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HomeMy WebLinkAbout12-2174CITY OF DIAMOND BAR DEPARTMENT OFCOMMUNITY& VELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 T (909) 839-7020 Fax (909) 861-3117 Budding Inspection Ratline (909) 939.7027 tie BUILDING PERMIT APPLICATION JOBSITE ADDREss�C�42� ti-a't15ix-t�T�Aai(. APN LOT TRACT OWNER M,ULg'-kj�j,[,j--12, ADDRESS ]•I `Z 0 Q—k4nL 1-9 It - CITY i) i I1LID ,ye; TEL APPLICANT TEL CONTRACTOR ADDRESS CRY ZIP TEL ARC UENG1 DESIGNER _. ADDRESS �y <'oa�� CRY —Y"",. _ ZIP f w4 TEL-�S OWNER BUILDER DECLARATION I Utoy MMIh U QEA P6NW.TY w PE0.NFfF THAT Iw E "MtW4 WMAWTORS lF E>PaE 4tWFORTNETCL1OWYw AEASON(� Mt a6USWESSANRPROFE59idVH OGDEAMYGTTYOR COLNLTVAN TO III ESAP6YETro OOXSLMIGTALTERNPIpVE.DEII{%l pf GA m%%fiP9TNJc TUflE PFdgR tp RS Sa1FNGEP1.4a REOINFB TB JPNLWF TpR 61511 PEAItlI'TO FLLE A BfdffO srxiEUExf Twa w: oR 6NE n ucErcEo wrrsVAm mTRE PRQYJ9atA oc TrLE cwrnAcfw LL amE uw N1APiflLAwgYUN1C@C WlRi 6EGipR Tmm� WvmoR as THE d+aNEssAIp PRo- fE34gH30]Bk]ORTNRilEM91ERE6ELE�TTw:IQ:FAWLNq Tr!{SFSS PoR t116At(Ep®E1�TP• LiCN xnvaaAfoL OFEEcuWeTmr66TrPAVPLrxn PoAAPERLAT aLRI6otAnrtAVRrvnm ALMI. PENAVI' Lf IIOt YORE TIM nVE 11FC11ER W1,4RS {tttl}R O LbCWAIEPUFIME PROPERTY ORYY@rPlOYfmWIlFiWAGESb TFi�tSOtE WAPBYIAMM YML POtRfi WOPoC ALAI Ti6 BTAVCTURE LS HOT N1ENOm OR OFFERED mR 34E (SEC rPLA NRF NESAAw1 PROFES6IOMS OODE T!@CCHIRAGT0114 UGEWAE LAw OOF9 wTT FPtiYW wgWN£ROF P1tfPERf'fMgbJR6SCRNPNYE9TRE.R1dl N#!MW UOF55Utl1 WOFU(RNSBf df w.AYnF WI TwauWlwaoR RERowr wrLaTEEE RRGvomTRAT euw wPRauEVEW+EUILRornrcrmwaR OF:ERm«iaL4NE W ROW6V6R, TK1AADaiOORRPMRSVFLBaf BaghvARmOXEYEaACf WMPLE FOR £ �yY Ems} Tiff 6r}OEN IfFPRWNd TFUT FEi G.9 fl1E Nk MN l0➢OR D4 Aa OLtrtROf 1H6> Y$AL4wEIGLUSP/f1Y OON[RaGiNO WT«tILQiBm LW1PlLfOk9 roOmlaY11UOTTME NkUEGT SEEG JNa fiUStl#SS AxOP co06 T1K OOWLRarncR6LL CEMBEUW OOE91mTAPPLYroANOW!lILAA gPAPROPERLYNtq EUE0.4ORIUPROeEET1IEAELYI,.VD WSFOGWIYiNOt6 P9lISik"HPRGIKf3M11fACIXfIRFGIOE46TUWH6EDPURSUMYTtttTVECWRMA 70R4tIGEMEIATYi O Iw EabJiPTLMOFAEEG E A PG iiBi TwSAEANN DATE orR�r UCENSEO CONTRACTORS DECLARATION r xEiiFat uYNLL Lomex PEwAn o PERA1Rr TRAT i w LrEmm Lun6R Prton Lnx4 aF owr6R s IO W WaEliyN3 YA1X LEOPCN T4R10F OM8%N a oc THE ®1SNE3J A!G Pf KFF36mIN OOUE A161 n IXY.NSE Et N RRLL PYRICE AIO 6iiECT LIGETLRE