HomeMy WebLinkAbout18-6148vW
I
g
U
IN
IN tI10 'l} Hi AI.
CITY OF DIAMOND RA CE
DEPARTMENT OFCOMMUNITY&DEVELOPMENTSERVI
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax. (909) 861-3117 Building Inspection Hotline (909) 939-7027 FIRMLY
BUILDING PEP -MIT APPLICATION www.cityofdiamondbarcom budding(N'diamondbarea.gov
41 `/ 13r'a2kli
MaKe
Dr
JOB SITE ADORESS 7
APN _ LOT TRACT
OWNERYLA tin)
ADDRESS
CITY ZIP TEL
APPLICANT TEL "
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCHIENGI
3
DESIGNER) "A�A Le
ADDRESS
CITY ZIP TEL 1
OWNM4PA DER DECLARATION
I mo y emrm orator poetry of dedurp per I we erdmN Tmm die Qmlmda's Steps L LAW la DW f rK$l
WNW baNw OF the dowonaM1{al, I here oldies sap on den mPsmoa tardal l Kdffl TOEib, suites sad
Pfefn"M Cods A" dry a amN4 Wet,"Wta a porNt to mnawct, now, WWM camoSBN, a FOP*. aM
edMatlne, yW to a Immo, map raouha Oa emBcent#R SuparmN b flM a asud snurantbud ho a ela
aOemrptl wmaab Mpreddoa MlheCm,trector'n SriYet�ue WWICWDIa81 oka Batson
JSBo naaNusaadNaAsdaaCa Wrapoabw tin
ashutaaaEeearns M OpOft
pdmW47alAny
die sampan Apyvc!(Wini5adbn TOSL 54y ayaPtl�RbrapomR eugAeb tlu ePpRam`RaafdpouRy
d Mau fin five nurapad Gaon (&SWI
U L a Woo, India we". Or my wrosaym Woo "on adidr mu m 009dbn. WNI an U al den U ParGa,
of den wok, Wrd dW mucbm Is no a dMrOd for we 15adem 7Get hadwers Wrap Pmta Cod, The
lbrmecmn' SWa tlrensl law aces tort apdybotaawdr d PIWnM1Y*no iNOuONNnda d rahsPeaw
a lmPmra Bs, pmp¢rip PIOM9ed WWia NnP 870 roIImBn0B0aasmedWale espionage,
ImpmW moR k WRNn om year of mlryNnlhn.4mevmar adlar wltl hOVB to btnCa d Pmdnp dWl II ge9 ns sdt
a ImPnaatliadi0 ptBPaba as l
U 1, a Winer of die sadefty, at escMdvery cmdalbo west arrested evidence b mnetrud the project {Sitars,
7044, Busses and ftfamarks, Code The Cammda4n SWm thi na Low dos tW as* as In on d smarty wo r
bulMea IMPamhg WdWIN) mndmtafa, diapardeaswith aflooseConada man" Is theCWalPderB'S7aW
Loop" Low)
I LJ lore comp: Nam daaTBme Wda the Carmn's Stan Lamm" Far :10 toawhp rooked
Date Sign
:...''.,.
By my so" blow I aaktamairs To coed for my personal fudsm In g140, 1 mad love Ireland tin at ant oa
year pro towark atot of on lmpmamade mvam oy this parruil crosttaary Ball a structure OtffiI Errs Wd#aan
OwAr hd* d C his nor NM mnmocta In as enisaty by Eowsed =*$Ml I understand tat a COO, of die
apolmoa III, Seaan 7044 of the UROW,, and PIMearsda COO Is avWBM upon r o eep who this Ippkftw Is
abmmm as Sa taawi� WBP ea mIp.MMW Ngmv a pIV/nOaW MM
LICENSED COeragoo m'S OEGLA14TIGN
I "May AM under dealTY of perjury that I am IReaad ado owslat0 of Under 9 (mmmembD with Grow 7000
d Division 3 d Ta Susses so-0 Froeaba Ca/re, Wins} pana W Will force and ead
CUSS �� t1C NO S O
E0 DATE
EJtP OAtE �' CONTRACIOP
WORKER'S COMPENUTION OECLANAFION
I HEREOY AFRRM UNDER PENALTY OF PERPAY ONE OF Tiff FOLLOWING DEn1AATIDNS
1 have Ind WBI maIntaY a CeNMers If Consent On Sol Wive to NbnuYB Co rsonaeda!, a wo did by
Sedan 3700 of the Sabo Cade to tire paYormance of the wait fa Whleh the Perms Is Issue
I hates Bled wbl Sunnbm Workers Snderod w, Insu9ne9, 84 reddmtl bYSn an 37oOdme�amr(sNb,tof
ON pasaame of the hawk to wnbehth8 parch Is Issued My Waats Campensaon Inaranoe Csnh]Iad
Randy NumberIIIR
POLICY M WR
(IHSSECTION Nla)NJT WE COMPLETED h TIEPERINT IS MR ONE HUNDRODOMIARS S10C 011i+L%
IpNtydandoI dduworkb Shotmitlfia,?d,idatl lWtamDNYmY4WrWmMWry raaarmaa
Lama.tars biomeused b7u Wakar's
a
oammesubadb SIO N'of
3DWr�fdd Lags din,
Swi e, I&W.Andaoaa
fth ft
OXrpat PIW4sbne dSecdDn 97O0d 0W urea ClGe, I aedbrdW4Ptpanpywa Woe Dmri4Ma
uPLOOOK
WARMNG Fa re to mum Workers Sbmoa68tlon mVaGde Is uNflwfid, am am[ whoa an to almaal
gumUs and 041 Ana up es ore United duuead dalM (SIDO DOO In &Mom b Ore min at fa n,
dWnapreffi lorded bran aaOTn 3706dDu aha ma Interest Map Ma(nay'6Pore
CONSFROOTIONLENOINOAtalNT
I h dsoy AM tsar poorly of pedlpy Cot tau is a forNimdlon UWQ Aoprv,:y br the o rbnrume at be Weak W
diapermd taiaued (Sin 3057 M C)
LENDERS NAME
LENDE 'S ADOPEM
11ardN tlati nW7e,a�d� adaMe tat agabPNN.wrnawnaaamE ipgaiammpy gait dltlty alap
araancBs MW rite uxa RMCiq b aAmrp walmCal, seJ InahY eydipdm rap84aASU080TddnmurtbJ u
Ape die ama�v0 mm�tla�od p�ryta laromtial
N'VuTa�"t Lt 7J��
NAME IFIONR
In
DATE
APPLICATION DATE ai \+4- i1 S PIC#C'Z
ISSUE DATE "` 1 - PERMIT#
TYPE CONST OCnCCGROUP
n .}
Scope o1 Work ;K L..X 5 5-.f i
ed ate-
is DWEL UNITS a STORIES
U co r)
# BE MS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SFRIADDRAEM
CBWraOdCapgrk
,,,,.�
'.
Ivs
j sd o sae
................
=�fle-NWf
........
5
CGmmode
m
YaWANdon
Ad[ Arch
QUANTITY
DESCRIPTION
FEE
y
d
2m
a
f
CONSTRUCTION
PLAN REVIEW \A!�
ELECTRIC
MBIN
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
�f
. l
BASF
7�—
4 �
PLOT PLAN S1a1C5 COO
ZONING CLEARANCE
TOTAL FEES r ��
COMMENTS
yq
`"F"l �A
(r anal
P/C PARODY
RECEIPya ..... PAIDaYA
VADMTinN ,
VALIDATION
WHITE—DepeymMt Copy YELLOW —F copy.—Pssawr Copy