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CITY OF DIAMOND BAR y
'-�--"-� DEPARTMENT OF COMMUNTi'Y Bc DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 19D
(909)860.3195 Fax(909)861-3117 PRESS
''^�'�� SUQ.DIlVG PERMIT APPLICATION FIRMLY
o ADDRESS f S 3-� I�k h CoNr� .��J' D�� PERMIT ����P/C
>- APPUCATION
� DATE NUMBER N
ISSUE TYPE pCC
APN OT T CT DATE CONST. GROUP
� OWNER _� kM� G�t �C.
ADDRESS � r ZONING SETBACKS
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ADDRESS
� CITY iSsi.*'► „J��� ZIP�Z TEL. .p� PROPOSED USE
� ARCFUENG/
DESIGNER NO.DWEL. NO. NO.
AD�RESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� OWNER-BUILDER�ECLARATION DESCRIPTIOk SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q SFR/ADD/REM
I MEHEBYAFFRW 11NDER PENALTY OF PERIURV TFi.�T I ARI E%EMDT FR04 TIIE CONTRACiORS L4 Garage/Carport
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TqN.MfYYqIATpNOFSECT10N7051.6BYANYAPPLICANTFORAPERMR6UBJECTBTHEMMJCANT70 � Ra-Roof
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� NESS AND PROFE6B70N6 CODE:THE CONTMCTORS UCEN9E UW GOES NOi MPLY TO AN OWNER OF �
PROPER7YYNi0 BUILDS OR IIAPROVESTHEREON,AND WNO DOE9 SUCl1 WDNI(XINSELF qi XEHSELF OR
� iNROUGH NI5 0R MER WiN EMPLAYEES,PROVIDED 7NJl76UU1 MIPROYEMENTS ARE NOT iNTENOED OR m
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61MqVE PDR THE PURPOSE OF BALE1.
� OL�^+�YINENOCiNFiF10PEii�V,AlIE7(CLUSNELYCONTRACTWON7TH�ICENSEOCONTMCTOqS
TO OONSTqUCT TiE PROJECT(3EC.7aa,BUSINESS AND PROFESSIONS CODE TME CONTRl�C7WiS U- V91118ti0f1 AW.AREA
CFNSE LAW OOES NOTAPi4Y TOAN OWlIER OFA PROPERTY YIFIO BUMS OR IMPROVES THEREON.AND
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� DATE OWNER U
� LICENSED CONTRACTORS DECLARATION w
� I NEREBYAFFIWd tMDER PEqAI.Tr OF PERJURY h1AT I AM LICEHSED UNDEH PROVISIONS OF CH4PTEH �
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W LICENSE IB N FlAL FORCE AND EFFECT. m
� UCENSECUSS LIC.NO. � �
� UATE CONTRACTOR � H a
VYORKERS'COMPENSATIONDECIARATION �R'�'� �
� 1 MEREBVAFFIRM UJOER PENALTV OF PERIURv ONE OF TNE FOLIAWINO DECLARATIONS: �
� ��M�VEANDYVILLMAINTAINI10ERfiFIGTEOFOONSENTT08ELF-INSuqEFORWORKERS'
COYPENSATION,AS PROVIDED 6Y SECTION Yf000F THE LABOR CODE,FbR THE PERFbHYANCE�
OF TlIE WOqK FOp NTlltli iN15 VERMIT IS ISSUm. W
� �1 HAVE ANO YNLL MAIMAIN WORKERS'COAAPENS�TIDN INSUMNCE,RS REOUIRED BY EECTION � �
Q3700 OF TFIE IABOH OOOE,FON THE PERFDRMANCE OF 7HE WORN iOR WHICH THIS PE(iMR IS
J ISSUEAIAYY/ORKE S'COMfEN-SATIONINSUMNCE ARRIEF�,d[iDPOLICYMIMBERARE: CONSTRUCTION
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jZ I CERi1FVTFIAT IN TFIE PERFOFMANCE OF TXE WORK FORNMICX h11S PERNiT R ISSUED,I MECHANICAL
SHALL NOT EMPLOV ANV PEFSON IN ANY MMINER 50 AS TO BECOME SU JEC7 70 7HE
