Loading...
HomeMy WebLinkAbout13-0760CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax (909) 861-3117 Budding Inspection Hotline (909) 839-7027 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS � 19 SS ( rJr aYc 'LOc- APN LOT TRACT OWNER VOU- 1 5 Ar�r.AIPE ADDRESS :) q6- &rjS�� CITY'b%2L.. jj au. ZIP vl7bs TEL qQI' 239' S(F92 APPLICANT k z TEL fIfA 1-35-50 CONTRACTOR Q-Cr(9 Fdi..J 6" SC±(t S ADDRESS 7822+ Aft CRY / 7aD ottL+ ZIP ZSS TE 53B-To ARCHIENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER BUILDER DECLARATION 1 XFAEBY.V FtlPI HIDER PETLILIY OF PERIIgY TIUT I .W EIFYPf FIgN TXE mR0..Cfdl9 LL STWEIIIENTMT CEIIaEIAWPoRT1EF0.10NWp RFA90N PEC TD1td BD5WE68ND PROFESSL]IBmOE NlIGIYOIi COUNRVMIG f9OUYM9APERMTTOCONBTWR MTE0. WPPOVE pEMIXISNOP PTOFtE lSOMED TUBE PROR A Ii P R ME I AJCS PE D FQFC ME APPLOANf FOR BUC11 PERMIT TO 7 A BONED CEWEIIAW(CIM XE ORODUMC MPURS TOTXFPIWM3OFTXECOxIRAC PLL CEN9E LAW (CIMPTEA P ICONNEHCIND WITH SECTION TmBI OF DM910N ] OF ME BVSIME59AND PRP fEB5ON9 C W EI m 1 NAT NE m SHE IS FEEAIPT MERFFRON ANO ME fl1R14 Fm ME M1EOE0 EIEFMF TIOHANYVIIXAW OF6ERIIXIlOfl BBY4lYRED FORAPERMIi 6UBIECTO TIEAPPLIGNf TO AOV0 PEW1TYOFOF EP TWNFO MYEM 0YEES IW Y O LME MAX. MID E STFRIIC R W 1,10T WENDED CAI ERED A BOIF SEC 73 9AMM1 RES COTNFWORKMS THECODE. MECMT19NOTIMICENS OROWES FOq MALE(81E Tau ROOF PWER10 Nb BUILDS OR TIE9 THSRE .MIORS LICENSEES SUCH NOT OKY MSELF RMRSELR OF MRIOU TYWHOBUPO9m ENIFLCTBMEFEOKMIDMNOUW MPR WMRNMM9ENOSiTENDEL ON Mg0U6NxR pl E. F OVM R,MEEAPgONOR THAT611CH WPROVENFMBARE NOT OF COED011 OFTOIEE ER EHOWEVER MWMI➢ NG SUROM RDVEI.IEM MAT EOMN IE DID RO SIR. E ltlx TIE OWNER9VLLDEII NTL NAVE THE BUROEH OF PROV Wp TIMi HE OR 6xE DID xOT AIM OR MPRWE WERIA98EOF SKEj OlIi80VMEq OF TOWNSTRUCTHEIBY CMTWMQ UC HEa(SEC Tau Bw;wEwNPOF SIMs coSMEWOWTR AL- CFHSEWDOES M TRYTOM0S0 OF APLAWEDS 0PqURW6UPAMOTOMTNIEDNCEOONNT.MMA MND CONTRACTSFOR BUOIPROJECTS %TXACMTMOFS) oroIJCENSEIAW] O C- I.W CUBIST BEG B AFG WITM9 RFASM DATE WIRER LICENSED CONTRACTORS DECLARATION I xEREBYAFFWl MUFR P TY OF FFIWRI THAT IM LN96ED IMER FRTMSCM OF OMFTEN IAM ECL4 SECTION TMBIpIM OMOF OSLW SOF ME ESSND PROm FFSSMIS DEMO 9101009E NO MID EFFECT UCFMFCt/ASg C-Zi UCIVO Zerj E DATE U-1-7 ZP/ 13 CONTRACI011 /34GK-010 64-1 WORKERS