HomeMy WebLinkAbout17-2104I
3
I
' .. CITY OFDIAMIMONDBAR " '-
DEPARTMENT OF COMMUNITY & V LOPMENT RVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotbne (909) 839-7027 FIRMLY
A2»" BUILDING PERTAPPLICATION wwweallyofdawmondbarcom buildmg@diamondbarca.gov
Ae0"'T0 �wlt
JOB SITE ADDRESS
APNI T TRACT
'�'iSR.t£it +'S
OWNER..............`Q.....
1i. Ion q't�}n0 1 - M-14
ADDRESS, 90 FI-10=IT-0 LEr
CITYtiGIII:TW,fi_FS ZIP 7a.A TELL 5' 2I00 - 95TO
APPLICANT TEL
CONTRACTOR
ADD S ea)
CRY ZIP TEL
�...
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL
M M4WLDER DECLARATION
I hal MTM aver penally at perprty net I am names ham the Camaners Safe Ucrwa Law for fin reswnde
indi a enbw by ON rnramal I caw paw nose m ton apprk a am" (Sagan MIA, eu01w rM
Pro loft Cone Any MPy r county mM mWlres sow a mnsbucy awr, Impotia, dennMon. maprr, ey
emebrre, pderm to hmmM WIN Teadves Mae~ arDw p RO file a gipud �mM m area
Is Rmued Pursuant as Owputtsbu MDb Conwa o$tmLttnuLaw (Cheer9) Commw4V wWl$ocean
TWO of Olval3 M the Buskm am PM1AeMm Cood r pied he or Nor is exempt ern lkaneas and the Data
ttsragodexemptim Any*WWYSembn 70315ayuyatpNCAm tar apemil&MI the model cove penalty
of of ream man five mmdrad doa rt FINDO)
U E u awnw atone property. m MY OMO" s with wager 0 male aan, WIN do U 9 W al Parrs
of Da Mark, ark dw mNlmlm N M{ Imrmed of soared RY we iSw fiw 7e4, $:shear am Pmfessio a Cade The
sale Lka� taw rem rW epPylo M awnr M propeOy Wow bough om.N' al r pmmnm ettod,
mlmPawsa$wpmprh roaeod Dwt Ca knPm'm+'wm9 are mtlmrdedroNemd ffir awn nh m,thew"w
ImpmyemrR%amd Mmm am YPr MaomPwtlan, Pat tMTwr-$alder MN IMra me baTtlanW Pm#ng that h cots Y� mlNt
or Improved Nor aw WPM of ewe j
U 1, u mar of on vw",, am Maluwwty w *Wft win) lwn"d Cameare to prwsua 9w Project (Fretft
7M.$uauu and Code The Cwm WSlam OFT= taw does; red spay No an awyea M Pa" arm
W lda r ImProv66 iher9an, sad Me eam7am0 for" PuNan Mm a minem! Conpem er pleaded ffi Din Crf Ilaebm' Stem
tkeas Law)
U Ism exempt from b edicae under Its Commctar's Saa Jaws Pew for the allowing ten")
Date Sign
By my AlOvab'm decays! acknowledge Met, script for my pereone remtlrcer In which I may$ nee minded for No Deal ace
Ysar rbr b mnpiran of the Imormmnwe Fax" by Ods plural armot fiey awi a structure no f haw mote an
all R N as We Coon worwrbama9 In M "I" by IImuM rem M i uMeelend pM a CM of me
epplemble law. Saloon 7044 of Me nue nea am Resonance Cade Is many rew nauat Men one tWkMO Is
WbmKWw Mih Uk "Webaae h{mhw.w oegmkwmr Mal
LICENSED CONtRAC70A'S DECLARATION
I Names Oft bar pally of MaAWy Ned l am IDNMd under pW aCareer 9 4Mroffainfing WM Se'lbn 70DOI
myis la No lanes no affect
at DMarm 3 M the races all PN(KB'ons Code, antlyy
"'`► •iJ 4 B a
L'NSE UCLN ND
AT DATE CONfractoA
WORM'S COWENUTION DECLARATION
I kF" AFFIRM UNDER PENALTY OF PEAARY ONE OF THE MLLOWNG OECLARATONS
"1 i tiara and MN manten a CamNcam of David b Sae Merin fur Wmtar a CtlmCatcaOan, As R oral try
Sangn 37W More Labor Cads (mine Fertrruriae a me cork for wiiknOm pmmN M luuw
Iiaeft aTn MN mam&In WaPare CampeaM mwaecke, M nyiared/NSeMmr37W r me LefxOCara W
Unepartrmveerinewrkfm whkn robprnMbwawd MY Wamxre kiAmnm CBMsrale
pothey
I+nsuraaru.r.
GAINING�� f0 4�0
PDul dulN0O l d - 0
IiHSSECpON NEED NOT HE CDWLETEO IF THE PERIAT5FOR Oa row 0OUARS$1W OR USE)
I Maps =inMy Pa!tamwnaed ax wrafar ww@ inprmlt 6"an I aA nthanpby wy Pew m ry Mercer waW
oernme &eject ro dw Wrkefs Cmnpm!uliat Lwa at CONtdeNe And agreemffi e I ial became Su'blri Nods WNW,
CDMWWmn Pm+Manac(Sugon370CofftLAWCone IaWfMAwOmr" ftuprcMWA
APPUCANT
WARNING Farhat a Wool Wmmace Compensation Ctweraga is unkMr and vwx afteacl at employer b camaya
mMUe0 ern Me Nnu a m are hrMrod Monaco UM ¢$COON) In &Mon to me on M mP compeuMkn
tlrugae uPNAcod fmaeeee9rn 37O$ M me cam Wtla Notrsi, sat etmmey e1Me
CWMUCnGN L ENDMG AGENCY
I army affirm door away of o"Oxon Are is a CManiGmn Laming Agency for 1st p rtm m#0 writ car
an "not Is low (sac 3w Cat C)
LENDER S NAME
LENDERS ADDRESS
I a" Fall i nsa mad INS apPlmMbn ale stone test the Anne InOm ur.. is arm 1 span to comply Mth Be pay end
alMmean and state am mal to among ypw!vCQPn, and hereby man -Mrs, mWasaftva of In 3 aryNo
enter mr, ON am" Mrdana prapady, i9 Mpopwa
E ...
OP
LIRE OF PEfIM11'fEE DATE
APPLICATION D�ATE�
r�
ISSUE DATE T- -
TYPE CONST
10 nc� il R/CA
T PERMITS ( .� — `2 a
OCC GROUP
Scope of work
.m
A DWEL UNITS
tTf ' 1 VN 1 \ne
c C ti staz�ti k-
-may cc
A STORIES A BEDROOMS_,i��
DESCRIPTION
$O FT
FACTOR PSF
ADJ AREANALUATION
GFR7ADOIREM
''.
w
u.
Z
PeolSpa
''.,. Re Flc fi
9
: cw,mermal
m
VatunUarr
Act Area
QUANTITY
DESCRIPTION
FEE
u�
g
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
GJ,�fi 2
MECHANICAL
INSPECTION FEE
ISSUANCE
14
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE�ALT FEE
BASF
PLOTPLAN
ZONING CLEARANCE
TOTAL. FEES
COMMENTS
tT
77.7Y
PIC ,�.Yy RAID aY VALUATION�
RECEIPT e�,/(vK(j4 PANDOY VAUDATION
WHITE —Department Catty, YELLOW —Finance Copy, —Messer Copy