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Home My WebLink About14-4859I I 3 O M J ale oQ R 0 G1 E CITY OF DIAMOND BAR WDEPARTMENT OF COMML PY & VELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839.7020 Fax (909) 86I-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMITAPPLICATION JOB SITE ADDRESS AF N ._ LOT 'TRACT OWNER ADDRESS O CITY ZIP Q Ta 4jym -'- APPLICANT T L CONTRACTOR _- ADDRESS r `+ CITY ZIP TEL If>� ARCHIE &DESIGNER P^' y at W 02 ADDRESS Z CITY ZIP—_C4 TEL MYNEXBUM09R OECLARATON I hereby amain air paaily of PaRurY mat i am exempt imn the CuT.^a'ATr`a Saba tksnea law M IM1B steady) Imposed; below by the elemental I raw Pkcm fart to ale Valuable rmmore (Eactae MIS, Ruebwp eat PmtM aCade Awl city or aoualy Nat requires a prmlttb mlmbunt, 6* bip*M dtMtML a fapem, an atrrata6, pda b 7m aGNM.'6, aM0 regldl¢a dla eppiUAa fn tM pawm bflb a iMadBaamBal Nat b a sew b n,wnmad WmaMt NBm iwgMffarm aBa raitracm4steNumraeLar (drappa Ni'.wfmrmrr/nq with Seclbri a DMYlm3a thin BM Pfoleasldn Cma3a NatMat din klBwmafian Aaeaam eM thB baMe for at alboed meant me, hundred dwoon 7031 S6yayappikap ledapemiliaua0abN4 pkaip N0 WIIforay d fat more Nan 0w huMred ddMa {59001 L)1, ai owner d the aopot3'. or MY WITIo ee9 with wepee m arek adn conformation, wit OoU oil of or portion@ As tin work and the atmCNrs mast: reported or offered far Was (Sedw 7044, Baer s and Anderson Code The Cannaziaim' Shim Ucam Law does not apply to an atmad pNedy wte,throuph arPb'aem' eventual effort builds of Impioaw the protest Waited that the restatements fire Md ulwntlPo or dfaw ha are Y haYawr din balding IN moddwbnorwyuofm *ban the D.waNuttier whghaw the buniondPralnp auttwm nor GAIT aavowt far Na Dumm of so%) U 4 a4 Water a the enede riY Bm ewaueiatby attracted wit latme s Cmbmtka to calabgathe ptplma (Salon M44 Wasymores and Profbe er., Cate Ito (Werad om' Stara Items paw aced not apply N an owner a Weporry was p IttLMWe§Neiwn act allmdomBdeb Yce pmlectr wmal d6M0tl CoiNtadM DumuMSmN§CaaWtae'SieiO uxrea tmr) U l am aatnpt tom leaneam uMa Me cofbec4Ye Stets Lim nee law tar the fa lor%ng macmrai By my rafthme below l akroawtwige ihea, mrxpt W now pemaml readtlar Is wtkh I most haw MWM for 9 ieaa am War ale a ompnben d We ImWpmmeat cum" Us tie PWWV beest fill NO a eWtbm that I raw left an an bN reaimeend!Won conshartedm for onmetybyflamsmwntrader,I I Nato My of maSerrecla law SanOn AWL at No But=act °Mbowl CON d awtlable upon featured wren min danpkatlan Is aWaffeeda at the Nllowing Wafalw nNp`wwwlmglMo� poytcdawntm DATE SIGN LICENSE) CONTRACTOR'S Dn3ARAT1011 1 lemby Oman adopt *1 proxy that; am Ifirdammal u t paablm of Clmthor 9(aworeec gwan Sattn 7mm of Gamn3 of dla Dusbarm AWL Rafeaslonm Cott aft net kanma m an cull taw eM vNed, LICENSE CLASS UC 0 CONTRACTOR WORKER'S CDMPOiLg= DECLARATION i HEREBY AFFIRM UNDER PIN AM OF PERNM ONE OF THE FOLLOWING DECLARATIONS _ I have act wtl manfan a CoMcdo of Combat b Sat eeur0 sa Work," Cam09ametm na preldi l by Salim 37M of the Labs Cola ke the petWlltYCa of din wok ba whom this pmnrt Is leaved _ I boo and will ompMla Wareerlo Cmlpensatam hemOpw a restated by Sion" 3700 of NB Upon Codes NY Cm PaTormande a Nowakta wNm tom PemBtle Iasuat My Waka3Canpmaetbn Inaumwpa CWw eM policy Number are CARRIER FDUcy NUMBER M4 9CPOMWM PDT BEO"LMVTHE PUMT tSFat 0rEHtVMDOJA4S 410080RLEo} I mray, WmtnawgaAlrlreifa dtlmwa%kaw4xAmuoaadL m bvmE I tlffinartmPia}arrypaam in any aavarmmb Nmme Wext an glabllftit Comfoolsaon taw of CaNda Art spree that d I trmad b®nw atlatle MW**Alt C'armmsabm remelts of Gomm 37M dyne LeaaDade lslmiAMhnPY dompgwflh Me pmtdmm. APPLOW11 WARNING Fearer N 9acum Woramrb Composesw a, attempt in unlawful. Was "I saroot an employer m cfAblrmt pain as and owl fines, as as am hundred IW and Others I2100 00N In aftdon as ma area of the eanpolaretwn tlammpa9 as pinwdad to louctkn 3708 d the tdia ems mlomsL and slmrnay§tees CONSTRUONWI EBMWO AGENCY I hereby Whom aMa Warmly a paiwy that afore t a Comonad at Leading Aamrq ter am Wafted, w of the work ear won thin owned Is gwai (Ss, 3097 DG C) LBR EA S NAME .. LENDER SADDRESS I cadir that) haw ray Ora ePWkatem oW state that Yw notes iaammM la owner I agree b am" win al city and aumy a'tlalmra9 are ideal late rpiaabng N tutting Finareudem Endra her Malta maa%WttataeY of this palsyto arter upon the absem mentioned property Or Inspection points Pff*Mw NAME (PRINT) SM,K4RpiE OF PERMRTEE DATE APPLICATION DATE /y ISSUE DATE _... TYPE CONST J t t P/C4 PERMIT# OCC GROUP ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW ❑ ❑ RW ❑ ❑ PROPOSEDUSE ald a DWEL UNITS p STORIES t BEDROOMS DESCRIPTION SO FT FACTOR PSF ADJ AREANALUATION SF LVRE4A Gerap a'Port 0 W Pa1 ink uW. PmVSpa f Z RaPad t� � Commadsl ' m Valuation Ad) Area QUANTITY DESCRIPTION FEE ! G i 3 m a rt 1 I I P8' I CONSTRUCTION PLAN REVIEW b g � X �4 ELECTRIC 7 PLUMBING MECHANICAL, INSPECTION FEE ISSUANCE SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE PRE-ALT FEE ' BSAF 1 � i I TOTAL FEE 97 a COMMENTS JIADr L RECEIPT#, PAID ny VAUDATION WHITE— Department Copy YELLOW —Fmence Copy—Amaaaa Copy. GOLDENROD —File Copy, GREEN —ARAPertCopy