COMPENSA71ON DECLARATION I NEREBYAFTOW MDEA PFN4TV OF PERMIT MEW T9 FOMUWN] DECIAMTONS MAWMOm 9ANUnA CERTIF Tn a CCNS rro 6Eu-W KFOR wviDmv CpVEM9A1EE1 M PROWED BY BECTIM TPP OF T9 LIBOR CmE RMME FERFWB O / pF TEF MOPE FDg9100E 11a9 PFADTClA91ED V_/ IIMVF MOW6ILMNTANMOVEx9ATON0R BECT.Y1 TWpTF 1B011 CODE, FORME KINONVLE OF T0EWFW`1MIMMF5 PEINOf 15 NUEIl YIMTOPEEIL4 COIPENLTWT,N9UMNCF fIANFRMD PoLICY NMBEA NIE CAMa6R /o-04 r 5r 5 PoLDY MINBER W CM C OOO /I 7� 0 J PI®BECfaI®MTBECfEAF®OFTE FFSMI BKNfBE1EW®LCUM6PIDILFIESO I CERTIFY MO N TM PERFOAI OF ME MOIA FOR WW MIS PEWBT M BSUEDI 31K NOT EMPLOY MY PERSON W MY NMWER SO M M BECOME BUBaCI MTIE MAXERS CCMPENSATON UM90F CMIFOINIA MID AGREE MAT 616XOJLD BECOME 9UBIECTTOMEW EAS COMPENBATIm MKMSION90F SECTOR]TIP OF ME LABOR Ow Is FORTMNTICpIPLY PROW GATE L ZT 2D/ APPLOANF SIM ECT FAIWIIETOOECVRE IALP TIIESNSAT MESVCOWFIMEl9 VEA RD 6x.LLL BE DSIM CU-MITI FMMMW i0TONTO PECOSTOMO PENMEBMP TO SUEIIUNDRFDTHW9ND DOLLM9PED) � N AOWTOH TOTIE COBf OF m11FEN5MCN OMUYF9I5 PIpW0E0 FOIL W SECTION S!o] of THE LABdi WOE wTEREST NIDATTOgxEY9 FFE9 CONSTRUCTION LENDING AGENCY I IPHEBYKFYBI UNDER PENMT' OF PERMIT TMl MERE OACDrHTPUROII LFNDNOAOENCY FOR ME FERIOWMOCE WME IIWA FOR M M9 PEWYTLa I95UED(SEC SUIT OVy LOIDER911AYE OFIOFITS W 5`OSIAUX9 I CENTPYTHATL HME IIFAO TIa9APR1GLTW MD arAlETI4r TEF ABWF P6dWTI0N o mN2CT IwREB TDmLIPLYLWMAU WMCFVDDunramWTTIES 1' srM[uWs REUMm0MME D � CIXp1M1CTONMO xFRFHr AUMO1V}SNF➢ILESFMATVESa T®mEPOYro EMENERO11M6 ABOVE-MERTIUNFD PICIFAn CON 06PECfrDN FEPD06Efl 1 1 PONTIFF NMEE PIpN j SFIIIDUIQ OFPOrBrrEE DATE APPLICATIONZ '' r3 PERMIT PIC DATE NUMBER 0 ISSUE I.L� L� TYPE OCC Z DATE ii CONST GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE J^ A A r L eF Y F L? L S NO DWEL NO NO UNITS STORIES BEDROOMS DESCRIPTION SO FT FACTOR PSF ADJ AREANALUATION SFRIADDMEM (n Gerege/Cawn W P9BNDed1 LL PWYSpa (D Z FWRDDI Commercial m Veluapm ADJAREA QUANTITY DESCRIPTION FEE 's Ae-eeviy7.z]f U Q F U W LI LIP z S .LE9 D] J Jd 6 U aZ U W MI I CONSTRUCTION PLAN REVIEW ELECTRIC 6 /� PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PIC ENERGY PERM17 RETENTION FEE �0 PRE-AL7 FEE TOTAL FEES COMMENTS RECPT NO BY VALIDATION WHITE-0ep t Copy YELLOW—RRMrcs COPY, -A— Copy, GOLDENROD --Poe Copy. GREEIJ—MpR S COPY