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HomeMy WebLinkAbout16-1223n c m mc 59 * = CITY OF DIAMOND BAR _ DEPARTMENT OFCOMMUNITY & DEVELOPMENT SERVICES ` 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax• (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLYbe" BUILDING PERMIT APPLICATION yvww.cityo(dfamondbarcom buf)dmg{adfamondbarca.gov ,,JOB SITE ADORE �__... !'�.1_...._h�x kp APN LOT TRACT OWNER ADDRESS CITY ZIP TEL APPLICANTI lee -5-r i>?' TEL CONTRACTOR Y 4 ✓ 4r tLY ADDRESS4°- CITY ©n1'tC ZIP N�TEL ARCHlENGT DESIGNER ADDRESS CITY ZIP TEL owmia MMEN DECLMYATW I aBimr actor penny aI perWry time I am maw fan la Carmalda's SWO Lloapa Inn He the Rawas) been, by tie oeammd$sl I ban paced ran a the W ON@ IW* LSedlar TMI *A Bud m at pMlnlaw Coe Artymtyamalty amtrawmapa focamirual,ant, km�Uanw%h, ampar,ary epraaaa,prNrb Rs rmwian.abp neuka theappaCmi4a pm Paeatl pM a algnedalalOmBntitsatroaeM b lmameaptaewol the WmmurmdtlAlCamxmrb9tal tlametaWj 9)CIXnrl andmintake dMmwr3d19a BuvrwsgfS PaA701 Cadet or thatMaeM weXWNd imm omnaxeaM pm Maafa laamgadexemWmA'ryabiaamdSetlron7IXltSoyap 1IXanmgt Thee taaIXappamlty d imt man tli8ti gat Nmdred donna tasoo} of mownandm unciamis ofk tf aea wiN wad to aaa�a 700 do vnpdp{Jn da Can, nor dteawuk,ta7 Imermir ANmaeor We May baCAaed toeau tly*ft TIN WORM, aM, PttdT l CadsT$ CmmacmM tMpan",daWdoesmapknowrawemdpmpaN xdw ttaow 'apamnatdtat ngm kr lap mglswWwI .Pwy lA m and ma aoxam to met titaTtlaaW Cad npa IsaIXd walan ax y�dt leD,wla INwmrwa NaW DW a,mW dapdW liar N wa9nIXada « glrorerm ta tin gap tie or sae ) 70 W pt pre p2pHty.am nmmnerymnUamapwah gann&ai data aplCtoMdebw ao dIp C.,wlpo T0M BmlMaaa and Proteaagim Cade iM CaJracmm' lAxsm Law dam � apply W an ewfaT d PWedY who I IXMpwnlhmao sad wet rdlactslIXNw pmfwteWIlaiasr CWMCta paaantiepmCalractan'Stets I Law} U I am exempt Iron aCwwam under the Cunlrectaa8 State Llnti law for the tallomme remonW Date Sign By my elpnemre below l Ecklmwlmge that a apt fer my arional raslmrce In whin l mat been resldad fa at lend ale year poor to ca pletlon of the lmawemoa neon by let pemllLI mood newly n71 a Aadae Um1I haw MID a an dener buddy, If N has no been contacted In III alren by earned caaaches. I uMde=M tat a ropy at the appmaW law, Section 70" at the Bmpass and Roless ms Cade is awltdde New meant who the W armtio U SWO( Boat Dre MNwft Websde NNAmealepteca9payminwhlM UCENSFa CGK"LVTONS pFDLAFATIN IherepyM"amenoMtyd poury MAI amnamed undapmwaamdl ChWW9i Milwmdno wt eWw7ls= dDw m 3d the Bnnass and PmAmpe iCods. and myIlmro Is in Na NIa and open I C= LIC NO EXP DATE COWM70R WORKER'S CDMPDMAT psi DEUARATNM I HUM N'FaiM UNDER PENALTY OF PENLTY ONE OF THE FOLLDWMG DET ARATiOE _ I Maw and wd ❑amiam a Cabkm of Caeieor to $ep keen he ftkW$ WOMADW m by GnDaa 3700d Dm tabs iba M�th.eup�edar�.m.�apBd Dan wakibrwNar ddspegdtaaaad _ I been and ww madvA Wow$ CWPamelmn psaaia anfm f by$Nunn 37M it awtaba Cadets ace d lenience rpm din punt athaded Nit Wpdal'a CabpenatairAwroaOopkraM Petry Mobaara CAME" POLICY NUMBER (IimSSECION NEED NDr BE CgraLFEO FOIE FERWITISFORONEtepMDOO.L" $100 OR LESS} ImRNYNA a N palarnIXim III thewakmrwhich this time Isi®mtl IaMtlMempbyalypnreonihalrymaawr oml Manna mapicl M Me WOWS CMWMMOM Land Ceahrha And prce that N I oa d became MO to am WWW's Cdtpematlm redeem nth Swim 3700 dto ismar Code, I call finhae) comply MM than piwlscm. APRICANr WARNING Failure to noun WaYefs CaWamatim orange is aawlud and AWl Wb(ect o op ear c almiol and cMl Ban up to ame hundred fta d dome (9100,000) In addition l the Cut of DAY mmpematfal, damapn of prowdofa m NOW 3700 d aW WW ands, InWrmL aid a WWO Ina CONsnwu NUNDINB AGENCY I name made penny of pantry, Dal awn is a Cmmuchal Leming Agency IN pay paidemmaw at the work me welch thipama A assed SSW W97 WC) LENDER S NM& LENDER S ADDRESS iCaDlyputIbare and tair gpaka9aia n Ae1aapreabbeInWdhmn y&Aw imreetomt p"fO cstyand dNm*Wass w*ow wenplo moemp .and lalahy adwllm rep, dpa Camlyfo orderWWiM able for AapmAa KPAWUFWAE {Pfwsf} SMduIMOPPU%4nm DATE APPLICATION DATE rA�3. i ISSUE DATE PERMIT# TYPE CONST PIC# Via 16^ 1x- OCC GROUP Soope of WOAt Q.'K.a.-YI I+Ci e-.,n J. awed ec-QPMII JT # DWEL UNITS # STORIES l-af i"r�U 71' lOLcbt71dh Or BEDROOMS DESCRIPTION SO F7 FACTOR PSF ADJ AREANALUATION SFfU}LL3CVREM Oarape/Cerpon .......... w PailmDack ............ w Poa opBp ED Po Pppl 9 Comm .W in in V88aaHorr Ad! Area OUANtrTY DESCRIPTION FEE WU J w z CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE PRE-ALT FEE BASF PLOT PLAN ZONING CLEARANCE TOTAL PEES COMMENTS PLC PAID SY I ECEPT If PAID BY VALIDATION VALIDATION WHITE —Department Copy, YELLOW — Penance Croy, PINK — Assessor Copy