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i - CTTY OF DIAMOND BAR �' / COMMUNTfY DEVELOPMENT DEPARTMENT �� .,.� . 21660 E.Capley Drive Suite 190 � ' PRESS (909)B60-3195 Faa(9D9)861-3117 ' 4'�'� BUILDING PERMIT APPLICATION FI RMLY o AD RE3��✓�� �. �GZ.� APPLICATION � PERMIT � P/C • DATE NUMBER 1► � APN LOT TRACT ISSUE TYPE OCC �— DATE CONST. GROUP p OWNER I`nGl,-T�t�� "' ADDRESS ZONING SEfBACKS • � CITY ZIP TEL b�-3 S�I�] FRONT RW O - APPUCANT 4.✓�G1�0 2Da-+'�►/' TEL REAR p SIDElSIDESTREET RW ❑ � CONTRACTOR � I� 1� SIDE ❑ � ADDRESS PROPOSED USE I I/� � / o CITY A� ZIP TEL � . w AFiCH/ENG/ —�'�^ DESIGNER NO.DWEL NO. NO. • n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION p� OWNER-BCILDER DECVIRATION SFWADDlREM O p I MEREBV AFFIiUI UNDER VENALTV OF VERAIRV THAt 1 MI D(EIAPT FN01�1 THE COMMCTORS ll• Ga�9��rt , . ' W CENSEUWFOHTHEFOILOWNaREA50H�5EG70.t1.68U5HE5SANDPROFES510N3C00E:�HYpttOR (n U COUMYWHId/REGNRESAPERMRTOCONSTRUCT,ALTER�OROVE,0EM0U5H2ORREPAIRANYSTRUC- W PatiolDedc ' � �� iURE,PRIOR TO RS ISSUANCE.ALSO REGIWE3 iNE MPLIC+IM FOR SUCH PERMIT TO FI�E A SIGNED w � � - STATEMEHT T/MYHE OR SHE IS UCENSEO PURSUAN7 TO TME PPOYISIONS OF TME CONTMLTORS L4 � CENSE UW(�oTER Y�COMMENqNU YATM SECTpN)ooD)OF DMSqN J OF THE BUSINE54 M1�VRO � u' POOVSPe _ � ' FESSIONSCOOE)OHTHATHEORSHEISE%EMPTTHEREFROAIANDiHEBASISFORTHEALLE�EDEXEYP• TION.IIN'/VIOlATIONOFSECT10N7D71.68YANYMPIICANTFORAVENIARSUBJECiSTHEAPPIICANTTO z qe.p�} � ACMLVENALTYOFN0T1.10RETHANiNEHUNORE000lLAR5(f5oo1.)� 0 OI.ASONMEROFTHEPROPERIY,ORMVE►�PLOYEESWIMW.WESASTHEIRSOLECOAIPENSATION, COR7rt19fC181 ' - - Z WILL DO THE WOHK M!D TME STRUCTURE�5 NOT IHTEImED OR OFFEREO FOR Si4E(SEC.70�1,BU54 � � NE55 M7�iROFE5510N5 WDE:T1E CONTMGTORS UCENSE LAW DOES NOTAPPLY TO AN OWNEH OF ? � , VNOPERTY W/q BULDS OR IMVROVES TNEREON,AN�WHO OOES SUCII M'ORK HIMSEIF ON MERSELF OR � , � THHOUGHHISORMEROWNEMPIOYEES,PROVIDEDTHATSUpf11APROVEMENTSARENOTINTENDE00R m . p OFFEAEDFOR3iLLE.IF.HOWEVER7HE8ULDWCORMPROVFMEMI55qDWR1CHONEYEAROFCDMPLE , Z TION,TIIE OwNER�BUM1DER NnLL NAVE THE BURDEN OF pqOYMJa THAT HE OR 6NE DD NOT BUILD Ofi = W PHOVE FOH THE PURPOSE OF S�LE\ . �y,� 04���EqOFTH[PROVEH7Y.MIIXCLUSNELYGONTFUCTM10NrtTHLN�NSEOCONTMCTOqS Q TO CONSTRUGi ME iRQ1EGT I3EG f011.BUSINE39 ANO iROFE5510N9 