HomeMy WebLinkAbout17-10960 (641)A NOND
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CITY OF DIAMOND BAR a
DEPARTMENT OF COMMUNITY& VELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hot]me (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdmmondbarcom budding(jadtamondbarca.gov
JOB SITE ADDRESS 1938 Chw* V-t V`eex 9,8.
APN Z"-050T2-!5... TRACT
OWNER
ADDRESS lr5 4uu x Pleven_
CITY O(ALMDMD
APPLICANT �A.jtt� SM AMpe'ReE,J TEL
CONTRACTOR 3
ADDRESS
CITY MeOPflAin IP TEL
0 S NEft �J1�1 X1at3Cl M1+
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CITY 1-G}c . ZIP —O(A f TEL
OWIO: -RWER DECLARATION
I heabY arm Under witty of worry met i am Format boor, the CamrecWt sate LomM AN for tlha mampo
baIcYLBd beaw ai tm ph0pkmark(al I IN" Planed ARM m Lne applicable Imm(A (Borten MIA, Swbmn may
Prolbaslaa Cow Ain Ca ar awaty Real mNdras a permit m eonan 4 WWm U NNOM damolah, or ram, my
nru, in, prewto In Rare . also requlm to aWkmd 1W to lmdl ill Ra a*WW mwwtson an m We
If Ildaaeadpummnttoma Provisone of me CmtaaloieSWm UUmw Law(CARAW 91 Converting Mm SOCtm
7019 of olvWw 3AT to Sail am Prichwom Cmfa(a#sot he or she a emmpt from ikareure and the one to,
msedeped bsomptlm AnyybW'on WSeNpn70315 aYamysopiwt(nr a pemdt whpaa#n Wg4kam me clMl penury
W rat mare men t" hurramed Umv, 500)
i31, a0 awap W tla omPrry, a my amphryeea wort vnaea sa than boa Camprrdm, wm ao LI all of or L J pordm9
of the warn, mat The a woos a AN mmvabd a armed be Far Ma1M 70" Rus" W Prptgaipp Coda IN
Camreama Sera Lkmwa taw was one a" in an owrrmbf property, Mho, enough @mpmyear p PWs" ot4t busds
a Imports me ProP". Pomatt mW ba fmpmromme m nor ktanmaa offered far sea s heron r, am hulid rit a
0 ingwnw err the Mmm maygmW�@A@11m,m@Owrer Budw+rdl heVa mA bindanaPwBA fiatNwae Cal budt
a k'Fvo+r rOr the purpose W am)
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704k Suanss and Profeas4n Coca Inc (knnears' Smre License Law done not apply to an came, at pap9rty Ran
ones aenpre"smmmn, and who romnictimrto project with a acenconi Connector bumuam WthaCahRemom'Stan
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li 010bJldm e 4 an rot bow r, aru@aa m l mbkaly by case
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aPPkaa I A SW.tdn 70d4 ei m@ Snlnm all Pufasoboe Code Is $rOiI�B wm mquml ,skm this BpGdwdav a
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UCENSm CONTRACTOR'S DECW OWN
i aam4Y amrm aim pahWM aPal'urY fret I Bm ikaned urMa pmYlmanB W Caep'ar6 (crrmadmo wlm station 7}
of DIVI@Ion3orme,s m@a3and ume@910M Code,a�n'd]out t`kam IshiBX fame among
LCENSE CLASS iiy—} - LS NO '1 "+235
EV'GATT '��fry#�I jI� CONTRACTOR i1 a� 449NIEfl'S COfUBISAiiDM OEGANAnON
I HEREBY AFFIRM UNDER PENa3.TY OF PERARy ONE OF RIE FMLQW Mi DEWMT"
_ I new and MR miftO a Oedmpi0 W COMM In StlFNwna for Works, e Nffwmdm, a MMM by
Section 3700 W the Laom Coda, for the Paaamema W the Yauk for Mika this Pmal Is Nsu@a
shave and MR maintain Walker a Compensator keuram, asnequtrd by Section 3700a the LAW Coce, for
tWpanPananPaWte wWaforwNanta OBmtalrevea MyWah'a Cempemmh Cmarand
PWky Number
PDLCY NUMBER
M93 SECTION NEEDNOT SEWC REIEOFTM PERMIT B FOR OKKA,OEO Dd1N5 SWO OR LEW
I carsfYtninatw p Monti ce ntlawalt{a MdchtlN9 pamBi a Imed ISNlimempayry PWmh a WNnaaN W nto
became AA act In the Work" COmWMMn Uma of fallkm4a And agaa bat 0 i efotM blOdhw 9wlmt more WpMd(a
CampmaatYlppldtAB WSeatlaa 370741 0euba Cora Islam kW aAtllmrtpyMalnYlso prMsgrp
A17UCANT
WARNING Fadun m some WorkA'a awggB a unIR @m rm subMa in emplayer to oforms
p truddes and Wsd Crsr UP to one hUMMd Ualowed dDM (Sl OO DOoi, In atldibm to the curt of the o5
damages an proyloul AN in molar 3708 of the labor calla, mimes, and atanceys fca
CNISTM)C DN LENDNG AGENCY
I toWy arm aWm PenNY nl Pwlany that there a a Commmorm Lending Agency To De performance of ire YKKkfor
enrich mis Permit is twice tiS= 3097 CIV Ca
LENDER'S NAME _
LENDER S ADDRESS
I CaNNmred aaanBlaamWtwmmam mamna rn9mt eprmmtmnpft whh rdHmn
aWmencess aVl man, dwa reatlnptabuilding carevicims,
am lRrWry, anMdm mpmormdNes Wtee owmy, an
radar tar the above mmaiwndProgWtyar InAheCtan Diapmea
Ltit,.-S P/.��Z�} . / .j
EM%iiE E CPmNT( 5+
SIGWbq OFPERMITTEE DATE
SL:
APPLICATION DATE 8011 P/C# f r13 T IU If0
ISSUE DATE 1015 11- PERMIT# P R 14 — 109 G O
TYPE CONST OCCGROUP
n .,.'^i``
Scope of Work i�Y TJvvI%�tS+('((q
` V \ '�"m �ltMlhrVE .
# OWEL UNITS 1 # STORIES t Jr BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREA/VALUATION
SFR/hDMtEW
arm
q q r
Y
w
PMhomack
_
.. .....
wi
Powspe
''..
Z
Re Root
9
Cmmnr w
m,,
Valuailaar U IUXJ Ad( Area
OUANTTY
DESCRIPTION
FEE
2
+
4 4
CONSTRUCTION Coq%- 32
PLAN RENEW 5AQ5/. I/
—_
ELECTRIC 6d3 • ?%
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE 2 w 34 12
SMIP 5 20
ENERGY P/C
ENERGY PERMIT
RETENTION FEE 8.00
PRE-ALT FEE
BASF OU
PLOT PLAN Li 2,314
ZONING CLEARANCE
TOTAL FEES BZb•148 943 12
COMMENTS
PA', A„"�', 8al qPAIR BY VALIDATION
REGEIFITa 8 PAID BY ✓-r T7 !1 VALIDATION L'C"
WHITE — Department Copy YELLOW — Flnmce Copy. PINK —Assembler Copy