HomeMy WebLinkAbout17-11376M
a
4
C,DL1gllNil RAR
CITY OF DIAMOND BA
PARTMENTOFCOMMUNIW&�VELOPMENTSERVICES ��
21810 Copley Drive, Diamond Bar, CA91765 PRESS
(909) 839-7020 For (909) 861-3117 Braiding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMITAPPLICATION wwweityofdiarnondbarcom buildmg(,,iadtamondbarcagov
JOB SITE ADDRESS .7.
APN —LOT TRA
OWNER
ADDRESS
CITY ZIP TEL _.
APPLICANT TEL
CONTRACTOR
ADDRESS
CITY ZIP AUY442L
ARCHYENGt
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-BIMDEN DURARAnOR
I her" aMde under assets of Wd ay mat I am eeemtt ftmn Ow Oweetters Slate Lams Law tar the omvn(s)
"S"yed bemw by the c; d0a), s leery Waged nays m an.A 'fears) "'c"" "" S, siuem.. end
Possession Cade Any Ply a mrmay, M mdutAn a prank to mmduei, stay, �mre, dsreBWe or off, an
weans, pour0 Or Ina., eke addresses the appllsm for Use prompt Is Me a signed demanded that ken she '.
naeawed priced be the promsAs*fear Coneecmrre Code
tein(Cleapmr9) Commsdlp wO Ss ..
7m9 of OMam 3 of the Bushmen bed Cage) paWt is or sly is border u der from Nmbs add thaw ear
meAm�d er@mpim MY NolaBon of Section 70315 Lot any appmentiora pemat a4lecmthe dispoWO ma de idasgy
stnbemaeam Men kadred dosem($500j
UE as ded"theproperty, or MY empl f ludevA9oweges an Moir edawmpmmiion, WOO C) as else UPeitlms
of Me wr1 sad per sGuciu e m not Informed a anyone per sw (Simon 7044 Rudrdows era Plate uspon Code the
CondMmon Sffite Learned, taw does rod apply man ears¢., as pmpedy who, thmuplt emblem be prom eMan, WHO
or Improed the Pool paMdew mat me Improvements and, rat Ineadood or beyond for said a personas, tar eupoleg or
ImPT"memaSow wmM arm year of cam sbal", pay planar BWde, will have the stamen d p rvmB met d was not add
or impound for me psNraea sin)
U L an owner betty Pmpmb, era mumpHely mn" tYp w0111 psrwed Conducted by wnaUuct Mo Fusion ($item
7054 Business and Protean CM Tea Cannacibka Slum Ucanea lJM done rat apply man away Of ewer Who
buds almpmvas thrmn,used asset performed fix the pm)aie with amcaiwad contractor member thsCapownra'State
Laica w)
U I an exempt from premises bonded Godtraamra SmmLmensa see for and 1dbwlnA morays)
Oak Sol
RY my demean WID. l acknowledge deal, except fp my pamose rsammm in feel must has reWtled an at Mast pap
year poor ad mnps ion of the ImOrr+arWne crossed by he pent I sannot dead, mg a emotions that I ran easi net
amwr-tmi n It ter rat bass cuotWtLLE in era stamps, by Ikeniod onNecmpa I understand Mat a today of CH
appEpace kit, Seem; RNx of Me Modern a d RONasmn Code is avamNe tOm ( Art wmen Use applutm Is
am.^.uneo m at itw season Wed, a" raw~ forets or Aovtcmaw tape
UCE M CANMACTOR%OEd MMM
I here, samor order penalty of penury me i and scraad mans ptxyRmLe of care, 9 tx'omerpcxI spun extend 7000)
91 Wpelm 3 bethe ire98 end Pmfeumna CMfx0tl1 mym'AiiM/ffi Phll I6YG0 ad aRBGI
LCBISEOASS �&(y
— UC NO E 1'12+(} 37
DA114V,/,r�J�p,_ CONTRACTOR Gx—S37ib�1 7Q
��77 �� ft /f tV� WORKER'S COMPUWTM DECLAAAnDN
I HEREBYATFIRM UNDER P800Y OF PEKM ONE OF THE FOt.I..OMNS OEMARBnONS
_ i form and we maasakt a (procedure of LLnsni to Self §gym for warner a comparator, s prowdol by
Saresn 3700 bedW LIDOr Carla, its the prmnnsm UMa wmkforwnammie pans N Isrwd
_hare rate wi11 maman Wtrklt3 CanpenodWnlnumnrs. myYkrkday Sect.StWh Lohatbtbfm
thepemnmarcabe Magma its wtdMxYs peomllk laWmtl mYWedwte ComOrrdeael lsawake Oadm ad
AdkY NpMer ad
CkVXR
Parr WAUR
(THISyOMMNNEEI NOT BE=VUTDFTKPOMfa FOR ONE NADU OOUASS SMO Wt tESSI
rcwinsdealto foresee
Corm
orfarwLos the OAYMgwred,lWell9HIappyaRpepsmaAadperWram
OympaweArn pmMay,ofSecG,3Mof bn LeasberAaI sad Aradacmemna WUMbemnwne.supsmmeWMs'e
CamP9raeAr ppWWereaB9Cibn 37CabeVle Lease Lane (aloe amnrxn amply WM seals espies.
APPUCNR
WAFAING Failure to inmbe Wwkm's condensetin Primp is medical and Weal sub ed an amended he tpa ody
Oman am ohm Mn ad m any nupoee renewed &are ($100004 in eesaun be per cram of don mngensesm
demands ea appeal be In sacdm 37W as the 66r p1r, fdest. and abodmay a tam
OWI MUCnON SENOWD ABEACY '.
I iwaby aside elder Comedy of pepuy she these is a CanWhmNNr Lxpq Apamy for the drmerers at Me seen .'..
wNds Mier pammalasum leer 0097,01, C)
LEWIS S NAME
LENOM S
I rimy sera 1 ewer madpas applkaom and ssa dWI mwasA+e Mamatlm is mpeQ I mmmply wear as dY(spf
pmtyaexuse a0 KODWsrorpeny for
ig on. bra taradY eamnya rand msmyM
emir Upper the amps mPmlprod properly to Iris WPM
ROKV
PFAaUTEE NAMEE fFiWs) o �1
SISW5i OF PfAWi'rEE "` DATEd '•
APPLICATION DATE (
ISSUE BATE I V_ I I7R
TYPE CONST
P/Cd
t� "' 1QJ_i Cp '.
_ �(OCC(j,GROUP
Scope of Work `�( Ti A�j' 122
p DWEL UNITS p STORIES
r—Ti�: ! i= -
0 BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAAALUATION
SFFtlAOWREM
tiersga/Casport
W
PatlNDack
LL
PmVSpA
=
do
�I
9
Cpmn x w
m
YaNEattpp
Ad] Araa
QUANTITY
DESCRIPTION
FEE
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE'
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
/ /J ^J
f �i —I /
P/0 PAID BY
B£CE7Pis PAD BY
VALIDATION _
VAUDATION_
WHITE — Department COW YELLOW — Fimonca Copy, PINK —Aeeeagm Copy