HomeMy WebLinkAbout17-09740
I
-' - CITYOFDIA CINDBAR 4 vbv<5� 04
'l DEPARTMENT OF COMMUNITY&DEVELC_ IENTSERVICES tJ
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
w•„ (909) &A9-7020 Fax• (909) 861-3H7 Building Inspection Hotline (%9) 539-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdmmondbarcom budding@diamondbarcagov,
JORSREADDRESS 2t** - [•R S'H� Kt3C.C-- pi042
...
APN LOT TRACT
OWNER 1J !
ADDRESS :.,S: tP r1 C45 41 e.
CITY TSthnMaylod Jg[`,(-ZiP-!?I cyTEL f714—(2,1(aj I?,�
APPLICANT TEL
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCH/ENG/
DESIGNER
ADDRESS
CRY ZIP TEL
OWNER-MLOelOWLANAnOR
I Tasty aPom, undauntedly of Whany Pat r 6m am* pan GO CPdnxmrs Spite ticenae law Sor ISNO reaamLn
below by the dM d=*M I Mw PNCW pert N the "ad rWbw MA PaMean am
Plafe Cato- Ant ray Weft**Mtoga aPERM ar conbua,atMr, nwwvm, KwloOth,awpea�Wry
spab(e,yb M ON hmmlii• of mares ftwi�iw fMpwwu M Naa NaprvydaMMmadibethear Navy
apearaedpradlWltMPvy PrayslIXadPrecmoppaeMY'a SMM Leasetaw4CYvyDMr9) Cdaaareig WiNSalibn
d DtvsvyePdthp Paip M)aowent ache hertmptpanaCanaKa0nethaD LIX
lSodWo Wl5 y
1f¢BMPae MY"doo [$DamnTrot bby anY aPDarandmaDaadtatllaa the iDPleaA taadwp penalty
Dowfew
Nana mere man Dve hwbsq ddlwa Imo}
p[1, a anmer of Play property, or my with" am a their in* will do U do of or powma
o� f ills Walk, End th eWdUM IS we WWW44 In WNW[ W Sale (SWUM 7044, wee; and Profeadom Code wa,
Canute$' State Limmor Law time not appy Mat owner OF property "a, through anpkwws' or posmel effm tides
or Improws Wl WMmty, prolmed that the NemwNTwnb are not munded a offered to sets a however the t odwo a
Imprmem w is sad often one year of CmPyedel fha Omar SUINer will haw the bodah at "ON that It wed, rot bum
a kePnMd IIXE6 GWPoao Se daM )
sa Sena of Ore prou", am eaduew lj mouednP Web kensatl casados W mnanse the Posted (Sagan
Buvneed We Prdserldns Code The Cmeactax' State Lawnss Law does Not *dY to an wwar d pl OM Who
IX lmprMmiTaaem BMvfiDcantrachlIXme praaBCMeao0lkaluW Cmaa�(gawlantioml CmWedae'SWe
Lae)
{� I BII IIIBmpi l Vn COIIUBCIa'8 Mwa MPewwng'lBNen(E)
Da —
gyrating isa Odarrl eticnV+iodQe aPapN lIX mymspsl NMaAl moth htver6atdPdMdMin ma
wa plb M=nP"M d We tOMOnrft Mood 4 thisp U Camel Semy No a stmgNne dal I hand late a an
eulder it it has We beNN Ownweald In Its adnh pr momwe s 1 uMa#end Par a M of Pre
anakabs law Seow, 7044 A Ws Cupheass was AWrmaMn, Code h mOyaeN upon repuest onto Pats thentsman IS
saundad Or at me Moving Web No r1edwrow "aft w Pa'rwMw fthd
DCUW CDNi aAMR'S OECLARATM
I hesbyaOam under000ty d Won Me I an ECamW under provGaad ChADW 9 {mmmaohNwill Sectlm 7000I
Of D wrion 3af the mrsedar and ftatesaipts Chun and wt Suess N In FOR mace Sad Select
LICENSE Class LD NO
EX? DATE CONTRACTOR
Masten CDMPENSATION DECLARAI MN
I HEAEPY AFF INCER PENALTY OF PERJURY ONE OF THE FOLLOWING DECARSTIONS
— I ham we wed maintain a CeRlsnele d CaPeM to Pate head M Wbao's tbmperaa0m as pwvkNd by
Spwton 3100d me Labs Code Mrllvy Name work MrwNcn mNpmmRNNsum
_ new and WmmatdahrWaker'eCmysNeaem MaIwM4 asrequisdby Set4m370Od Ds Labs Care to
tla PadomlaaedPs wPrY.Mwdchtlya PwnWnswvyd rapWW 3Comp wtkno MMCaaMYslat
Poky Norman 0m
CARRIER
POLICY NUMBEIR
Laos SECTION WED NUT BECOMPFTED IF Of PGWSFMME RMffDDMLW $too 00LESSj.
rmWym$ eg,.WmltrWtcmn ERaypeamna,ynsNrarmvyto
dN
dates IDMOWNWSOaCdb=A-dWMMHIOWWbamre aDMaY M Pvy Waka'b
RPrhloNs dSwWon37md Pa tabor Cute t ds1 hiWaYBhminpi'wlm Piroe IaeWWee
JPRlrsxr
WARWING Fa1Nae To secure Mbaer's CotnpWtmtsrl DomRon in udaWW and spin subject an wester to cewmal
WOO M tdAl fines up to ERE hundred Amsevid dolNm (SIDD DON N edCiean M the cmi at the emdaymemon
damageseapradetl for In seNm37C8d NS Mha caM Ntemm, aim 0balvyY'a Ttea
CONNTMMON LENDING AGENCY
I hereby wrrm water penally of penury ERN there N a Carmwhon Tondky N om y for Pa pedamom On the wok IN
Ihvy IceNmAN Iguaa {Sec 3007 01 C )
LENDER S NAME
LENDER S ADDRESS
1whoy that I haw Now mis appttialW and aM%Drd Pm ehoss Idmmtlm N Waod I as" to aYnph wan a0 City and
adNarm end cam Nun stabp M Intoning o mrudlao and Mosby Sumarim repossessions of ars caudyN
ensr near the Roam mamoWd psperW an Insp anamr, purposes.
era-, l.! &,, w
�f jE' �If
Of PEAMMEE DATE --
APPLICATION tD
�ATE
'., ISSUEDATE ✓
TYPE CONST
PIC#
�^y .t�y
� a-PERMITIF T Fl t'�''1
OCC GROUP
.', Dopeoi Work a
N DWEL UNITS
1^p_O:t
P STORIES M BEDROOMS
DESCRIPTION
SG FT
FACTOR PSF
ADJ AREAIVALUATION
9FRiA00/REM
.................................
Ganger;; rpaT
_....�.
w
PataV➢eck
LL
ReTioof
(,�
6J
Cwnmercial
j
m
valusertlar
Adj Aran
QUANTITY
DESCRIPTION
FEE
UJI
W
CONSTRUCTION
PLAN REVIEW
""C Aw 8e%
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
'-21' IZ
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
�—
BASF
_
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES"'
COMMENTS
)
M
REOMPT P A(/�JJ,j
pose eery VALIDATION
— PAID ETY 4— VALJCIZ - _
WHITE— Depa"inent Copy, YELLOW —FMMO Copy,—A.aesmr CDR