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Home My WebLink About15-2883z a CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax- (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY e" BUILDING PERMIT APPLICATION -a 1 n'�I s L JOB SITE ADDRESS I` APN LOT TRACT OWNER ADDRESS I' i— CITY EL F3)U L421�)r3LW5:3 APPLICANT TEL CONTRACTOR ADDRESSI Cfll' ZI �EL ARCH/ENG/DESIGNER ADDRESS CITY ZIP TEL OWNS ULDER DECIARATNN I hereby aMm under penalty of penury that I cam common from the GonbadWo Saba chime law M the resson g Indicated below by no checl merkpl I love pbcest men to Me applicable b9rrNal ISdaOon TmtA, Bulneu and profession Code Any city or county Met mandate; a permit to rnubuc%oiler, Improve, do z her, or repay, any structure, prior to He Issunce, also requires tie epplka d an tie permit to in, a signed tote to May he or she ls Nimrod punmMle Me progAloro wee GaNegor'e slsle Lkema LAe (Clepler IB Gommarmcbrg vrM Suction of Division 3 of Me Imhmu and Pmlmlmm Gods] or that he or she Is sawwl from mwwm and the boob for Meallegedertmptlnn AbyvloletimofSecDm703l5byairyappllmrdfwap RwblssbtheapplkantbatlWpmay of not more Man fire hundred dollar DIS001 Ul uq of Meproperty,ormyempbyemwMwep®u Metesolempau ,witdoUedutwUpoDm of Me work, and the sMCMe is not Indented or also for sub (Slgan 7044 Buslrcs sal Pookssfom Cade The Cm*wt n' Stem lkenw law dma nplap* W w owmm of wWrtywho mmgn empbwu or pwvM effort, buitas wlmprwsm the pm" "MM Mat tie bprmwenb wa rot bmmded w offered for W g howerw the b hg w w mid rAlln m yma mmplgbA tle DwnmduiMm w10 new the bwOw pl oruArg tlml R ru n1 built wimprovedfmvmb Or tle purpc® of W As anew at that propety, em e¢IueNwy mrrbeewrp with licensed sed Commodore to moral tie prgws (Swtlw Business; noProleubm Code The CarMmfora State Lksme Law don nor apply to an owner by property who License! Improvudemon, wd Mao mroublwle prolecb wM a rammed Omncfor perermplfo the Cmtrafom' Stab License Law) U I am exempt from llcmuu s under Me COmbseloh Glad License law fortis knowing mmn(st By my signature below I wknowcedga that, except for my Delmmi nwdenm In which I mug have melded Ban lean one year prior to mmpin m of Me Improvement; covered by this pmg,l carnet Iagepy ill a Notre Mat I have built As owner builder If N in no been constructed In Its and" by scandal mMectwe I understand three my of the applicable law Satkn 7044 n Me BULng and pofimslaks Code b available upon mgmg when this application Is wb.9 ag Ie lw lepino ra awhbnl SIGN LICBM GONTRACmB'S DELLARATIN Ihm,byamrmunderMMplmduyMelIwt4rnedundwprogdomd Omptug(om=cWgwMq I TWO) dDMalon3pl Goal uulIand and mysmuehs1n,Ularrcew enact�e ^^RwugosCode LICENSE ��W 1%NO 1. � 1 I .� CONTRACTOR. I WORM'S CONaBNST DECLIDOfffi I HEREBY AFFIRM TINDER PENALTY OF PEAIURy ONE OF THE FOLLOWING DECLARATIONS I have and OR melgwn a Cemnce of Cam" to Sell M Swae far Workeru s Gonpentlon As prodded by Sidon 3700 of the Lemr Code, for the periamance of the work for which this prmR Is Issued I have and MII mabdacn Wodlefa Compensation Insurance, W required by Section 37M of t e Labor Code for Me psdamanm of Me work ter which this permit is Issued My Workmb Compensation Insurance Order sun Policy WIIEA POGCY MRABFA t OUCY MM W M1 NEEDera BEaW EYEDFTIE PBOAT S FCN OhE MNDIEDOlLARSDI10G ORLESSl Iowtity Mnin eOarlalrermntbowarkborwhkhM imN H6w I6h old anpb/wbpwsm Mwbraneral beeme WbIO b tie WdkwM Carga®Ilm Wf la Am e e Mg E I wrmld baone wolat ro the Ylortmb Lorry JImgIOe o �1 IopwAD bomb MOI®wovabn WARNWG F 0wpa Wwlreeb Compensation avenge b mbwM, and gull euigecl an wnpryw, to wankel mnaRNs and chilling p tam hundred tiumnd dob (STm,0001, Ina addWn W Me oat aftie c mmtbi, demegu M pmgded la M eegbn 37m ofrim Ina cam hdman and atlwmyb feu CONSMLIMOM LENDING AGENCY I hereby ahem under tortillas penury Met Men b a Continental, Lending Agency for t e pmNmenm of Me waitter which this permit Is Issued (Sex 3097, CN C ) LENDER'S NAME LENDERS ADDRESS I county Rut I have reed this application and gate mid Me above Iwornallon Is coral I agree fo=ply win m city no county criminal and gate lows nbMg to buldng mrmbuctlon, and hereby wtlWn mm® not Mb wanly to e rupm Me eL -me tam p rgweployg/pwei a (MPPom M� OF KRv APPLICATION DATE %z, T� I s P/Cp ^� ISSUE DATE (�I 10 I l s PERMTEN PY2 \S- 2'9 TYPE CONST OCC GROUP ZONING SETBACKS FROM RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ i PROPOSED USE i i R DWEL UNITS Is STORIES R BEDROOMS I DESCRIPTION SO FT FACTOR PSF ADJ AREA/VALUATION BFFVADD7REM GenpdCerpar I w PatlwDeck LL PooVBpe zRe -Roof O � Cgnunerrlel i m Valuation Adj Area j QUANTITY DESCRIPTION FEE CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE s— SMIP ENERGY P/C ENERGY PERMIT ` RETENTION FEE PRE-ALT FEE BSAF i TOTAL FEES p $ 4� COMMENTS �l I RECEIPT s ��GL PND BY VALIDATION WHITE — Department Copy, YELLOW — Firmnee Copy, FINK—Asseasm Copy, GOLDENROD— RICO Copy, GREEN — Appllcardb Copy