HomeMy WebLinkAbout17-10961CITY OF DIAMOND BAR
DEPARTMENT OFCOMMUNITY&DEVEL( IENTSERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
,� (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
- BUILDING PERMIT APPLICATION www.cityofdiamondbarcom buddiag@odtamondbareagov
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CITY Zin TEL
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DESIGNER
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CITY ZIP TEL
OWNER-BUUER OWARATRYN
I Meby etfltm Under pawNy W ,Pe y tat I am exempt From N ConitMmYH State Jude Law Fir to respM(e)
eWkMW below by the markmsrYje}. I have pMcea near to Ra SOWN Itemts) BkxvN n 703f 0. Ionise" and
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Litarea Law )
U Ian exempt tram d erwintieWwthe CnoOactara State Ilaeries kwtu the fonoweg rmsaaN7
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By my abriature MAY, I aaknowli fti except for my perearid MOM nWhkh I meat have nNOM An M bead am
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LICENSED CONTRACNA5 DECLARATION
I hereby 9dhm sets, bBM",y of III that I am Ikensa0 Larder WfrdNonsof CMptar g laammaxing wear Section 7100)
of 014on 3 of the 8.0" old PrAso urn Copy, and my dtenm N In Up isms and 90911.
JCENSE CLASS —&_ LIC NO 5 �-7 t
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I HEREBY AFFIRM LNOER PENALTY OF PENJIAiY ONE OF THE FIXLOYANO DECLARATIONS
rye entl win maintain a C8lbttata of Consent to Spit pt n is Worker a Campeneai ae pmWded by
mun37COWthsLemxOne (prW,aperfom Vitro we* for whithis perintIsMued
have and Wit maintan Wa liar's Compenoeuon Immmepee, mrrµemd by Septets 3700 oft" Lahr Cape.. for
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mber
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I Mreb'y affirm WON proaQY C P*q teat tere N araneiRxymr L"i Agency for Men of IN WWk For
whom" permit N IaeUi 3097 CN C I
UNDER S NAME ..
LENDEFISADORESS
to "Uatlhmermd thloapNINUMOrWMUI the above lmnnnaen Ncwrece Iapmato aamPywWl at p"y arty
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somprDIFARRem - DATE
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APPLICATION DATE � 7 Pi
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ISSUE DATE Q `01 PERMff# rRil'"j - 104[c1
TYPE CONST OCC GROUP
V
Scope of Work X
#DWEL UNITS #STORIES #BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SFWADD/REM
D aga/Carport
PMW Iftk
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Re Rost
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Commarcia
CO
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Vokurt10Yr Atli Area
QUANTITY
DESCRIPTION
FEE
i
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL i np,.t j)tT t t
INSPECTION FEE
ISSUANCE G . %-
SMIP
ENERGY PAC
ENERGY PERMIT
RETENTION FEE-^
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
/ �3
TOTAL FEES
COMMENTS
PIC ,/PLAID 9Y VALIDATION _
RECEIPT# S�-j_��_(zey-- PAID BY V / It"9-1p VAUDATION-i Q
WHITE -Dap Copy YELLOW-Hpirnpa Copy, -Assessor Copy