HomeMy WebLinkAbout17-250160
CITY OF DIAMOND BA
WDEPARTMENT OF COMMUNITY & DEVELC LENT SE J10ES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Bmldaog inspection Hothne (909) 839-7027 FIRMLY
BUILDING PERMIT APPLiCATION www.cityofdiamondbarcom buddmg@E iamondbama gov
JOB SITE ADDRESS iI'"161 +�•A-
APN ..........................__ LOTS—_- TRACT
OWNER
ADDRESS
CITY pAay_'L�{�ZIP TEL !I W -
APPLICANT Cr2ofhli:�1 liiw,.'� TEL ¢"1
CONTRACTOR ............ ('I,'
ADDRESS h41:5. 9 SS A Vr L llleck... Jill
CITY ` Z14(1-q&_TEL -
ARCHtENO!
DESIGNER
ADDRESS
CITY ZIP TEL
OWNMt4RMM OrAWTION
f hisay ape Van delay 0( pmRiq MM I am skampf ban to w&wws Sets LhxMe Low it Ne r MOI
Ind'Cm bows, by me Gr anw%pI, I Mw pwo we be, dry twuft MIN,#) names 70N >h BWa am
PMftnkn Cede Any M a W" OW MW*n a WMN M=Wboa4 Aft, b WMa a
sbmaas, PWTo it ,also lsw"aa appowt farther pmet flies YgMd eat he IN,
a Named sex pravWom at Na CarNmIXaHexaa tlmnM tw {Chapmra)Com�eMmg MaSx9on
UAllgW6WrOM
OAnfwWNMpmmm tt70i
of Mnews tam"lamed aUESOC SbCYeaanyj aoPf pMpetataMtfadr eNlnxrammt,ae�Rtrryput tatmvna EpwwilWtmandarMeMcha timgaslne eiRmy UI, a wool of the anow'y.a " Making -fthewgeamthe§me tomed"Nuomwe00Uso of or Per#"
of on WWK and Mn AFFIRM is rot nmMe N some hr aso Isfahan To", Summs so frrcks*Ps Cade The
hope Betetke tewdaeCoteWAYa en awns of Popehywto. hsouph art:.pkyem'Mpamwi ffiMI, b'.aids
oranpmme Ms sual word
Fo Met pa ner rutw WHI momet Mesa dmflegm., kmlkAnga
impmwnxnt ls WM w50dn as For of �rsddikn, Neihv+rer Enadw will Nome mrrmn N PAxr9 dxI tt Wes Cot bmtt
ar Mpmwd tar PN DUNaa at ace }
U4 mavwds al FWU$bA,em,cTho Generates
enSewidewm,Le,a area isMN%a Me Pekes(Seem
Ulm
Buekpear#RN9 wasewthat, the Canhmd bloodbath
Staath a l tsw axerotr NeasnpwxrmprapMYtte
mr�ar+mNowsmasm awwMtormeiLl9Amaw Pc{etnwlihaPamedfaMator puMRMxlheCatracfhm Sate
tkeMe Lary
UfmmempthamharemntiN Me CaOWWrb Soria Ltp LOW M the IWIM*o MSWns)
Dale age
By my N membe bast I eckmw wp Nat, Moral for my pemoMf eadenca in whkn I must Mw moad MBtimNOM
thus, does Incann on of We adavemeras awned by as N N,l camwt kpelly rill a emaum Met I havebalnmm
awax!-bunter '.f N hire not bean aMWcled In ns at" by Handd contra ides 14MdeMtBM Met a Duty Of the
apaabk law, Section 70M of Me gAlvae and Pmiessmn Code Is a'wbable upon Norman When MN applHoWn Is
BubsNMd or N Me Miming ing web and now~ legima a govicalay, mml
LICENSED CONTRACTOR'S DECLARATION
I MreOy, Nam under penNty of perjury that I am livered under pmMNnns of Chapter g (commenting arm Satdon 7000)
of OMWon 3 of Me Buelnea aid Prolemlorns Code end my license Is In full fame and one.
