HomeMy WebLinkAbout17-2529We
8
c
a
3;
LL
-�i
O
V
N
0
w
n
5
coo
7
�w
0
s
a
z
w
._ __. CITY OF DIAMOND BAR . ,
DEPARTMENT OF COMMUNITY & DEVELI LENT SERVICES
21810 Copley Doi Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 961-3117 Budding inspection Hotline (909) 839-7027 FIRMLY
""°� BUILDING PERMIT APPLICATION TrwTv.cityoldimmondbarcom butldtng@diamondharcagov
JOB SITE ADDRESS SA0 2 b......... � r
APN LOT TRACT
OWNE,iSE GL� If ill e h
ADDRESS
CITY IP TEL
APPLCANT TEL APPICACON FACTO
ADDREil
F
CITY ZIP
ARCHIzNG/
DESIGNS
ADDRESS
CITY ZIP TEL
OWNER-eULM MCtARAnai
I herribY a"Ivm wmr heallY of family mat I am emmpt wan trot CON"W4 Smm License taw for Me reasome)
eklceted him by me csckmddYel 1 have No W W In bin applloolaw Ibm[s) fkaon RKR S. &sines sat
Pro how Cods Any dly Ot county Mal relations lawsuit mmWct alter, bronco, domeWN a molt, soy
sawn re, pdorm ib isuese, alw repulm ON ppft&m kf asp"It se n4 a signed siabnmtN that Mar she
bllsnss dduWtb is prmhlaee of NB Co tmaOrs Sib Unless LBW(Chapow e)Cw,mrthq With Oectpn
7000e Division 3OtNW CN Inm end PmhwksC"01atbet s Gran Is ewmmfrom tcenaaeendme balefor
th rem: mom than two
Ahted ealer aSealaa 70319 bywYaOdsntmtB pBmlll aUh�BaeihaapM;ragkmaolNl panel;)
a cot more men fW0 N:ndmd doss 1$500I
U L a Manor of the "try, or my apmYwe who wpw a door We wmpen4alloair wD do U at of W UPaNmn9
of Din wok, me the amet" Is vol Intended or offered (a sale {Seaarn 7044, BuslsBa and -'vaasosw Cods The
CeMMMM' Mote U mime, Low dean IW early loan OWmr a,MVV Y wild, Brmom tmploywY a netspsl etOf., mlm4
W IMMM me property, prokmd Ism tell Impmvemenb we not InN!mw a aflbred nor seta It however, are budmg a
Irreverence IB sNtl wth[r one Wr of mmpietan, me Owmr R91Cacot hoe Ore Wow of prusUp met it was not pile
a impwvod to tW Purpse of wN y
U 4 a women at ma imparts. an sin uwass oadmaing with lbws Oweardee or construct the M*d BWMA
Rine, RaN:aa art Pmbssbs Cade Ts COrdreams' Sob Llcww LBW lbw M pp# to on owner Of mc0orty wD
pNdea maroon arowfoo do for tire piclaps wtrellasod Comsat mommotkme Comracers'Stale
ucarWO Lee)
U I ern sum$"saeare older two OaWapms'e gab LAmse aw' far the t twins ramrte)
Oft Sim
9y my aprekev below laEWW ROgeth4Lsapt s my#pond rmkence In WW I Mat Woo Mwadfin at least one
year prior to ovoWm of tW Whew wsconsole by tie pamhd calla legally sell a Atrucmm hat Isms bum a
O -buildv It it ill as deal constructed in s eaeag be masd cammapre I unsmmm ter a copy of hW
andkmis law Sectim 70" of the etemeae and Pretests Cade N avWlaae mam request when thb namonon as
wbmhWamthaMWq Webss bitp+rnvx legimo Ca.ppWgBaaN itnp
LMMED COMRACFOR'S DECLARATION
I sreby amm wma #math of parker alai I am W sod "or WwWwm*a Ctpis, 0 NommBarAm wall %KW Tot)
a Dhiamaata&WneaaW fil /�m�
nora4almsam,wny�ytcaa}¢ a shot
L£.ndSECtASS6r LA; ton! • 6
EAr DATE CONIIAMOR
WOR OSCOMPEMTION DSMARATIQI
I HEINBY AMW WDER PENALTY OF PERA W ONE OFTK FOLLOWN6 ODUARATiONS
_ I ham cod wit mNnbb a CertOcen a Cagan m Sell Insure M show a Carimmodon, an aomea by
Sector 370001 ma labor Code tame pMwmama a Cho woAtbwmch ton part[ Is Isstl
I hBvewtl wsi m&nmhVlOM1ar'e Canpw4alatfnademe,ayWorke by SaptrmU dlnwmceor Cadt,fa
the Pa`ananca atW work br wdeh *va poem i4lsued MY WOma'B Canpb�tiw lamrence Cartkrwd
Pak# Iaane ale
CARRIER li
POJCYNJMOEN
RISSECMNWMNOTBECOMRLTEDIFTHEPM,rTESFORONEH'UNDF&DOM-Am 1400 ORtFiS)
I oMwanden t pw9 ivido'amewaktoWLaws
aw mlepen u9 AM
ofIG lay ens Q-Y�ifio�d manrer�®m
Oawnle aa'�atm mB W(dar'e COnpBsatlw LaWaa Cesfaae A^A eptee t'attl ehO�I ;ectmis WYNtar'e
CDM f5BYan5705&Mffl orfos,IS%1 lmmwmicanyy�MViiw�pMs{.
74 a. JOINT / %J'' .."'aww
WARNING Fee re to Secure Workers Compromise wsrepe le u m. U0001 an o ctm',nal
Pastes eon evil toes up to one rearmed weefand dollars I3100 DOW m adatiGn of Cs G .40r ton.
aamms aptaaW to in awdm 3703 atne IWor cam [merest arm attorney ems
CONSTRI CMN LIBMINOAOENCY
I weary afarn until Mow Of IwPq lost None b a ConsNstdn One An AWq Mm0 Pmmnnence or Be W" for
wtm tots pamm is Load(SBc 3097 CN C)
LENDER'S NAME
LENDER SADNESS
I awmb marl (eyd (08d A4e�k'Wm wtl Bna dot Neaeava imama{bn le coma I ow"wa m#y won oil dty a t
wumy milsacs ern Sias mW# r�prp k mikanp potrwuAOm, aitl namY aNiaiEa 19ptBrip28fMsd1 fhismtaym
asr ion meedaro Pgsr:ykrinwaWon maPasea
PE WFiEUWE ORNT)
nawarult OF PERInMt ... DATE
(fyJPPLICATION `DATE I I + P/C# —t
I DATE 3I PERMIT# P1t I r Z q
TYPE CONST OCC GROUP
SCope Of Work
0 DWEL UNITS I STORIES 0 BEDROOMS'.
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
spwADLVREM
DampetOatpdrt
...........
r[1y�/5,j
PeOnrDack
....
LL
PoobSPe.
zRe
-Roof
Co wrorcbi
m
Valuation All Area
QUANTITY
DESCRIPTION
FEE
�a
G
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING 228 q
MECHANICAL
INSPECTION FEE ISSUANCE 44S 3
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE I
PRE-ALT FEE
BASF
_
PLOT PLAN
ZONING CLEARANCE
7
TOTAL FEES
COMMENTS
PIC PAID BY VAUDATION
RECEPTa 3i PNDnYW 8 D VAA1DAnON !nc