GlA48 LK: i10 DATE GTNTM A WORKERS COMPENSATION DECLARATION L HERERmr I.FFEW twFn ,4Aw.YY6 PFRLYm Ot1Fa Twt Fp1pMm OEAARATOI9. _�IFLAYE MOMLIINNYNR AC£AiVM.AT60: fOraENTm REi£ WWriF FORNOPo¢AY OOYPERSRpN b PPWOm6Y�OTIORaPm OFTlVE IABORO®E FORiPKPERmWINwE �TYYMVRRwawww LNEI v6RLET remarEo _�I RAYfi tMIwALAvi+4N WOAR4R903ilPENSATxN P19UWxOE,b PAW.tlflm RMLTIWI aim OR tw: UROR MOE mRTNEPE bTf# WryNiOR Wwa+TRa PEIOEt 8 LSWm. W %NNEIK W W FlL9ATtY1 P6VRNwE fwRREflND N%iY N1YRERIAE CJllwffl NA.bY IR.YrSEH iP1196[LT.11NEmN0(SEiaElFlm#if6FEiMf6RAQ1E wPp®iilANbiM�QiL8.51 rcilR6Yittti NONE PFPfOwrWKE 9F iNE WOnR PoRWt(iar TNtl PLP}BTa I39YF6I I EIWLRO[ELPI.OY ARYPEflSW MART WtertREObm6ECOME w6diM mis4 WORMERscOWERSAT41{,4%9R OALLPOAgP�ANQ MIEE R41 i I6w%Im 8E{IIY[ 616FCTm if& WOWlEI@SAl5WFNMlY9i PoUY4iCNAOf SEEM1a:'n almOf ii#I.PBO14 « O06E ISWLL fORRRKM gYq,YWTMIILOSE PPWtSOMB DATE AP{R.ICJRT YuiVNxi FIaUIRQ 1OSKLRE FrOWt[AT COM>iNSATAIR mv6WG6q LPMYTFUL..«rm SWtL9E S{8fEC1Ni 6VPLOYEfltO CJiALNALPFNMTESAwa GtA FlRESLPmONF RUNREATMOWAPO C4LN18d«m SPPi N,iWY11011 mf+a m9'TOP wawoLaaPur oAPan:csb PauMmFWiN 6ELT'MafL Ci T1ELASCILCMENM1A6Si.NQ AliWNEYHFEEA i CONSTRUCTION LENDI AGENCY i lt6RF8T' AFiWiUMER PERAVYOFPFFWRYTFARTIQRE 9ACAraS1RP.TWLtEPiW1O AOENOY FORIfYPFIVOwWPCEOf miEYKN6{ PoR YRmH TIl9 PERLRi W ¢amIA6GaaN tN Gj J : LEMFA4 NY6 LELP]fR8A00RF59 tCERRFYTW{i«BRAE REAn TrRFAPRCA,%Mr ALN6TATET}UT�BABP.E P6BmATgN OCOAR[OT IAOpEE m WNRYIM}RALLdTYAwIOCUN1YtxriNYR:F3 HAT &TATE lAW3 RElATNO roannNa OOriSFNFlgM NORxRERYAUOlORRE REPRE6FMAtrcfa 4f 1Ral marrtY roENf6RUPOR iM6 2 A6waarEWrcRmNpPFJ1M1 fORN0P6Ci KN %1�£0. J J U P6RieFLFE wF4 PPaRR E 2 � bt1XATUPE OFPEitlLRTFE OArE C _ APPUCAJ(O PERMIT DATE "" "t �� 1} NUMBER ISSUE TYPE DATE CONST PIC # OCC GROUP ZONING SETBACKS FRONT REAR '.. SIDEGIDE STREET SIDE RW RW JI ❑ ❑ ❑ ❑ t� PROPOSED USE M1�t O �EL NO DWEL NO UNITS STORIES ACC NO BEDROOMS DESGTAIPTION SO FT FACTOR PSF ADJ AREANALUATiON SFRtAUDeREM � OEnQ�1a+PNT ... W PA LL Poo , z O CommarcW rn VEIUEMm'(. 1 Li�fl _ ADJ AAEA 4UANTTTY DEECFILPTION FEE 'a F to w Z z ✓4 a J n. W .... CONSTRUCTION PLAN REVIEW }� ELECTRIC PLUMBING MECRAMCAL BISPECTKINFEE ISSUANCE SMIP ENERGY PIC ENERGY PERMIT FJFTENTION FEE. PREALT FEE Q TOTAL FEES COMMENTS Qt� 1313 \ ri( 5 EaY'+ NO BY VALIDATION -AaaamWCopgG COPY, GREEN- 4Owy