HomeMy WebLinkAbout16-15540
M7
j
M
w+
I
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909)839-7020 Fax (909)861-3117 Building Inspection Hotline(909)539-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cilyofdiamgov ondbarcom budding@diamondbarca
JOB SETE ADDRESS
APN LOT TRACT
OWNER w'i u'� (...;u rot
ADDRESS "L`S ",S'2.S� G�4',rC�t�,wr�n� 'i?Y
CITY `b _ G. ld 1 _ ZIP�+a1,11(o TEL & 7zf Z Z.Q >'5-10
APPLICANT %i2r(�-W_..,1 nVVV1noTEL C,aZ6�8 'f
CONTRACTOR C J
ADDRESS �tl2rra �" sr.2 --
CITY ZIP TEL
ARCHIENG/
DESIGNER
ADDRESS
CRY ZIP TEL
OWNB-BWLDER OEG A ATM
i h"W amm wnm Deludly d afty iw I WT added can to Co d"I Scare WmW taw to dx fum(aJ
salsaod below by me M Wrtaa(n I twtw DnoW Lam to Dx pot" Aware) person 7031 N "Eta ark
ElWaiera Codr Any e4mcaay Olin mgiba a Damn IDCWWhCt Oft, meaft, Oaf W W%a rape6, my
ebahae. prow mfabNnwci, oWnoaltw=IWMImthe Deenam7maNpratl stain mbahoocahe
away pwasaof Wine FvAwed ffcm*wbw%stamoxeaboude, piaf9![andmfxinpwahSea6oa
7000 of Dhban 3 W M Blahaeea 0a Radtke CotleJ a Ma ha a elm eexenwt flan lennom end din LdWF�
dxaxnW ow
oM SaMot 7031SlyaMeDWBolnlaspmmiia e¢aiheeDON+aId toBd,N palyh
d not mae tlxn Ire tanam tldMre IISD(A
Lf I, be well of Me pigiefh, M as eapoi awyah Wama saw WIG annadenten we U in of W Lj DahDa
of the war, arm ew ammte a not bonded a oRmxd To Wn ibctlm 7014 &do= and Pfdessows Cody The
Conbadaa'STae Uametawdoa Mtapplyto We otpWefhwfw INoupABmPkkea'epeeWlxl eRm,UUatlS
a apmrea Din POPay, ptaMW iw lha tPmmfnaa ae IW iMWOGd aoOam fa Wk O wwGw:f, the adhen0 a
Impmsement IssaieWxl axyard oanpktlW, taB Dwna RaOawXl hate to 6adend Pfaq mstAwa w bulls
a Mpmwm la ae DwmaeafaB!
LJ i. downer GmGosemea emeRawhndaye SU wWlb�Oed does
not to W 0 Othe ofoad1SelOkd
70a4 &Wness end Pro(emmmt Cede /e Cuticles State LkAim taw tl0ea not epph (o W awiet d aa[eA} we
acrosalmOmwa OKtpn min MbCMimC3410FNepralaawGlfB Ekmtaa pleaxnttoie CmOedae State
7 aw)
{j I&n eal inm beMASG W-Ar DM 001M V4 State Uesew low tatSao following fason{d)
ode Slon
"agnanasbow l aCMMWP#4 eax(t la MyPOWO fandof In when l TO Way wall last NMtdo
year pea to arsoon of to ImpmwAwb anybody by the porau Coat [SON oil a stole HIM l h3m last UW
NmBr harder d A had not bean =VhC W at Nt enadh Dy earned wlomay, I wo,staal BAR a Copy GI any
exandano aw Section 7044 at Ox tiLdh Wm ytdaelaw coda Is ewaaads pal Mual whW fist a e
submhted a si to sdimWg Web am bttptw ww "We ce pyk alsw had
UCDMD CONTRACTOR'S DECLARATION
I neRtry atom weer Really Of Prluly that I an banned Oda proveas of Ghats, 9(oanmeacing wets Sect 7O0d}
of Lesion 3 of the &alas and PWexbns Comb,, anndd�E.M We en Is In full face ea ehaa
LICENSEGLASS C- y% LIC NO 5 92s *' f
OW LATE : St t fI CONTRACTOR-^e4•'+.':'iPl
WORKER'S COMPRIRATM OCCLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF TEE FU.LDWING DECLARATIONS
I have and will messnbl a Cantons of Cm*M k W may by Worker's Compeneailon as "dud by
Sedlon3700dIMtadar CadO forihB{xldp'maxGottha wow tar wMcn UN pasnfl 0eaum
I have Wd,da main Waboad CampBnasdSM1lAWranha, as dow" by Section 3700 of to Labe Cods, for
the perfomencs at aO work la wNCh this pseatk tMW My WnWr's Cannonade handled, Career and
Wky Numer ore
CARRIER 'Zf�i/'s't-t+s...