LICENSE CUSS UC NO %;Mt\dt"
EXP DATE 12'sl — CONTRACTOR-Is_Q1'Cxc
WORM'S COMPENSATON DECLARATION
I HEREBY AFFIRM UNDER PENNTY OF PERNM ONE aF THE FOLLoavi O melear note
I Mw and see maMmin a Ceedaa Of Canxld m Sea Meem for we"a comp Mn m proareems Try
Section 3700 of Mefeber Cade, W Me pedmmmaaf the work or whlth Me m mili Nowell
INC I Laveart Mi mNrnNnWorkwv CA "MakllmNtlNKO, as ePAed bySm1Jor37COof fuadwCade, for
tMMda meof PemMtotwNtnnepamllllsameE Nhf WCrkerIEAaperdeLbnlaYdreMB Cerrlsrend
Poicy Numbefus
rAMnts2c ,'c II 4'ezc e.c. .
POLICY NUMBER
UNESECRON NEED MIT BE CadPtM IFTHE PFRtHT S FORIXSH.NOPEDDOUNS $100 ORLESS)
IcwCyy tlal In 7m pedarmeneeNNewea MrM:m bsi�nrn lslsuN �. etii mAerz�yenY pMmn Nenf rrmmrenxk
Ce[ a;anctabx or Sac CsrMOollMLbwai(SldhsrYe Ati aOm Matr ahcuN bxa*e whPe[bME Water's
CCmaMa'm Omnmre m SLibn 370pa1 Vx LNm Cae I Nwl txtMvnh wmPlywttndl�l Pnwaom
DATE APPLONT
WARNING fame a Uwe Workers Canpan aike emw aP la unke ix INI Nil mC(ent a Wrou r (a cdmkai
pem*w Md wl Ms, W m ON hureed thmEand ddUd, (SIDO OOO) IS W UO to the as at #,*
demgiosmIvwkedarinsa1kn9708made Lade maned alMaOmceyafem
COT ION 1EdaitNO AOFNOY
i semby aehm WMpsMDY of eequy M Pee a a OwNa Bn Lumfing Ann" Mgx Nothemence, of Pro ark for
wNIXS Ode pemdtha9ad{Sat 3DFFCh, C)
LBIDERSNAME
LENDERSADDIESS
iaary Datihsve maDdtla arx slam DiAtlx ebaw UdmmagwatoDect is�mmpampywdn Nl aDYmm
mrxrty era sate asO rNedng bo bu me u iM hweay eNronta raPawmativcatd Las atyx
marapanma ptopeRyka mpMpasee
FflatrriEE NA
E' `Ea~L�
APPLICATION DA7,Et ��^••LA�__� Pic p #
r•�
ISSUE DATE L, L3 i`T PERMrr# 1 IR \-I -
TYPE CONS? OCC GROUP
Scope of Work katar Aw sldfen.R.1 '�_
� 1 Ilis-
AT DWEL UNITS # STORIES if BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAIVALUATeON
SFR7ADDIREM
f.maga+C.srpwt
PeNp+Deck
w
w
POdF3Oa
ZDanner
�_
CanlmerGei
YBtuatkm . 00 Ad) Arm
QUANTITY
DESCRIPTION
FEE
CONSTRUCTION «ea"`i 01
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE 42. a+
SMIP fGS
ENERGY P/C
ENERGY PERMIT
RETENTION FEE 'ea• 3S
PRE•ALT FEE
BASF I • CX'.1
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
P/C «� �pPPAIID BY Imo.,„,,,( pVALIDATION
PECEIFTfe 2r TZ' -i ++ PAID BY J-1 QA`-%-sVAUOATDl; __]R)M`
WHITE -Depirtmmn Copy YELLOW -Finns Copy PINK -Autonomous, Copy