ject to Ue Worker§Compensation Laws of Calrfomia.Md agree that if I should become subject to fhe Worker's
w Compensation pr ions ot Section 370o ot the Labor Code,I shaii torthwim�c�oLmply witn those provisions. EN ERGY P/C: 4��• �'�I
J s 4 co
J DATE: �IUAPPt1CANT:_�F�-T aN �P � �M� Ci�
� " ��----�—�-� �7��I r ENERGYPERMIT: L
� WARNING:Failure to secure WorkeYs Compensation coverage is unlawlul.and shall subject an employer io criminal RETENTION FEE: � %• �
w penaRies and civil tines up to one hundred mousand dollars($100,000),in addiUon to the cost of the compensation,
� damages as provided for in section 3706 of ihe labor code,interest,and attomey's fees. PRE-ALT FEE:
0
a CONSiRUCTION LENDIN6 AGENCY BSAF: �'�
w I hereby affirm under penalty of perjury ihat there is a Conslruction Lending Agenq for Ne peAormance of ihe work for
� which this permit is issued(Sec.3097,Civ.C.).
� LENDER'S NAME: �'�' '�
� LENDER'SADORESS:
� I certify that I have read this application and state that the above informatlon is cortect.I agree tu comply with all city and TOTAL FEES .C"'.�. 1` . '3(o -
Z counry ordinances and state laws relating tn building consVuctlon,and hereby authorize representatives of ihis county to COMMENTS: ��
p enter upon ihe above-mentioned proDerty for inspection purposes.
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¢ PERMITfEEWVM n +Qlc �1��14\3 �f a"�'34 �+'Y�
� SIGNATUREDF PER OATE RECEIPT#�W 4'� PAID BY:����VALIDATION:
W HITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy .
CITY OF DIAMOIVD BAR _,. '
INSPECTION RECORD � ` �
, 0 � � . e . e � B , . � .
SETBACKI LETTER TRACT AND LED6ER
_
F06TINGS FORMS,, _: SWITCH GEAR
SLAB':•. = � = COMMERGAL HOOD
UGrPLUMBING,':� ; _ ��ir, . . - :�: T-BAR
UG,ELECTRICAL.,. = INTERCEPTER
UFER`GROUND�:' � ` - - HOT MOPlSHOWERPAN
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING RQOF DRAINS
FLOOR SHEATHING ROUGH CONOUIT
SHEAR WALLS EXTERIOR POOL/SPA"; �< _; , , � i'��' �' �
SHEAR.WALLS INTERIOR . ." ROUGH PCUMBING -� } � ' �� `'
_. .
• - -�
.
FRAMINGNENTING -�-`�.. _ _ _
, .�;�'� �} � ROUGH ELECTRICAL�: `���: ;; �. :"��' �_..- , , <;
ROUGN�MECHANICAL `'�:_,,, ' , ;�,. �;;, _:�-. � ' �'" ROUGH MECHANICAL: � , .�:�,, - ' �_
, :,. , .. ;, . ,, � , r
ROUGH ELECTRICAL'W( •�).0� ) �1fL 4 . , ' -: Y . ':> '. � GAS TEST . � _ ,: . ..; -
. ._ _
ROUGH PLUMBING PRE GUNIT,E- . - �;�
., . .-. . � . ;
, . ..- . . _ .
_ .___ __ F
.. ' .. .,-' .." .� 1 �. .. '..I; '-,:
INSULATION WALL POOL PRE.DECK BOND�NG ,_�. . ` " r:�
INSULATION CEILWG P=TRAP ' . � � o.�
DRYWALL � � -FENCE/GATE!ACARM, �
LATf�(PRE) FINAL POOL � ;: . --
LATH EXTERIOR ' WALLS:
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�T( i 2ND( )UFT
SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL ORAIN/SEAL
GtIS METER RELEASE WALL FINAL
SPECIAL INSPECT�ON RO.�FRAMING PI.J�NNINGAPPROVAt `- � ;, h ;;,5_
� _ �.,, .,_, ;
�INAL'�BUILDING ' �i ��,�a � � '�� ' � RUUGHfIREAPP,ROVAL �
FfNAL MECHANICAL . ' _ - -,-`. : .�- .". '= :' `, '° FINAL FIRE OEPARiMENT ._ , , �
FlNAL ELECTRICAL ; . " r 'FI.NAL�P6ANNING �;` :' ,�, � _ .;,r
�
FINAL PLUMBING , :, : - . .;� ' « .. :, ... � ' . : '.. FINAL ENGINEER{NG/PW , f''�., . '. j �' � '
T. � , � � •' -. , ,., _ ' ;_,. _ '.-';,` ..�� „ - : ' ; FINAL COMMUNITY SERYIGES ; � ,:� - �.,•`� .:�
, , . - .
CERT.;of OCCUPANCY ; � ;' t ;.' �:'. FINAC HEALTH DEPT. , ; . `
FINAL INDUSTRIAL:INASTE�: '� ' � ''� �
,,
- - . � _ � _. _
COMMENTS: �
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�IV � �' p� � r d�µ-�.
—�o. L w ���.' fl 10�� �CtC����l'C � 1���'�dIVT .
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Page 1 of 2
CITY OF DIAMOND BAR
RECVD BY: LALLEN 01000006716
PAYOR: EDDIE LIU
TODAY'S DATE: 08/04/14
REGISTER DATE: 08/04/14 TIME: 08:57
DESCRIPTION AMOUNT
CUST ID: 1.000
BLDG ADM SP REV FD - C $2.00
CUST ID: 1.000
BLDG PERM FEE-CONII�IERCI $546.90
CUST ID: 1.000
SMIP FEE - CONIMERCIAL $6.30 .
CUST ID: 1.000
PERMIT ISSUANCE - BLDG $35.22
CUST ID: 1.000
ELEC PERM FEE - COMMER $57.06
CUST ID: 1.000
PERMIT ISS FEE - ELECT $35.22
CUST ID: 1.000
MECH PERMIT FEES - COM $59.88
CUST ID: 1.000
PERMIT ISSUANCE-MECH $35.22
CUST ID: 1.000
PLUMBING PERMIT - COM $59.25
' CUST ID: 1.000
PERMIT ISSUANCE-PLUMBI $35.22 '
CUST ID: 1.000
RECORDS RETENTION FEE $14.00
CUST ID: 1.000
ENERGY ENFORCEMENT PRM $54.69
http://192.168.1.215/gas2.32/wa/ft/17ded3772e52da853475002fd82a2f69/1/28878 8/4/2014
Page 2 of 2
CUST ID: 1.000 -
BUSINESS LICENSE $10.00
CUST ID: 1.000
$1 STATE BUSINESS LIC $1.00
CUST ID: 1.000
RETURN CHECK CHARGES $15.00
TOTAL DUE: $966.96
TENDERED: $966.96
CHANGE: $.00
CASH . $966.96
REF NUM: RETURN CHECK FEES
http://192.168.1.215/gas2.32/wa/ft/17ded3772e52da853475002fd82a2f69/1/28878 8/4/2014
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