HomeMy WebLinkAbout16-2241CITY 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) 839-7027 '' FIRMLY
BUILDING PERMIT APPLICATION wwwcityofdiamondbar.com building@diamondbarcagov
JOB SITE ADDRESS cu"
APN LOT TRACT
OWNER —A j
ADDRESS 2 Z ei e 3
CITY —^rY�`' ZIP TEL '!�
APPLICANT t'b r A44t,.) _TEL
CONTRACTOR
ADDRESS t
OTY__2T, zIP_c4K,kLTEL.Ii2 6"/f 7!Z77
ARCH1ENGf
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-Uq DEN DECLARATION
I HMM ioder pmmm of MOM fat i an gum Man the cabeda a Site U ae Law fa Gen maaQe)
Wonted bel by #a daarlarea) I here dead ewe to me oulrabla Hone} patow AmA Bu!#nu and
PrMrsliae Gwr Any enter mony taerpueaa woof W o n truct aft, wwnmre, deablah, or real "
Pwr mrm also reanbel awapotcmaia an Normal heawn
a Banned nonewit, UMPmutrlmlai the rmhactrbetaOExamine LOW
1pmytmB}Ctrmwnchlp WmSactlon
of Dwwbm eat Melanomas and Pallaawna Cade) mere W a she N umoo Men fienane and Me bash he
anaaQatl eamptim MyYddlaid$Oa1m 70315trYSIry tee pamnf mmjedlmPe�Caa[madru Pmara
d m ream man frva tariwrrn dtawa RSDU
JMe! aX dtM PMwnaarye#MwNd offered
s! to "campensdknwitl daU �aiIX Cod Me
d me wak, AM Hn asto L ee b IRA mmndad a dl an at re {seam I amnm dw r Winonacs Cade The
CPWeon s' SMa LkenaB tee Orwell
me ply m an Man d pre" i n mrmAh ury at eB a Winona adds
a
a ngeaa me ploiNlw praidM mwmebTwaranmb as M IwaaM adbad to 60m H noweaa ma bWbanp a
mamaTlsodaafd W0N aw YPaTacorrpmeon tln Dwna RubdawM iva8 ma DWUen d DIrNrP Oat awaar� btlH
a aryxrree fa ma plapoae d &aN I
(jl, aaaeneCNdw DmpaaY meWlnwaYCoa2caW With Named connowirs to mlWnn we Mellon Peace
7DAa aid PrdeaablN cM! sop armttara Slam u®n9q Law met eal �p4' m M Owner d aWalr.ra
aal@aalmarrramaeaaadwhamraaW tamaaaklarwWl a Ianoadaraaoi8nt n maCmaaaoa Sole
umue law)
U Iern exasalMOM bR wwa as COMlaCWSSWa B150139 lawtor INIHIMAMMKIWon)
Dam Swn
By ay signature beta) aklmiO*Got. Metfa arfpaaanl a kiffn In wlwm 104 hM needed fa of ball an
Year Prer Id amnyKeeatd anknpoa+nmb mend by do, Donau {mood We*$0R C OUCkn Hat HOW We as an
aHda It In Nee "earn mamraM in no a" by Exxon owraaaa 14MabUnd eat a aeY of BY
anplicade bw Spam 70" Of me uncens one Rahmsseso Cnse Is flaphle yea AMID oern me aNweadm Ia
sdmtted a waAe ibDowhDwtD din idQywnw bMniom gxtr#aw itrd
UCEL50 CUNIRACTO"DECLAPATM
I amrm uMupeltdMdpalaY dialan Ficoaed mode arwdaad Dlpmr GNyarmrdngwnh 8aNm7W07
d OMam3d Dn &sieaaaM Cab aMmyNcemmmhR/m7rcx am dbd.
umastwiss _jc-'M BG No
E)M DATE A lA, 4/1'T MMMACTDRI'n6Yf ld,�
WDRIDH'N CMPb AnO OECURATION
I HEREBY AFFRiM HIM PENALTY OF EYAARY DINE of TIE FDLLDYANG DED-VATM
_ i one aw Will "%Amin a Ce14ft90 of Consent m self Iam ear Wool F.mCuaadm as pinned by
Gomm 37Mof to Labe Gele. mrfa peMenwaY of to wall Welkedespemd Is Named
I one awwill maiden walar's camagm Inauence so legu'eeabyseem 3700 MY IN law Cade far
me pedoas� dine wOa fa wdchitaspama w lmad MY WOwa'l CdnpBaanai meuaMe aaaend
MryNwaaM aN
rAwn S 68lG
POLICYMtAIP 1I Y
(MMcTMKED NDTBECCMPLEIF.DIFTE MOM BAR CITE Hill DOLLARS $100 GtILEA
Tandy ace N me paMisalen d me wain b' wbdi tlIN peas w L41led, I #eel Ire mplo) ern} paem w ar7 melYwr M a m
Coopmeoutm OnnsofSae Ube
aEMa AM agBe aalal Nnultl eaaaea mia Wakes
CmgeaWkn paduow dsaemsraad me taOaCMb I deE taamtmmaalywdmmoea faoaaa
dPPLICAAT
WWM1G Fame m aeons wakes CanWMM Merage N uMaWd cal mad Milan on STOW In atmaa
pendeas and Call final Up to Ore banned maimed dollaa ($100,000), to a7mem m me cost of Be
damaa2 aeprmnatl to In sedan Dtebd as Nam some Intermt and ilea ITT
CWIBTRUMM LENDING ACFNCT
I hereby all u1a er Panand a leff" man Mem Is Cmaadlon LeMing AgakyV en paHmneeNo of ew wok MY
wmN Die panAHs'stmad {Sec 3007 Cw C)
LENDER S NA1ff
LENDER S ADOF
I Candy mat l harm read has Helkanm aw note eat the ems mlameem is ar(aa I new M anal MIN 00 do and
adlnzWes aMat* AM rela0a to Who" vreArgwmid hereby aumodae ravowalfas dale curdy to
ens upon the abase inwilmad Mewed for abPedlm peones
�rrcuJ
g J
sGNATuRE MITTEE DAT�—
APPLICATION DATE 9I1a I t %. PlCY '—
ISSUE DATE i 2'3 11 e PERMIT# Fyz it aL4t
TYPE CONST OCC GROUP
Scope of Work
R OWEL UNITS A STORIES
P BEDROOMS
DESCRIPTION
80 FT
FACTOR PER
ADJ AREAIVALUATION
SFn+ALTIX+HENi
C3amga7CarPa'T
w
PatldDeck
PooVSpa
...................
2
no -Awl
Commaciw
Do
dg
VatuafGs#r
Adl Anse
QUANTITY
DESCRIPTION
FEE
pZ�p�
fi
1
f
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
�y
aaL Ss . SO
MECHANICAL
INSPECTION FEE
ISSUANCE.
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
ai . CYQ
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
an
PIC PAID BY �
RECEIPT # ( . _ PA"O BY ^#'r TJ�iGi7
VALIDATION
VAt.1DATION