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---�� --- CITY OF DIAMOND BAR ' � I COMMUNITY DEVELOPMENT DEPARTMENT ;"� ': -,�. 21660 E.Copley Drive Suite 190 • PR ESS (909)860-3195 Faz(909)861-3117 ''"' y BUILDINGPERMITAPPLICATION f FIRMLY ¢ JOBSITE /�� / S f-�/���G� APPLICATION � r PERMIT P/C o ADDRESS/ � Y DATE �L �NUMBER q � � APN LOT TRACT ISSUE . 7YPE OCC , DATE CONST. GROUP p OWNER ��' L � n ADDRESS �� ZONIP�G SETHACKS z CITY ZIP TEL. FRONT R�/�/ ❑ Q APPLICANT TEL. SI�SIOE STREET RW O � CONTRACTOR SIDE ❑ ADDRES � � CIN ZIP � L PROPOSED USE W� w ARCWENG/ Z DESIGNER ' '� , n a ADDRESS NO.DWEL. , M1a NO. �� j CITY ZIP TEI. . UNITS STORIES BEDROOM� � cn DESCRIPTION SQ.FT. " FACTOR PSF ADJ.AREANALUATION p� OWNER•BCILDER DECLARATION SFRJADD/REM - O p 1 HEREOV AiFIR1A UN�ER PENnL7Y OF PER/JRY TY1AT 1/JA E%EMPT FROM THE CONTRI1Ci0RS LI• Gef3ge/C2fpOA W CENSEUWFORTMEFOLLOWWCREASON(SEC.7o71.5BU5ME5SMIDFROFE55tON5CODE:ANYCITYOR (n V CIXINTYWHIp/FEOUIRESAVERMITTOCONSTitUC7,AlTEP.II.IPROVE.DEU0U5H2ORREPAIRANYSTRUG W z 7UAE.PRiOR TO RS ISSU1INC[,ALSO R[WIRES THE APPIICANT FOH SUCH PEWAiT TO FI�E A SIGKED P2Ii0/DBCk � STATFMENT THAT HE OR SHE IS LICENSED WRSUMIT TO 7HE PROVISIpNS OF THE CplTMC70R5 ll-. LL , , � CENSELAV��CHAPTERY(COMMENCINGWITHSECTqN7000�OFDIVISqN]OFTHEBUSMESSAV�VRO� POOVSDd FESSqNSCODE)ORT/ATHEORSHEISEXEMPTTHEREFROMMDTHCBASISFORTHEALLECEDE%EMP•� C7 ViION.ANYVIOLATqNOFSECTION7071.58YM1V�PPLI�ANTFORADERMITSUBJECTSTMEINPLiCANTTO Z Re-F{OOI . , A LIVIL PENALT'OF NOT MORE iHAN FNE HUN�RED OOLURS(SSOD).): � ❑4�SOVINEROFTHEPROPERTY,ORMYEMPIOYEESWITHWAGESASTHEIR50lfCOMPENSATION, ❑ COR1R10fC181 Z WILL DO TNE WORK,AND THE STRUCTURE IS NOT INTENOEO OR OFFERED FOq 5�LE(SEG 70��.BUSb J N NE55 M!D PROFESSIONS COOE:THE CANTRACTORS ULENSE LAW DOES NOT AVPLY TO MI OYlNER OF � . PROPERTY'M10 BUILDS OR IMPROVES 7MEREON,AND WHO DOES SUCH WORK HIMSELF OR MCRSELF OR � THRWGHHISORHEROWNEMPLOVEES.VFOVIOEDTHATSUCMUAVROVEMENTSARENOTINTENDE�OR m ' � OFFEFEDiORSAIEIF,MOWEYER7MEBUILDINGONIMPqOYEMENTI550LDWRMINONEVEAROFfAMPLE• � Z 710N,iNE OWNEq�BU1lDER WILL HAVE TNE BUROEN OF PFONNO 7NAi HE Oq SHE DIO!qT BUID Oq = MPROYEFORTNEPURPOSEOFSALE). . � . O 4 AS OYMER OF iHE PROPERTY,MI EXCLUSIYELY CONTMCTING NATH IICENSED CONTRACTOHS � TO CONSTRUGT 1HE PROlECT(SEC.70��,BUS:NESS ANO PROFESSIONS CADE:THE CONT{UCTONS LI- V3IU011q1 ADJ.AREA � W