HomeMy WebLinkAbout17-0192CITY OF DIAMOND BAR
` DEPARTMENT OFCOMMUNITY BA DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 1 PRESS
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION Www.cityofdiamondbar.com buifdmga@diamondbarcagov,
JOB SITE ADDRESSAi _&. % -3 A1_DF� 1'egAt A^'
APN LOT TRACT
OWNER . ,. -GrIttQ 1JF2
ADDRESS
CRY ZIP TEL
APPLICANT TEL
CONTRACTOR
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DESIGNER
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CITY ZIP TEL
DWNER-BWLDER DECU"TION
I hemby Mann under Welty of pBpury that I am eaertWt mom me Contractor's Sffie Limits Its for the mapblRal
Indkaimd below by the dMedmna'kial, I have placed Pay th Me Impkceble nemisi (Sedyno 7=4 BOkh and
Pretaeslare Con rArty very W awmty m91 random a period W cumtraat alter, pmproys, d mdlsh, or rapalr, any
ikMWr% Prey to aB WJ&I .Map mdulds bw ankud AY tit PWnd to fits 0 BWM Bftn beat N W ON
isbcenaedpursuadto tmpmyB of Any, apbr's Stab urea Lane (Cooper 91Cmpaw " with Seohon
70M of W4wI0n 3 W the pin PreassummCnlk) on thin N or Mew is exempt Rod te2rwwe add fhm beta for
floe sbgad maimptlon Any ANaam is Sscbsn 70315 by any Amount tar a peat sublech the as to a deJ Welty
ofndmae Oren fled hundred a(AN Unix)
U I, by owrcr at the property, or m}9ndayess with mpg aman we compensation, wIH do U b eof atu porroome
of are MA, and me structure a sin mkndi d or offered for any (Saeam 7044 Barren and Cade 3N
CmWactaa' Seale Llmnse Lew ticea IK4ap@Y Ion owner of prompaRy whe ihaMgh mployeM A persaai eftwi With,
W winners them", prowled flret aw Wmrwemanffi am nil amounted aahorad threats II hm m tie bwtimg or
Niprwenem isadd WImM one Year of CWnpksem the Owner Bauder wsp twee iN NotlwM d DrOeng drei it watrmt bust
or ImDrrn9d to il'4 Purpose d BdB I
U I, an member or The propedY, em mCkshwet, ovememn t won hued Confredoa W oonstmd the stud Who
7044 BusnBai are Prdesalpns Code The Oonbadas' $Moo Unisys lax Aped MNt apply to W manor he Mop" who
builds wimprWilthpekbn and who CmmbdByW iNptoJeds with a Husband Dantmdar WlwNrttbtheConaadas'Side
'en)
U I Bra emmptttmn $a9reuro antler ihaCom'adWa Stda Deense low fW rya fdbwag reasanis)
Dale S p
Ry mY dpremre bebw i azdcaodedga that eared Fin mwpursmai residence in w4icn t Mred NMB rasded br M kartatm
Year pdato mnplakwr at (N'mprwOmmllM ewer" by Mamodl I food Ie9allysell astnKUo r rest I hate Win "an
Wiaw If n 7,g5 me bass con OM A N emaely by answered rmoacri I ram a Copy of the
appll Mama law Subdue lose at ion BudnM and Pmfea9mne Code is a,spabk upon rem when the appllpkon la
wCmdled or at ere talbAmg Web one hff$dw•ww kpdp to Ismaili Year
LICENSED CONTRACTOR'S DECLARATION
I hereby aRlrm under penalty of palmy thin Iam IUW2ed under dm4aans of Chapter 9iammaanp whh Semon 7000)
d bmdm 3 ofthe "saw
Bl/m JYMessLcee Code, and my Ilcense N in felt fore and effect
I CLASS `^yob LIG tN3 r"I Ci' (Ofi.iZ
DATE�i7 I'i C�{iPdLTflN
WOMIM COMPENSAnMW OEC ARATWO
I WOW AFFIRM UNDER PENALTY OF PUULRtY ONE OF THE FDLL&NM DECLARATIONS
I here and wit mmnn a ceffah IF CWBani to Suit hone to Wmkeea COMDermm Be D+wWd by
Semlan 3700 d the Lees Cotla.. PotOm pertormanmd 1W wpk ea went this peaty M issued
_ I lrematl wWl mmntem Nbdte('a GanpaiNedm Inaumnt6 as requited by SecLm 97D0 d fFs dahW CAda hY
foe pertamaMnB of the work hkwhidi Oa6 pompIlaa�i7teu�^e'd My WMkWsCw"nsadon Ure�ulrBl CaaWr3W
PakyCAJM Water are �n('.''P# ILVIrY/ r i.. JNU lC.t...
CAln9ER �Gf eS
POLICY NUMAS
(TIES SEEM NEED NOT BE t:MdPLFrM N TIE PEW IS FOR W nRa DOLLARS SIO) OR LESS}
I hat in McWarrants 0Me work far wdaehthis pramANbound. I"I Mat ondhyany pesr»Mam mannWaian to
su i to ire Writer's Compem bra Laws of Cammorma And agree and d 1 shOUN minimal sugM to the Wwkak
CanpebaUon prometU¢d Sttap03700d the LANt Cads l ahze tatlmaCMmnelywtin m�e wn+sdaM
DATE APPLiCAxT
WABMNG Raise in Wave Waker'b CanpeneaUon mvamge Is wdawfui and shop W WA an manpower to wmthd
PahathG9 and died fines UP m ma nundmd thousand use" ($100 In e0ditlm to the cond by me Cwnpere w
damapos as prwlded tar in sebum 3700 at-inlabsmine Imemd aml attorney a fees
CONSTRUCTION LENDING AGMY
i afros under penny dPoly that More k a CMMOW Leasing Apancy to the performance as fho work fa
miciathis peMmp w Issued tSen 3007, Cn C )
1 RAW
UARDIER S ADDRESS
I on" Rai a hare road this applandoM wit seam that me ease Idormmun IS Capri i agro r to mmaaY was 3n 0 Bad
wMmy orWmWs aro state lam cant th W dyq consumption and hereby eilthapms mprmenffitires of this cam to
msar man awe dime mentioned property to i mmdim purposes
f�-
REOFTr}LM�DATE
APPLICATION DATE 11'a4-I R - I
ISSUE DATE 1ICI 41 \'1 PERMITe
TYPE CONST
PIC41
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OCC GROUP
Scope of Wax 7� �.fe-�li't/M
or DWEL UNITS b STORIES
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U BEDROOMS
DE$CRIPTION
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FACTOR PSF
ADJ AREANALUATION
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
1 bi . Scan
MECHANICAL
INSPECTION FEE
ISSUANCE
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SMIP
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
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BASF
PLOTPLAIN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
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P/C , PAID BY a
RECEIPT4C PAID BY
Zoos - DATION �+
VALIDATION ; r\