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CITY OF DIAMOND BAR
DATE CONST. GROUP
COMMUNITY DEVELOPMENT DEPARTMENT
21660 E. Copley Drive SD t-190
FRONT RW 0 -
(9(x))860-3195 Fax (909) 861.3117
SIDE/SIDE STREET RW ❑
BUILDING PERMITAPPLICATION \
ADDRESS
APN LOT TRACT
OWNER ! l! r t 1C !L c 4 --
ADDRESS P-0 ce'%e I'�f
CITY I • ZIP TE S 2000
APPLICANT T
CONTRACTOR, 17 1/1-'f3 00 �C
CITY r-1, Vrwr ' /L ZIP Lam* TE 417 $- r
ARCFL''ENG/ —� /
DESIGNER -A-V- /'c i !rP �! /
ADDRESS Ki I ^A--!
CITY > ZIP 2 TEL. 614-7 12 2 • 12L'C
01,JNER•I3UILDER DECLARATION
I HERERY AFFIRM UNDER PENALTY OF PEFLARn'J T .. IAM EXEMPTFROM THE CONTRAC:OnS I.I.
CENSE LAWFORTH.EFd.LO'xl!:GRCASON(SCC 701 SBUS hCSSANDPnOEESSIONSCCCE ANYCTYCR
COU\TYY!•IICH REOUIiCS A PERMIT 70 CONSTHUCT, ALTER IMPROVE. CEMDLISH. on REPA:n AN"S:-
TUn_. PnICn TO ITS ISSUANCE. ALSO RCOUG.ES THE A1P-1CANT FOn Emil PERM : 70 FILE A S'GNCD
STALE Mi YT THAT HE CR SHE IS LICENSED PURSUANT TO TILE PROVISIONS of 7..E cONTnncrons u
CENSE LAW (CHAPTER f (COMV ENC'NG WITH SECTION TOW) OF CIV:SION 3 OF T14E BUSI%FS S AN7 PRO.
FCSSIONS CODE) Ofl THAT HE on SHE IS E%CMIT THERE FROM AND THE BASS Fen THE ALLEGED C %CMI•.
TICN ANY VIOLA ICN OF SECTION 703 LS BY AN)' APPLICANT FOR A PEr•MIT S',;ajECTS THL APPLICA.•IT TO
A CPJ:L PENALTY Or NCT MOnE THAN FPJE FM.CnrD DOLLARS
C7 L AS OW`, En Cr THE
PROPERTY, OR MY E MPLCYCCS W'. TI WAGE. S AS TI ICIn SOLE COMPCNSATICN,
W'LL DO THE WORK. ANO THE STnUCT'JRE IS NOT INTENDED OR OFFERED FOR SA' -E (S -C 704d BUSS
NESS
AN PROrESS:ONS CODE 7FE CONTnACTORs LICENSE LAW DOCS NOT APPLY TO AN OV/NCR or
PHOPER:Y WIC CU'LDSOR IMPROV=STHERCON, AND W110DOES SUCH WORK H:MGCLF OR HCRSLLF On
THROUGII HIS OFINCROWN EMPLOYEES, PROVIDED THA' SUC14 IMPROVEMENTSAiRC NOT INTENCEO 011
OFFEREDFOn ME. IF,FK7W'C'VERTHE DO;C:NGCH MPRCVCMENTIS SOLCW THIN CNEYEAR OFCOMPLE-
7)CN. THE CW"
CBAU'LDCR W11- HAVE THE BVIT2EN OF PFIOV NG THA' HE CR SHE DID NOT BUILD on
IMPROVE FOR THE PURPOSE Or SALE).
D I. AS OWNER OF THE PnOPER-Y, AM EXCLUSIVELY OONTRACT:NG VA'H LICENSED CONTRACTORS
TO CONSTRUCT THE Pno.'E CT (SEC. 7NA, eLIS NESS AN')PPOFESSIONS CDC[ THE CONTRACTORS U.
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PnOPEnTY mx) emws On PAPRC VCS THCREM AND
VAC CCN-nACTS FOR SUCH PRO.:ECTS WITH A CON T RACTCR,S) LICENSID PURSUANT TO THE CON: PAC.
70115 LICENSE LAW ).
D 1 AAA ExrMPT UNDER SEC. B S PC. FOR THIS REASON
DA -L oWNF.R
LICENSED CONTRACTOnS DECLARATION
1 HCnEDY AFrInM UNDER PENALTY OF PE;UUrIY THAT IAM LICENSED UNDCn PROVISIONS Or CHAPTER
f (COMMENCING WITH SECTION 70Mj OF C•YIS'ON 3 CF DHE B7S:4ESS AN:) PiCFESSC.':S CCCE. AN7
MY LICENSE IS W FULLLFFFFOFICEAND EFFECT.
LICENSE CLASS _ r UC. NO
DATE 1 2 -9:7 COTTTIRACTon �LC'vt9f
WORKERS'COMPENSATION DECLARATION//
I NCnc9YAFF.nM UNDER PENALTY OF PERJURY ONE CF THE FOLLOW NG DCCLARAT:ONS
_I NAVE AND W'LL IIA14TA N A CE RT'rICATC Cr CONSENT TO SELF.Ih S',.nE 101,W01",
ORWon, 1111'
COAT PCNSATION. AS PRDN:DE7 BY SECT.ON 3730OF THE LADOn COCE, FOR THE PCn FCRMAN--E
Or TIC WOPK FORNIH�CH THIS PCnM T IS ISSUED
_I FIA':E AND W:LL MA'NTA:N WOnKERS COMPENSATION INSJnANCE. AS PEC_AED BY SECTION
7707 OF THE LABen CODE. FOR THE PERFORMANCE OF TIIC WORK FCR Ya1IC1I THIS PERM TIS
ISSUED. MY WOR+,APS ey:A'KY+ INS.J4riCE CAnr :i AN7 POLICY hLNBER APL.