CENSELAW�OESNOTII7PLYTOANOWNEROFAPROPERTYWHOBURDSORkAPROVESTMEREON.AND � NTqCANTMCTSFOIiSUCHDROJECiSWITHACONTR�CTOR(5)LICENSEDPURSUAHTTOTHECONTflAP QU,qKj�N DESCRIPTIOW � FEE Y TORS LICENSE LAW). � O IIUA ExEIAPT UNDER 5EF B.i P.C.FORTHIS RE�50N Q � � � � . . - U � . - � — - � 6 _ DA7E OWw[R U Z W • . � � . ¢ LICENSEDCONTRACTORSDECLAFlATION W . OC IXER[BY AFFIRM UNDER PENALTY OF PE0.IURY n/AT IAM IICENSED UNDER PRONSpNS OF LHAPTER � _ � Y�GbMMENCINGWRH5ECT10N7000)OFDMSIpN70FTMEBU51NE55ANOVROFE5510NSCO0E,M1D Z �� MY IICENSE IS W FULL FORCEANO EFFECL m � � LICENSE CLA55 �� LIC.NO. ���+ �� � j V DATF/ �corrrnncron _ a w . � WORKERS'COMPENSATION�ECLARATIO Q � IHEREBYAFFlWAUNDERGEN�LTYOFPERIURVONEOFiHEFOLIAYfNG�EC1AfUTIONS: Z � __IH�VEANDW�LLMAIN7AINACERTIFiCA7EOFCONSEMTOSELF�INSUqEFORWORKERS' ¢ 2 C04lENSATqN,ASGRONDEDBVSEC710N]fooOFTHEUBORCOOE,fORTHEPERFORAIANCE W Q /OFT11E WOFN FOR WMILHTMIS PERMITIS ISSUED. � I� w �IHAVEANDN�LLAINiNTA1NWORKERS'OOMPENSATqNINSUFlANCE,ASRE0UIHEDBYSECTKK� � ^7 � ]70oOFif/EUBORCODE,FORTHEPERFOREIANCEOFTHEWOPKFORWHICHTH6FEFYM1T15 r�.,� / LSSUEO.AAV YIO/q�(ERS'COAIPENSATIDN INSURANCE CARpIER AND VOLICY NUMUER Ai1E: CONSTRUCTION �/ �� Q L� �� � � CARWER��`�'� 1/ PLAN REVIEW , 0 POIICYMIM9ER �'l ELECTRIC Q � (MSSECIIONNEmNOTBEmMPIEimOFiFEPERAt6WROnEH1N%�IDOq1A�L5(f1�lOfiLES51 PLUMBING ��r�i Z ICERTIFYTMATINTHEPERFOPMMICEOFTNEN'ONKFORWMICH7HISPERM176155UED,1 MECHANICAL � � �� (.�} . SNAl1 NOT E4PLOVANY PERSON W ANY MaNNE �5 TO BECOME SUOJECT TO THE / Uj WOpKERS'CAMPENSATIONLAWSOFGAUF J�l �DIIGREETMATIFISMOULDBEGOM[ INSPECTIONFEE �r SUDJECTTOTHEYqRKERS'COAIPENSAt O.SIONSOFSECTION77000FiHElABOR /� s CO�E,I SHAIj F. n�win�caaa�r vntH n s aovisior�s. ISSUANCE * o i p DATE. C � APPLICANT: SM(P � •� WARN!NG:FMURE TO SEWRE VdDRKEHS'COIAP SATION COVERAGE IS UNUWFUL,AND SHA;LBE ENERGY P/C � �y SUFLIEGTANEMP�OYEHTOCFiMINlLLPENA�TIE ANOGIVILFIKESUPTppNEMUNDREDiMOUSANO ENERGYPERMIT OOLUAS(Stoo,00D),INMDITWNTOTHECOST.FCOMPENSATqN,DN.tAG[SASPROVIDEDFORN , ¢ SECTqN37oeOFTHEUBORCOOE,MTERES uDATTORNEI5FEE5. � RETENTIONFEE: � � OLONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' � IHEREBVAFFIRAIUNOERpENALTYOF0E0.JURVTMATTHEREISACONSTRUCTIONLENDINCACCNCV FOR THE GERFORMANLE OF TME WORK FOR WHICH TMS PERMIT IS ISSUED(SEG 7oY�.CIY.CJ. Z W � lENOEF'S NAME � F- lEN0EH5ADORE55 � � � � � � � � TO7ALFEES � � ICERTIFVTHATIHAVEREADT 'SAPPLICATONANOSTATE7IUTTIIE�BOVEINiORMATdJISCORRECT. � IACREETOCOAICLVYVITN