POLICY NUMBER a.At 5-01 9 7-110 L •/
(IRS BECOON NEED NET BECOMRkIED IF THE PERMIT IS FOR RR 000 DOLLARS $100 Oeam-
IcaMyf Welm pa#Wraxwd#w wotkhr+edwil9rspemaf ImfO Igpv Iqt WlPkl'aypaox k 9mnamlef W pk
ndgat m fire WDMW9 CmOa�ial Larmd CaEfaNa AO apmG Nor f! dated Oacnne aubDd faits Worao's
Carcxll Poispmd warden 3747 ddx tmarma I aaOlbrtlrattlr WiryRywlaDAxe Pat5ia0.
DAli:r�2�F_(_r�APRICNIi ��if-.1.tR�A-.
WA&BNG Ran to aeon Wnnft ftVoogm ✓>7raed is unfoxta wen"MW W employer to aimbml
Mota, We CA Feat p k on onded Min W Omuta (GTOD DLO) In SOOM to fro M ate mnpensaVm
MM""W"AdedllnsWOM37080?ftn0amde Noost adoonswas4a
CDNSIRDC =Erma AGENCY
i IwfOby added ama pmft d parlay as ten O a C4m9tdae Landko AoaxT for ie performance of to work for
alslxmihisaablSao DOW CN C)
TENDER S NAME
LENOER SADDRESS _..........
I nsfdydall OamraBfdq aDPOaaoend ado tlla aBmfveaaarx0m a facer] t aOee keapty wM a dry Bred
OWHaanacaark Bata xwsapatgateaKtmpuM nark ManyBulhWmmpraxntmwsaOa wady to
aaf uf011981 mow RblaBnmNnerN l arDatikfr papma
_ Mt�ef�+ew +via
rEENwaEt� mY�E��.ltl�.ti-- is 22-f ta
S6BLATWE OF PERMU'IEE DATE
APPLICATION DATE Io - Z,77 ' I PIG# ~�
ISSUE DATE do '71I 14a:s PERMIT# FV2, t to - % SSaA+
TYPE CONST OCC GROUP
�y
SCOPE, of Work i7.. h:3' wt !` t'i
# DWEL UNITS A STORIES
..
If BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
BRR7Ai7LkAEM
'..
GBrai efcanew
w
PaIWEeck
.............—
uw
Pod+ida,
Re Poe
�
Commacrai
m
Vapti3tla=p
Adl Aea
QUANTITY
DESCRIPTION
FEE
ZZS ?2 {
u^
Z'
CONSTRUCTION
PLAN REVIEW
ELECTRIC
—i"a,.- Alt
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCETo-l-
...
,n
SMIP
ENERGY PIC
ENERGY PERMIT ...
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTALFEES
COMMENTS
p1
�'49 4R2_
PAC PAID BY VAIDOAIRON _.......G
RIi'$eb QAL�_ PAID By `a r s �� r;.' vwQAMN QWNn_
WHITE— Depeanent Copy, YELLOW —€ienca Cary,—Astaxtcr Copy