CODE 7HE CONTMCTORS L4 V811JeIlOf1 /1DJ.AFIEA � W CENSEUWDOESNOTMVLYTOIWOYMEROFAPR07ERTYWMOBUIIDSOHIMPROVESTIIEREON.AND � YVIqCONTMCT3FOR5UCHVROJECf$VATMACON7RACTOF�S)IICEN5E0VUR5UANTTOTHECONfRAG �UANTITY DESCRIPTION FEE � TORS LICENSE UW.). � OIAMIXEYPTUNDERSEC. &lO.GiORTHI3NEASCN � �=' DATE OWNER Z � LICENSED CONTRACTORS DECLARATION ' � I HEREBV AfFlRM UN�ER PENALTY OF pE0.1URY iHAT IAA1 UCENSEO UNOER PROVISIONS Of CHAPTER � Vr . p„ ��COMMENdNOWITHSECT10N70oD)OFDMSION�OFTHEBUSMESSANDpROFES510NSCO0E,AN� Z _ `X MY IICENSE IS N Fllll FORCE/ND EfFECT. , m � UCENSE CIASS LIC.NO.�Z 1�� � • V DATE G CONTMCTOR � � W � WORKERS'COMPENSATION DECLAAATION � N IMEREBVKFIRAIUJOERPENAI7YOFFERJURYONEOFTHEWlLOYNlM70EdJ1MT10N5: N � _IHAYEINDWILLMAMTAINACERTIFICATEOfCONSENTTOSELFaNSUREFORVpRKERS' , . � COMPENSATION.AS VHOVIDED BY SECTION]700 OF i11E UBON CODE.FOR 1HE VERPoRMANCE /Oi THE WORK FOR WH1C11 TIIS VENA�713155UED. . C / Q ✓ 1 HAVE M1D 1NiLL W1NTAIN WORKERS'COMPENSATION INSUiiANCE,AS REOVItiED BY SEGTqN ]7000f THE LABOR COOE.GOF THE PERPoRAIANCE Oi THE WOPK fOH WHICHTHIS VfRMIT IS � ISSUED.MYWORKERS P HSA WSURANCECARRIERAND CYNUMBERARE: CONSTRUCTION - � CARRIER ��� N� PLAN REVIEW Z -raicwNuueEa �'�� ELECT I ¢ 0 (nlSSECIbNUE�NaTBEm.aFIIDOFTfEaEa6RSR7a0rEHl�f7EDOn1JULS6t0010filFssl LUM . � Z �CERTIFYTHAiNTHE►ERFORMANCEOFTHEWOIiKFORWNIp1THI5PEiiMRI5155UE0,1 MECHANICAL (,'} SWLLLNOiEMROYANYPER50NIHANYMIWNERSOASTOBECOMESU&IECTTOTHE � WORKERSCOMPEHSATIONUWSOFGLL�FORNIAANDA6REETHAiIFI51q1ADBEC0IAE INSPECTIONFEE - " S SUBJECTTOTHEWORKENS'COM7ENSATIONPROVISIONSOFSECTION770DOGTHELABOR coo i voAne+nnrcouv�rwnn�nasev��ns�a��1+s� ISSUANCE � Up SMIP p DATE: APPLICANT.� • � ENERGY P/C WAqNIN6:LA�URE TO SEfX1HE WORKERS'CO4PENSATION tOVERA6E IS UNLAWFUI.MO SHALL BE � SUBJECTANEMPLOVERTOCRIMWALPENALTIESANDqNLFtNESUPTODNEMUNDREDTHOUSAND ENERGYPERMIT DOlLA0.S(f IOD,00o�N AOOITION TO THE COST OF COMPENS�TION,OMMOES AS VROVI�ED FOf11N I' � SECTqNJ7000FMEtABORCODE,WTEREST,AN�ATTORNEYSFEEA � REjENTIONFEE: � � � - ' nW. CONSTRUCTION LENDING AGENCY PpE-ALT FEE: ' O � IHEREBVAFFwIAUNOERiENAL7YOFiERtt1RYTMATTMEREISACONSTRUCf10NlENDWOAGENCY - Z FOR iME VERFORMANCE OF 711E WOAK fOH WHICM iN�S VERMIT IS ISSUEO(SEC.7oY7,pV.G.