ITyAN7fAUNTYOROINANCESANOSTATEUWSRELATInGTOBUiLDiNC � , �JD �� ^ � � GON57flUCT10N.ANDHER UTMORIZFREPflESENTATIVE50FTHISCOUNTV70ENTEflUPONTHE I' ' �� Z ABOVE-MENTIONEOCRO FOR SPEC7 PURPOSES. COMMENTS � � � 0 J ` � .,����� - m VERMiTTEEwuEI �.L• . .. . . � N S:GN�TLREOGP :REE �DATE � � � . \ � •,'` '�:`.' - ' ' . '.. .', �'�. . -- RECPL NO. F'AID BY VALIDATIO � . � WMITE—Department Copy,YELLOW--Finance Capy.PINK—Assessor Copy,GOLDENROD—Fite Copy,GREEN—Appticant's Copy �CITY OF DIAMOND BAR :• ' ; � : �. � . � �-- . �• INSPECTION RECORD ' : � � � _ , . . , � � :. . � ; . • e � � � � o - �. • � ' � - SET BACK � ' FLOOR JOIST - . - � . .._. . FTGS/FORMS/STEEL_ __ ' ' FHA REQMTS ' .::.,, � - , _ � i ... ELECTRIC GROUND • ' ' UNDE ELOOR DUGT [.. � . GROUND PLUM8ING - � � UNDER FLOOR CO�IDUIT • ; SLAB GRADE . - '�' • � FIREPLACE FOUNDATION .-_ .� �• � • ' ' TEMP POWER�: '� -- FIREPLACE BOND BEAM �:• � � ••.' �� : G�c { • WATER SERVICE . _ . • . ;'� MID HT�gOND B�AM `.. ,��..<.i " _ , �.. ,•_,-� �, . ROOF , a��'+ i '� �' 7 .. -�--_.._._... 8 FT.BOND BEAM � FRAMINGNENTILIATION FINAL 80ND BEAM - - . ROOF COVER -- '� - 1 1 - PRE-GRADING � ROUGH HEATING � - � "�" BENCHING - --- - ROUGH ELECTRIC" - � - ROUGH GRADING ROUGH PLUMBING - -- FINISH GRADING SHOWER/TUB TEST . � � POOL ELECTRIC � . EXT.LATH/SIDING POOL�FENCING WALL INSULATION POOL'FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER .. __ _ _� ,.;.; FINAL ENG. SEPTIC TANK . _ ._ - " � . . .:. ... '�.� "! . LANDSCAPEIIRRIG. . . ; SEEP PIT/L.L. --- - - - --. : _. ON SITE IMPS. GAS AIR TEST - �� - �� - - FINAL ZONING • • FINAL CONST. ---- - - "' FIRE DEPT.FINAL - � FINAL HEATING �� - - HEALTH DEPT.FINAL - � FINAL ELECTRIC - - � - OEV. FEES PAID . , , , . FINAL PLUMBING � ENERGY ' , � _. , _, ,.. i , , �� � �., �_. � � • \� ��c;�. ���, _. .. _ . -- . - - — _ , � .. , � , - - --- - _ . . - - .. . _.. - - . . . -COMMENTS _ .. . ; . • , ! . � , , , �,• . =� . - r _ � - � ..w w p'» � .. . .. . � . . � ' � . '! - . .. i . . _ 1 ;�:�G ' � , - - ' �` + �����\���. . . , , : ` ,. , SEPTIC TANK SIZE - ' : � -- � - -- - - . ' _ . , SEEP PIT/U SIZE � ' � � - . � . - . - � . , . .. ... . � � _ ' 1 ; �. � : �, ' � . � �, . �-�� , . � � , _ ;; '\ ` t _, 'Y . ` •„ - ; . 1 ! I ' ' � . , ` " . .. . � . . ; . , , , , , . Gy / . . � ���?/ .. - --�� : -- _. . .. :. . � - _. .. . .4. .. �� ._.1��Y