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+, CITY OF DIAMOND BAR
DEPARTMENT OFCOMMUNfTY&DEVELOPMENT SE VICES
21810 Copley Dearer Diamond Bar, CA 91765 PRESS
(909) 939-7020 Fax; (909) 961-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
O8° BUILDING PERMIT APPLICATION www.cityofdiamondbar.com buddmg'adiamondlearcagov
JOB SITE ADDRESS>4u_fl QW.y.... __.VIZ-40 P,,,_
APN jLOT TRACT
OWNER p ..
ADDRESS
CITY P TEL
APPLICANT TEL _ + ry
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CONTRACTOR /4dp -� C
ADDRESS 2� ' 3 "
CITY ZI TEL - SIC
AROWENG/
DESIGNER__
ADDRESS ...
CITY ZLP TEL
OWME WILDO CECLAMnMN
I hereby aPlrm uoor genii of perjury met i am aearom him the Capital Soto License Law for Me nunneas}
entrated balm or the MdW V le) I hers Fast Sea to Coe Applicable III (BecGan 703119, Badwes and
Pmreeelarm Cadw Any M or mmrly that readm a Permit to candrpm, aft, hnpmva, dwpWW or wpmr, awl
swueoae, prior is ICI lea . aim reaulm am arpaown for go pmeIn Gb Maned ittknwn that hem the
Isllcanwl pmmmntorthe provisions of the Caasc'ar'aS�Domee Lew DAmpiw 0) Cwnffwidq with BeeGoa
of Division 3 of She Business and PmMmans Cecil in t et to at ens Is esempt paperbomn4we and the basis fw
Ide 0%pec esamptlon Amy Ahmt of SoYan 10315 by opens W 0 pemdt Subjects the Somfleato 5 b,vI penaly
of rot moil then eve foliated dollars; (ISM
L) Lavpower mthe apparel or mymmlyanwell wages n Yeah sea oarppnentlon, will doUadofSir U bla
of He wit%, and IN stmcima Is rot k*mdtd ar aflared for we {Sxtim at", BAI ess end RTfiwdw d Cade Tne
Comremaa' Slate Lkw%Law does Ian apply tow owner of prournivoo, tmwgh amploYaes' air www Can nedds
or improves do pmpaty, provided film the ImptosEmema Are not Intended amen for sea II however,, me b l dea a
Improrerhol is WO when one year of comf stlmt, the Owner-Buhaef HU nave the bmdw of proving that It was not tall
w Imm0retl is ma R'eWn m sag )
(J I, AS owner of the properly am nmuerve% wnWcft wish lkmnsed Commodore to oanwd the Hasa tmmbn
7344 Busmen and PlNeaswns Cal The from taw does not aMy to on deeper of property wind
WAS a Improves Garcon, am who commas fre en p'o)aCts wth, a licensed Contractor pon wins to too Cuntrmnom' Bats
Llcenn Law)
U l am worse from Ecanase war ma Contractors Alb Limas low for the folawing reemys)
Data ........ _Sign
.......'', By Rryalg(aWM meow lecklawsdgatfat, emem b' my pelsmm temilusln wr4m l must have tesmofarak USA one
pat" Interdependent the lmprovemems carema by thin Parmii,l aaniat NgesY eel a capture ihml hate Spanish
ownw-balker 8 It hn ran been xneducteo in h Closty by Ikereea cohlare m i undarsa!M that a :pity @ the
app oesee law Swan 7044 of the Guslrne and P`aWon Carlo Ls Avdlbsie Som request when this BPpaeetan is
Submitted a a iha bemmrcd Web aim htnaw'Ww igmto ce govicelaw hnnl
LICENSED CMRRU'M'S DECW MN
i hkrepy affirm: du party at pantie oat I am Nownd mmw dmmdana of ChaRer 9 {mnanendng With Seotlm 70Gy
of 3100on 3 of m aBurica, mdJAphpANs Code, wail my Inane Is In IVY force snd affect
LICENSE CLASS >^ LIC no - 9�-ur44.r _
EV DATE ZOVIZff COWI ACT09 � i f
WORKER'S COMPENSATRIN DEWMT10N
I HEREBY AFFIRM LWDER PENk1Y OF FER.ARY ONE OF THE FOLLUMNS DECLARATIONS
_ I been and will maintain a C0115oda of Conant to Sett mars fm Ahrka s Compensadm, n owned by
Secaa: 370C of the Labor Cade, Her Ha paldm ce of the woafarwnkhthle permit le isaeE
_ I have wd WI maintain Wpdmrs Compenwln Manta, and madad by Sunup 37W of the Labor CoSAV
the Performance Vohs work forwh utvthisperme by Wood My Wcnmr aCamgorwxpor Inamr4a CAmm and
Pdm/hhanbar
CARTER L L
PDHCY NtaoHFA
(IMSECmN HEM ton SEDDMPLETEO IFIHEPI Wu4ITSPOR OM: HUNDRED XUA S $1 W OR USS)
Iwmtypatl the perorraraeatha wmkiv wteeh mil penHl+s ,total mtemPlay any pNax+l wY moaner®rob
baWrvesACi to the Nichol tame of Camara And epee Nis N 1 Could towpone apdact to and Workers
CwowMCm Mrsiva of Section 37W arms Labor lode, I CC bloods car4Ay with those DraW re
DATE A ACART
WARNING Failure to mecum Woaard Compensation ooserep Is unlawful.. Eat ones Nlbjact an employer to Comlse
pealiko and dot fro% up to one harmed CmU9am ddlaa (it 00,000), h adtlaa to the Cost of the p..
domaBes as Pawned: rot in motion 3708 of me:pa ciao, Immam, and astray a Ponds
CDNMMZTtM LENDMG AGENCY
I haeby ab i a'fdw Macy of partvy that them a a Oammooaon Landing Agency tar ma petfi nimam of To Shwk far I
which this perish of toed {Sac HOT, Civ C }
LENMR S tLLNE
UM)En S ADORESS .... .
I cerfiy r 1 have read NtlS AaacasaS end stave met tAs flaam ntwmEpcn a wired l Aires m carpywim NI tlyy wtl
s m and auto awehavrgto?wGang eonstruabon wd haabyalahorCs repreanatNnmGa cwviyro
emwubal m>bao mentland ae.an purpose,
PEnan'rcc.i.0 {PRIFfi A
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SIGNANRE OF PEflGN7FEE Dar
APPLICATION DATE _ .�E_�{P}tC4 —t y I
ISSUE DATE t PERMiTN i" Tom, l ` I`� t
TYPE CONST OCC GROUP
Scope of Work file A4 (?iia-) fti
AW _4' wry Ge+.
4f DWEL UNITS N STORIES P BEDROOMS
DESCRIPTION
SO FT
FACTORPSF
ADJ AREANALUATICN
SFRr'ADWREM
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QUANTITY
DESCRIPTION
FEE
0 use an
CONSTRUCTION
PLAN REVIEW
ELECTRIC
...
PLUMBING
MECHANICAL
rP%• ��
INSPECTION FEE
ISSUANCE
3& i2
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL PEES
COMMENTS
t
PAID BY
RECEIPT p )SR TPAID BY a'( F"7 tw+"' YALIDAT,CUN
WHITE — Depwtnrent Copp YELLOW —Rover. Copy PINK — AsssumbrCopy