} , W - � LENUERSNAME ' � LfNDER'SADORESS ' � W IA(SRE��a���,��o�T�;���''�u"��"xi'��o� TOTAL FEES . - � COHSTPUCTqIyANDHEREBYAUf/10RREREPRESfHTA7NE50FTHISCOUNttiOENTERUiONTHE � ABOVE�►1ENTIDNEDPROOERTVFOi11HSPEtt10NPURPOSES. COMMENTS Q � •�� . . � � . �E 3 � 7 � . � � 8 O VEHYITTEE DATf � RECPT.N0. PAIO BY VALJDATI WHITE—Oepartment Copy.YELLOW—Finanee Copy,PINK—Asesaeor Copy,GOLDENROD—Ffle Copy,GFiEEN—/lpplkanYs Copy . . , '.7; :.}' ,?: 7�Z:.u';:C., - : .. �r' ,4^..., .y, ;.o,.:.�; .Yi`.tl':.!,_�r 2.y.t'��n;".�7'�`,y'^. ..�.,.,. .,:rxo• .-u'.•,-:r;. ., , ,..�.. ' . ... .. � . . .. . . � . ' f. .•j'{�r.�l,�% 'J X ��� � CITY OF DIAfIfiOI�1D.Q/�R ;• .'�: ' : �:'� ', �. .� �, ,� , , . .:���� .��� . ,: f _..} .... INSPECTIOR RECOE�D,;.�;r : ;.:�.'� . 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SLAB GRADE ------ U' - - - - ---. --� ' '��- ' �' FIREPLACE FOUNDATION=--_ -,J, � '.. ` ' . � `- TEMPPOWER�_:—=---__ ____=- - _- -:_ - -=_- --�----`.- ;FIREPLACEBONDBEAM�- •,,. ,� �, �� _ ,. ;_• ;, f+�r: ;.�:• .� � �,� WATER SERVICE-------- : --.-, ___,_ . _. _ '-_ ,:_ ; MID HT.BAND�BEAh1~�-�, �!��� ,r-��- - ,, . `� �:� : t-\ •,�r, I `- ROOF SHEATHING---- � ,-- _ ., �`.- ---- 8 F7. ROND BEAM ,,•- -�-���, I ; , FRAMINGNENTILIATION �_. - �' '' 'FINAL BOND BEAM -- - - --`--- -� -- "-�,� .•� -_�� I �r, ROOF-COVER -- ----- -- ----- - -- --- -- .--- --- - -PR�-GRADING-- - -' � -- "' . - -- -- - - - ��� � I : - - - - - - - - - ROUGH HEATING --'� _� �� - - -- '-' -� -'_` ' � -6ENCHING i ,. 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SEEP_PIT/L:L-'---- -_.. .-- ----- --�-� �-- --- '-._ . _ON SITE IMPS. ,: .. . , � ;- GAS AIR TEST-------- --- --- ------- ---i----�- - FINAL' ZONING' '�' - - - - , ....: • •„ . i �, , ._ --- ---- - -FINAL CONST.-; ------- ---- - --------- - ----- FfRE QEP , FINA ,,•. • � -- - ,. i FINAL-HEATING - ------ ------- - � --�-----�--- --- � HEALTH DEPT. FINAi..,v� -- --- ____ ----, ,�r.� � t ' FINAtELECTRIC_ _._. __ . . .-- - ---•--i� --- •- �EV. FEES PAID . �„ ,• ., , .. ,. � � ... , � � � - ---- -- ---- FINAL PLUMBING; ,� ' 1 � � � � �ENERGY _ ' �� � � � �� ► ; . , , . , . r i , � J - I '�� - i - - , _�. _ . _ ,. _ . . . . I - � � '.Ij�w�1Slf7�rT'�tl�C L`; .. _ .i. � � , __ _ _ _ ' 1 ., t.\ _ ' 4 1 � - . . ...i, 1 � . : . . . . �. 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