HomeMy WebLinkAbout18-1380C
I`
n
an
l
�"" *t.� ___ CITY OF DIAMOND BAR
IT DEPARTMENT OF COMMUNITY & DEVELOPMENT $ RVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909} 839-7020 Fax. (909)861-3117 Building Inspection Hotline (909) 939.7027 FIRMLY
'8�'J BUILDING PERMIT APPLICATION www.cityafdtamondbarcom buddmg@dtamondbarcagov
JOB SITE ADDRESS ILQ(Q Ib N
P
APIN LOT -�&— TRACT
OWNER -r tLJlc$
$_ r
CITY ��fl��-z--ptPTEL S`t 5"'T
T� , �—
APPLICANT T_,..LTEL 35
CONTRACTOR It
G
_
ADDRESS G
QITV t 21P�&TEL
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNE"WLDER DECO RATUM
I avian, afRsm ur;8, piney of pa}Ay mat a 9m sampt Nxn row Cord"f a thane Ucens to a fa me r9 ver(sl
InP'•.'CAM dekw by the Deck alklal, I ,`ram Farad RXI to the aDplaidee lamt9) Mail 7031.5. SUMms as
PM%Wme ones,My vM or sets" that randres a pormR to crosbaa, Oar. Pllpwe, dema4t, m'wpW, any
Omebtm,"in Re Instance. raw mgwm Me sppMard Ow the Parents her 0 eavrod aaama dthat MareM
bmCrlMO MSUM ftofbpwslebn Of Oro GM*a tM ogbb Lkam LmY(Chepta9) CommwwhVWNhSKUM
of DMefart 3 ame Saalnse end PdoW MDoge( a ma he areas Is minor tram i'RMure eta me Msrfo
the isaindeamptim Any wMatbn of Sides 70315hyey odepama for openrol ubyheame exacart in a eNa pe it
al M mina man Ow random rmlwa RiSOR
U I, s stained Pre ProOany,amy ampioymwanwedoaMae r ass compeMatlal, wndeUelof orU defMM
of the wax and We strialma is not intended or offered he as (Seeman 70". BMIres and RofasWOM Cole TM
tbmact ife SaM ticanse tan des am eppry a enovmtraf aapaSY Min, mrwgh emWayms' apereoMl eMd bddda
a ImPm4M me paapedy atPaded mat me onprsemema ere bM o±tsnpsar olfm� tare's d irnvmrer, tlw bminng a
ImprovemeO if tldd vXWn erns yea omYnDletbn the Owns Budder Wa here me blades IN ptoMp Omt 11 wM IW bldX
a ImFa'eo la mtlexaaa asak }
U L u omw of the Pradeakov m mty mmreeShi with a b armauctOmp�fl E+eodon
s, The saveN
yDAs &akms errs PrtesUM tbdo The Wmaoae Sinn Lktras Low inns as apply to an owawa NOPsw1 ate
amaewon, end WtamMxratama DrgeW wMe CamrecmrprrawmiMCmirettGe Safe
tivafwel
tkrm taw)
U 1 we eaapi frown ticensum under Bm Cavboodam's Saa Lktl taw torts annealing roason(a)
Dan Slam
B7 my%dRVi iabXe I aGMMWge Par asmdt far my pesmnel M16MUIn ~ I mug ham reeked first boon as
year okr a mmoram of me ImpRvsm 2weled try ins pomlLI reran bpary sea 3"One IhK 111010e roaLM an
bNea it R tma M bean mnstruend in 0 imams as Ikanotl deflation, I ondemand this amp/ of Pm
vol mtlle ios, SeCtkn Jane at me euslltas etl Pmewism Code N "tare LI M mdueat man this w0aOmon Is
WbOhad a a min bboning ykb site htlpWww 14M097WWW MI
UCENSED CONTRACTOR'S OECLARATCN
I harsiay eflkm u mor metals of peajoy area I an mxMed under Provisions Df CMpar 0{conmen*; Oadda Sadler 700D
of Dh, Wi n 3 of the BoWMs and PMesslons Cadekend my IyyRaamm Is In full tares and aMo
LCOISECLASS C UC NO c_` GQqf+
Eye DA'E e$_ JJ = CVN'RACrOR—(,,,a%f L„�yrP tars.: \ t VLa
WORKER'S CDMPEIMTMMS DECLARATION
I IEREBYAFFRM UNDER PENALTYOF PERAIRY ONE OF THE FOU.OMNO DECLARATIONS
_ I have and WR mamalne C Arose of Common ab" imu(8 it Wokere CAmRnsittay as Pmvkad by
Sermon 37DO of We tabor Code, for We Dafvrmerew of the shark far Wmkh this prmr.is lstatl
wBl meXAeIn WOM1&'e CanDa"�as bn Ms�ml6a a6(apUked tly SBCtlon 37W INUre CAda,M
ma Nummbbeee OUmysxk faWHGm Pamll l9 asub tA7Woaw aCampeRamvn naaara Gamer eai
are
parent
Perky Nuer
EAIIAER (f or5 �tAL
POLO RMER
(IMSE ION NEED NOTSE GOVEDFEOF Tit FERMIS FOAONE KMOWD DOLING $'100 ORL£58i
I mrafyma NthepemanarceomerdittbrxtdNllW pamabisvatl Iehfia rKKropgar(pnmllaarylMrvnwlafu
become albjsct a aN Wakr'e Caime� sera of GRaara And egma tlat a t asdd Fermi Wga,1 m tlw wmwa
LbmDaPlgaaam OSeNm9700OtlminOar CAfk LaaX loCMRh Carely Waemswa PoamPR
DATE _.. APFUQW
WARIINO ROOM b snaa Wake a Compensation windoe a uaawbl, and SW suthol an i mpkryer to chMrv9
panOas shod Wa hMe up a sale modled OtlumW Wm (5100ON) in oft*n to One ma a the mmpelaOPon
dBmaPMM pmaded la in secikn 3708 of the abr cork, moalst and=may Bran
COMMUCTM LEND ARENCY
I Worry omme Mbar peaQy of pr7a y that owns is a Construction Leading Agency OR the Oe fomaace of the wok b
wthm has DemN Is ISMd (Sin 3097, Chr C )
LMMSMME
LENM S ADDRESS
I Gent that 1 tlaro reed mleapPperbn arJ state inert me above inkmae N mrecn I agree ro CanPh+am as CdY end
mmRjas ON Stan him neaGm; a our&; mnsWftn.. and "by eummdae rePmsomo;Mea at ma cmmly to
emaruao Bin mrtloned amp tin rspecdoapurposs
�-
SICNATUREGFPBiMtREE DNIE
APPLICATION DATE
ISSUE DATE' —1 _
TYPE CONST
( —_ 1CR
PERMEfk
OCC GROUP
Siopeofwork �)dz,
A DWEL UNITS
cglo>n 16 r r,Ul
I
N STORIES R BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SFFVADDIREM
G"wCwowt
W
Petl4rOsCk
PbpU$Pa
2
RB Roof
�_
Commercai
V40liA9Hom
An) Area
QUANTITY
DESCRIPTION
FEE
MR
Rinni
q�J
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
1,P51
INSPECTION FEE
ISSUANCE
SMIP
ENERGY RIC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
Q
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
/.�.
w
P/C P'A^'II�TD BY �y��VALIDATION
RECEIPT �j—PAIDB '+""-tN.+`-Tl�a"'DATION�
WHrM-Osprafterm Copy,YELLOW-F'mmvice Copy, PI (-AMeMO Copy