HomeMy WebLinkAbout18-21868i J w O :y r S: c: :7 i j ca CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax* (909) 861-3117 Bmidmg Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdeamoodbar.com buddmgQdiamondbarca gov JOB SITE ADORE �� APN 7j02 GQS LO..,.. TRA OWNER ! n ADOgT'�ySS r CiTA a ZIP TEL _ APPLICANT TEL Z_.4s OONTRACTOR E'YY 'e JV/7 AODREJew f OgTY ZIP TEL ARCHIENG( DESIGNER ADDRESS CITY ZIP TEL OWNtfl•BGILCEA OECLARATIDI 1 haaby oadn grant ppstty of papery tat I An gotten tern as Wromotor'e State License law M #s reOem(s) mdrgMC below by the dstkarral , 1 hew Plano War to the lookclM Naval le M 71321N, 9widem Sold halmtlone Code Any city a waft twt rwi m a 9dmat to amdut attar, impmw, damages, a agoom any fittUOZ%Wla to M Isom, arm NO M the WPIIM A M the permtt to Ib a signed oratbnem and he aaha M purmmd a thepw[WM maaca onica "aSteM Lie Lem (C*br91Daga gral,g wNmSeeliw of DMBlmi 3 or the MWm am PmamloM Code] or that he a ets is mampi from licensing And cis hater for he amadeampta My MOMwn OfSedbn 70313 by any mlgoa nM0 Wright Stogta theappllewolo aC101 M" d not momMhat/1ve mmdmd dales } Ui, mmum afamprop", or myamployeeawar wrong mthBlrsole compartment, heal w U ell or orUWo o,s of as woe, alas We surcm, Is not Intended or named rat sae (section 7D44 Success and prdwmom Code the Cbriating StBta LNmpB awdow nag Aaplytlen Swtwe pmpenty wnp th,ur emplaymorm pearl Briar(, bolds ar Impasse me pmpmty, m"ll that the InRapverts,s a9 not intended brothel M mM N omvear, tha bulofig a Impmwmaq ISaaA wlaw acts year d empetla nag lumer amda wig Nye Me burden d pmvka dirt li warred met or Improved for the p'nagem dma) U I, m another of ale tormany am aalualmety wnbmttAi with imonead Cantatas m chnsmat tha few Orator, 7044, auewm and Praemms {ode The CanoaWmat $MM Lk" Lew Wu rot apply to an motor of property wed births amembers thereon ago tems hmeCaMme prgeme0tha#mmmConnector ommentonthat 'State uk LAW) U I em MMO alas Ikmahw uwaMe CK*Ktoee State IJw Moefix onflWawmg r (s) we San army epmtam Mho [ecNYMledgaihM exoeptM my waawl aeldencclnwt&ni motlava rwltletl Mai sartas awn pfttooOOM tithe lmpp MMweeated bytherpodolt l case leylltyawa resume=1 have agent am Whale! a 9 tea la bean cmnbaMd In Me emwry by laughed wnbmbma I aMBaarU cat a Cop of are appgmWe Mw, Section IC44 of the &edam aM PttfOW= Out M an", meant round win sue nPpNal M eamaed aMa. togfninp Pleb Nag hteka "mmww)*aMhero UCENSFD CONTRACMI DECLARATION I hmeOyaCmn ulmrPon" orOIL" that I eon Aa,mG wtuVmgod=cal CMpar9iwmmea ft with Section 700M dD vWm 3 d the Buarsm aM Pmfweum Code, and my iksaw M In lug farce aM effect LY'ENSEOLASS TIC NO DA7E.�J" � � CotiiRACfafl signafl'8 $A O IIAi 9N i HUM A"Id UNDER PENALTY OFPERIURY ONE OF THE FDUOYTNO DEXARATIONS _ I him and w111 maintain a CeNOMM err Winston m Ago mate M Wawre compnaadaL as th rMw by Setting 3703 of aw labor Code, #the pefnm in e of the weafa Mdahh ths xrmf M issued I urging wit member, aaera Cm wembn loosens, m reWime ay$WaW 370D a the newt CoM,M tha pertaNal:wdihe waNgwihbadw pmgb Maued MYWama4 nlneLarM:6 CaalaaM Peony gum / CARROMDC+f l .f •LLE pomus _ p�.. �F/ [�C1 (THISSE7MWONOTREMMRZTED'PTKPDW ISFOROWKMREDDMAFSSICO CALM become that InbspaMmhpes tma DamnMamMa,� amployd 14 bcomen WgoDmraoaW homeB aibjBClMgg Wd Uncommon,cal long deem Oat fl ehoultl become sdgett go Deal Wo.:ur9 SoccoatlpvtseDen'..e Cam•re p1 P. roMdSacUIXh 37WM o in atprmN wta iMee eras DAtE APPLCANT el WAWNO Fbnwe to mum Waaa's C Sabo avvemge Is Minnie, eM shei w d an employer to eomi'ent panew9 get del ones up M a'm Insured iMucard dare ($10DOM, in Indedpe or me teat of the commarm, demagea as pmwtlae M In Barmen 3708 of low sda Was Imeratt, and aWMy's tees CCXMRMDg LEWWO AGENCY 17Creby aahm r4aNr wnlity of pray lost them M a Candavtim Unomg Agency M he paf:n. Wof as heath W4xm+tMMttsd(Sag gill Dv C) LENDER $ NAME LENDER'S ADDRESS I May tltalltsse raga aM BowmarthaaMamtandshelM wlmdtt hmN'wW3im ytno aamMm eM Mae Mwa aMNnt co MMba wtb WctlIXh, eM I+way afMdxe mpax,alPma 1Ns cwony to oft mmmft the abow•memlmhM pnppatyM #stetson pmpsea ff ftwilm OF ITTEE y DATE fQ APPLICATION �D^A'T'E"%f ISSUE DATE -\.% " TYPE CONST J 'I PERMIT# f1 _ GROUP Scope of Work # DWEL UNITS � ./T�Ela/Yittld'ddVd 'ram 511 r,�% d # STORIES ��JOCC !/tLZ .a G2 re C 1Q k BE ROOMS ... DESCRIPTION SO FT FACTOR PSF ADJ AREXVALUATION j SFFVADD/REM'. i3aa9a'Cerpon '... w Patrat>ect LL PdditSpe 2 Aa-Roof 9 Commadei V*hMtfon Adj Area OUANT1 Y - DESCRIPTION FEE CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP r--���— I 'e ENERGY PIC ENERGY PERMIT RETENTION FEE PRE-ALT FEE h BASF PLOT PLAN ZONING CLEARANCE TOTAL FEES COMMENTS { , / PIC RECOFra Day PAID aY_ VAUDArNsN _ VALIDATION WHFFE — Oaparbnent Copy YELLOW —Promote, Copy, PINK —Aaeeaea Copy