L� }TFT^
CARRIrn
POLICY N`JN3Cn �4, ___,j_7�Lly
(rWSEV mNh wNOT BE OCMr1 ETcoC'FTe PLLW-.95 FOACNE HIJIDA DoaLArc s'x)oRLast
I CERTIFYTHAT fI THE PEnFCRMAYE OF THE WORK FOn W':1 CN TEES PERMIT:S ISSUED. I
SHALLNOT E MPLOY ANY PERSON LN ANY MAANCn SO AS 70 BEO-^ME S'_1_1ECT TO THE
WOrIKEFi� COMPLNSATCrF LAYJ, CF CALIronN"A, AN7 AGnr E THAT IF I SHOULD DC COME
SUWrCT TO THC WCnKERS' COMPEN SATCN PROVISIONS OF SECTION 3770 OF DCLABOTT
COCC. I SHA:. FCRT1HW.TH COMPLY W TH THOSE PROVISIONS
DATE APPLICANT.
W APN NG FAILL'nC TO SECUnc W'CnKE R,' COMPE):SATK:HI ODVEnAGE IS UNLAWRIL. AND SHALL eC
SUUJFCT AN EMPLOYEn TO CR'MINAL PENALTIES AND C:V':L FINES UP TO ONE HL'Nonr0 THOUSAND
DOLLATTS 13 100.000), N ADDITION TO THE COST OF OCMRENSATKW,DAMAGESASPROVIDEDFOnIh
SECTION 37CS OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES
CONSTRUCTION LENDING AGENCY
THERE 13Y AFF InM L.%DCn PENALTY OF PE FUUnY THAT THEnF. IS A COfI STn. C71ON LEND NO AGENCY
FOR THE PC RrOFmANCC OF THE W'CRK FOR W1 HIGH THIS PEFIM.T IS ISSUED ISEC.3W7, C:V C)
LENDER'S NAME
LC NDER'S AOCFIESS
1 CERTIFY iPAr I HAVE nEAD TIES APPUCArCM1 AND STA -E 71 IAT THE A."VL' P.rOn.YAf ION IS COnRECT
1 ACHE E TO COMPLY YJ17H ALL CITY)ND COUNTY ORCINANCES AND STA -.E LAWS RELATING TO OJILDING
CON. "F
nJCT ION, A.ND HERCDYAl3THOILZE ALPRCS-cNTATNES OF TIPS COUNTY 10 ENTER LPON THE
ABOVE MENTIONED PPOPEnTY FOFINSPAC7 UnPOSES
PEPJA .,Eu ,.dl Nll
SIuNATUnCU PEH i.E OATE
PRESS
FIRMLY
1S4PLICATIC, PERMIT /V P/C
T!� NUMBERpUE
ff TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW 0 -
REAR F3
SIDE/SIDE STREET RW ❑
SIDE ❑
nn --
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION
SFFVADD.nEh7
Garage'Carpor,
WaPat1'Dock
U-
PooLSpa
ZRe•nool
"woo
Commerc al
m
Valuaf.on ADJ.AREA
QUANTITY DESCRIPTICN FEE
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W
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CONSTRUCTION .-,:k�%r
FA 19 / 1
PLAN REVIEW
ELECTRIC
JINO _f�(� f���
MCCH•
h'CCHANICAL
INSPECTION FEE
ISSUANCE
�7
S,!IP
ENERGY PX,
ENERGY PER 4T
RETENTION FEC:
PRC -ALT FCC:
TOTAL FEES
COM.VENTS_
RECPT. NO. PAID 6Y VALIDATION
( / WHITE—Department Copy. YELLOW—Franco Copy. PINK—Assessor Copy, GOLDENROD—Filo Copy, GREEN—App!-cant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SETBACK +
I
I I FLOOR JOIST
FTGS'FORt.1S/STEEL
11 FHA REO'."TS
ELECTRIC GROUND
> I
UNDER FLO-OR DUCT
GROUND PLU'."RING
I
I I UNDER FLOOR COL•.IDUIT I�
SLAB GRADE
I I
I I FIREPLACE FOUNDATION
TEMPPOWER
I
FIREPLACE BOND BEMA
I
WATER SERVICE � I _�
ROOF SHEATHING
FRAMING:'VENTILIATION I
LAID HT. BOND'BEAM
8 FT. BOND BEAM
FINAL BOLJD BEAM,
ROOF COVER
PRE -GRADING
ROUGH HEATING
I BENCHING
ROUGH ELECTRIC
I ROUGH GRADING
ROUGH PLUMBING
I FINISH GRADING
�
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
I
I
I POOL FENCING
^�
WALL INSULATION
I
FINAL
CEILING INSULATION
I
�I—POOL
I OFF SITE IMPS.
DRYWALL NAILING
I
DEDICATIONS
SEWER
I
I FINAL ENG.
I
SEPTIC TANK
LFNDSCAPE/RRIG.
SEEP PIT/L.L-
I
I ON SITE IMPS.
GAS AIR TEST I
FINAL CONST.
FINAL HEATING (` l� I_�
I I FINAL ZONING
FIRE DEPT. FINAL
HEALTH DEPT. FINA'_
FINAL ELECTRIC
I
I I DEV. FEES PAID
FINAL PLU'ABING
1 ENERGY
COMMENTS
Mc+lt:9 a e�
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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