q� WORKER5COMPENSATqNUWSOFCN.IFORNItiANOAaREETNATIF �BECOME INSPECTIONFEE
�SUBJECTTO THE NlOHKERS'COMPEN9ATIOM PROVISKKIS Of 9ECTq oo OF TNE UBOR `
CODE,I&iALL FO Ih7 GqAPLY S/E P�/p'V'I�SIO�N�S./�/ ISSUANCE
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� �, ENERGY P/C
WARNINO:FAILUR[TO SECURE WORKERS'CDMPENSATION COVERAOE IS UNUWFiJI,M!�SHhlL9E
r'y BUBJECTAN HAPLOYEH TO CRIMINAL PENALTIES AND GIVIL FINE6 UP TOONE HUNDqED 7110U6/W� ENERGY PERMIT
¢ OOLLANS(�100,000�,M hD�Il10NTO h7E GOSTOF CO�IPENSATION,DAMA6E5115 YROVIUE�FOR M
SEC710NlTOeOFTHElAk10HCO0E,N1ERE5T,AN0�TTORNEM5FEE3. F1E7'ENTIONFEE:
OCANSTRUCTIONLENDINGAGENCY PRE-ALTFEE: `:�Fi r` � �
� IMEREBYAFFIflMUNDEHPENALTYOFPERAIRYTHAT7HEREISAGONSTRUCTIONLENDINaACiENCY
Z PoR iNE PERFOWMqCE OF TME YYORK FOR WHIGH 7}115 PEflM1T IS ISSU W�SEG 70Y7,CIY.G�.
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� lElI�EH'3 NAME . ,
� IENDEH'SADDRE55
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d IAOREETOCOPAPLYY177MALlCITYANDOOUNTYOROWANCESANOS7ATELAWSREUTYNiTOBV0.dN0
"� CONSTRULTION,ANDifR[BYAU�iWRREREPRESENUTNESOFiHIBCOIINTYTOENTERUPONTFIE
`r�' ABOVEMENTqNE�PROVERTY FOR INSPECTION PURPOSES. COMMENTS
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N &GNANHE FPE 'E DI1TE
� RECPT.NO. PAID BY VALIOA110N
YVFpTE—DepeRment Copy,YELLOW—Finence Capy,PINK--Assssaar Copy,OOLDENROD—Fib Cqry,CiREEN—Applicent's Copy
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�CITY UF DI/AMOND BAF� , .
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INSPECTfON RECORD ` '
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SET BACK ' FLOOR JOIST � ' . ; , � ;
FfGS/FORMS/STEEL FHA REQMTS -
ELECTRIC GROUND UNDER FLOOR DUCT , , ' •
GROUN� PLUMBING UNDER FLQOR CG�IDU.IT� ;•. �•� ' E
SLAB GRADE FIREPCAGE�OUI�DATION - - • - � -
TEMP POWER FIREPLACE"�OND�BEAM �" � � "
WATER SERVICE- MID HT.SOND BEAM - `
- — • . . . ..
ROOF SHEATHING 8 Fi'.BOND BEAM '.
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRAQING
ROUGH HEATING BENCHING '
1�OUGH ELEC7RIC ROUGH GRADING
ROUGN PLUMBING FINISH GRADING .
SHOWER/i'UB TEST � POO�ELECTRfC
EXT. LATH/SIDING � � PUOL FENCING
WAL.L IN5ULA710N POOL FINAL
CEILING INSULATION OFF SITE IMPS. •
DRYWAI.L NAILING � ; DEDICATIONS ?
SEWER , / j FINAL ENG.
SEPTIC TANK i �ANDSCAPE/IRRIG.
SEEP PIT/L,.L. � f ON 51TE IMPS. '
GAS AIR TEST: � ; FINAL ZONING
FINAL CQNS7. ; � FIRE DEPT. FINAL i
FINAL HEATIN� ! ; HEALTH DEPT. F1NAL �
� FINAL ELECTRIC ) i i DEV. FEES PAID j
FINAL Pl.UMBING , z �, ENERGY ' �
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COMMENTS
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SEPTIC TANK SIZE
SEEP PIT/U SIZE .
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