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HomeMy WebLinkAbout17-05499 s Q, 1 I 'F _..__ CITY OF DIAMOND BAR wV V ck*" e- U �+ DEPARTMENT OF COMMUNITY&DEVELOPMENT RVICES 21810 Copley Dnve, Diamond Bur, CA 91765 PRESS (909) 839-7020 Fax: (909) 861.3117 Building Inapecnoo HoOtne (909) 839-7027 FIRMLY . ;�,-w BUILDING PERMIT APPLICATION wwcayolclmanandbarcom buddtng@dmmondburcu.gov JOB SCTE ADDRESS Z 1 0 L 1 Cool %r�pr APN LOT! --TRACT OWNER ADDRE�SS]_Y _ " CITY—ts7sk-7'"' ZIP � r- 'TEL 0 ©y'I APPLICANT TEL CONTRACTOR .. �.,., ADDRESS _ ''.... CITY ZIP TEL ARCHIENG/ DESIGNER ADDRESS CITY ZIP TEL ___..... or ffWM4LALOM OECIARArM I hereby aftnt leader Pon" of Pansy Not t am Meeyd Ran me Can WWS Stem Learn law for Qe noemLN IMICM below by she Chakinande, I tan Owd imd m m0 Mylltame Micro ISSC b 7031A OWi and Pmeeedwo Code Aft dlE Of apathy May Mrdma a pMM to VORIM 1, Or, t WIM Emmftdl or Npem, any Mnnebae, Prior in he bamaca, am "am pm appRewd iMtM permN to file a tlpoatl amareme tlW madame b11 pmsrsr#mOwpmftmm MmaCalmaemYsSbarLkmm tow (ChaporAd omww *q Wall guidon 7 0101 WIN Its Hafi�eiW Pmapemrw Codej atlwi amar sale Neaempt Man aM the Pa49 tut One ebeledammptmn AlnnbMdmofSed)n 7031 SbyMi tics psrMsublMd me AWMMtoaCKRaWry a MS edam tlMn 0ronixadmd ddlpe t3`00I `` // Ydmewup"Amy mmp new in Mona" solemmumob. veld dreOmiaeorUpoVbna walk, and bas MI a nth #4~ Or shared Me mia (".aetlpl 70m, SuRkam wry PmfeWM Cad fie cwftd s' Stitt tsewa law dim not anal} to an Owner of Many who"Mo eM*"N' or Panama! entry, orImpOea me poverty pmAtled Most its Imgarament3 an not IMar-0ed or dosed for was d Novel Me mftnpa IMM"Merd Is Red WMAN ale Ymr of MMPwdm Mw DaTw adlmr wu here Has Ngdon Mpm ng dad It leer, M AM almpomtl Matw mNOle) U 1, as events at the pmpWry, are OadeMYdy cmncft WD ikaoaad Ca*awm NO cawtrnd. OM RMIM(Swast 70" Outboards And Rgutam Cod The CalUumm' Suite tldawe taw deal to apply, W m Oscar of properly wen m1Ms or IntrRvmVotaal and was conditions for the VWMWMaIkerwal CunbacM prNMmmit* COntrmttm'Stale Lvenae Lyle) U lam MamM enwas tractor's stateUmnm Way be mebOOWmp Date,v,t{ Slpn A OYmY,I,Pe hotwleck aNNdpa dot, mrmypersonelresINJ musthoe mined for M mew om year prim to connotation of the lmpmyeman"a caromd By this periM ltaYdlt ea9 a dmctule mat i idea Hilt a ownw h,Gbia tf a has not dean mnkructad in d emtery by lice, Conn I anobernew, that a copy at the apPlNm'e now, SOCUM 7044 of the OUWneas add ProbUkR Coda IS aadlerNe Wa ncis 1 when has NgikMwn N mbmmedcret@wlefkAdq Wadelm hllpawww leOlnm cfl wmmw Mml LICENSEE) CONMAOM'S DEMMTION i returns Alen under Penney of Pe7try met I am 1)"Md eMe PM&Wm at CMapmr9 {c*Mffo% q wad Secikn 7000) of OwINm 3 of the OuSneR And Pmiarranora May, and my lkaM 4In all toms sad aneat LICENSE CLASS UC 90 ..... Er CARE CIATTR4'7A WORMS COMPENSATION DECLAIATM I NERMY AFFEM Lp1DW PEMry Of PERAM ONE OF THE FOLLOWING OECt MMDNS 1 hoe AN was Imlmain a CeVr att of Cg1MtR to SaminwO to Wake a CAmpamadm m profiled by SMdn3MOolft Ube Cade btile pefmi}IameMmewank is wdM daspMaWmlmoM _ 1 twnegwwN mNnwh Wbdwr'af4nwen4anai k,mrarce umauheYW Secow 370Oa MW IdO Cade, far themrtamw MOMaad M which Via peron is Mod My waror a Composdm mmmnaCerrMr and Polley NwdNhM CARROn POLICY NLMOER MiS WZnON NEW NOT BE COA# LEM L'TIE PERM 0"One MIXED DOLLARS $100 DRIES I listafyOm M tad pe.'� at Me vmakimelkh des Dome It Issued, I shall not angtryanY person m any mdMw W Min banana aml'ect to the Wb**'e Comlwmwlm Levee at Cdlydia Aid am thin If i Wood Lemma suseect to an Wnnfm'a Campens3bn pmd#o4w at SxdM 37W ofdad Laou,Code, I shot kamwhh fwith Mtmt aatrekM1a DATE... APPUCANT WARNING NOW m mere OWsor's Compmeatlm C WOLF N uwawRul and snail RwyM m amviceer to Cmnlne P"We a mtl del area IP to aM m;ndred Mi dmtaa {S100;300), In season m As cast M. tie compensation, dmspm m poeldd fill in sedw 3700 M the IObprcod.. (ndevo, was of errey a lea CONSTROCIIOM LEMDOLOAGOW i Mersey ahem under jo noiy at avice Me there's a Conenalfin AI In, me pedan. of OR aork ter w*f lob just the Issued ISM 3097, Chi C ) LENDER'SNAME LENDER S ACORESS miY tlpt I been mad this appllCMim and ON Hat the A oe IMotmatim Is correct IRO M CampN win YI My and rouMy o dnecons and else laws %haft to WWV taamro-don aid hereby atlMdm �e of OR, Cow%y b aMa'ru�^� o than poparytabNw y{ (jT -lPffA9T H NAME M ROTE, V APPLICATION DATE f� A3/i�- 1 PICO pp, 17 "J I ISSUE DATE,[ 7 l� PERMIT# PIS TYPE CONST OCC GROUP f? Scope of Work —�i- �����.... —E� #OWEL UNITS Or STORIES #BEDROOMS DESCRIPTION SO FT FACTOR PSF ADJ AREANALUATION SPR7AOLNREM ' OempMCMpwt ''... w PatwDeck .._. W PaanSpa ........ ..... 9 i CLPmnerolAl m 1(YalaOatloPr Ad) Area - QUANTITY DESCRIPTION FEE CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY FYC ENERGY PERMIT RETENTION FEE ... PRE-ALT FEE BASF PLOT PLAN ZONING CLEARANCE TOTAL PEES D COMMENTS PIC PAID BY VALIDATION RECEIPTa 3qa, PAID BY h VALIDATION L-C >41 ),C, WH� ITE— meat Copy,Y CW— RnonclCopy, PINK—Assaesor Copy