HomeMy WebLinkAbout16-2258rao�r3s"
CITY OF DIAMOND BAR
DIVIOND Hui
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 www.cityofdtamondbarcom bullding@diamondbares gav
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OWMERBI U)ER DECLVATiON
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Lanka, by Oe check"& si I have olareo mat 10 me apWrame AM* tSemW TPai 5, and
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of Pw�m 7 0l Ua Buamaba and PofasssiomCmm] mtha! M aena a ammlA ham lwraure Wages bmM for
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ban alapad axomptlm Any emission of Sectsn 70315 by any apalhant mrapermisu fOCle W aild amtoedvil penalty
of nor more Pan Ida hundred wears CI51001,
UI, as owner of the property, w my emmoyeesWith India an War sob comdnswlan, will do UAdofor Uporpom
of the oak, and the structure is not abandon w dfemel for sate (Section 7D44, Business And PdeW= Code The
DaamCMs'sthm Larose Law does net antyta an banner at property who mmugh wMicryeee' w paeonm even, Wins
or dnprows be property, provided that the Impnvzmenls are Am amended or offered TV own If Whom, Pie building w
improvement is smtl within we year atcompletlon the Owna-BmKKe wiu have Ole human of pmwep begin was bat Wilt
a Improved IV the purpose of sale)
U I, as Manor of the property, Am exclusively commadmi; W a Iasonsed Cemmaom to wnePua the proles (Section
7044 Address and Protein= Code The Contmaom' Stag Under, Law dead not apply m an manor of property who
or improvnothemon and Me cortmda an the proucmwdh a Ilralsed Contmch r pumuentb the COMCWM' State
I low)
U I Am aamnpt from haBnswe order the DNstmemes Shana License We fa the hollwwag tendrils)
date Sign
By my signature below I mi novdmge Pet eaapt for my peremal rasmame in went I mum have "One for of Wet we
year push moaalbn AT the anpmvemarts cwored by this pound I cannot legally Ad a Mature that I ham halt as an
holder If It :as had been cmmncad In As. merely by immune mwmcom I widambeel that a copy or the
Adduces law Shoran 7044 at the 8mu em. and Pmteesioas Catlin Is thambe upon modest Won tors amm aWe Is
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UCMSW CWRMCTOR'S OECIAPATMN
I hereby efir ed Auer penny of parody Not I an Incensed Merprovl9CYca Chapter g lmnmendng with Seum 7000)
of OMsmn 3 of tiff msness am prarlonews Code and my Nicene Is in hill Von and avea
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WlOMEWSCWPBISATIONDECLA TIOM
I MEREDT'*BW UNDER PERA.TY OF PEfULRYOWOFTK FOLLOWWG DECLARATIONS
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DATE APPLICANT
WARM% Fwum to mum Wonar'a Menominee Tram is mysinfui am snap subject an employer to *"nil
peralles and call once up An an hu wred lb nd rbllars (310(hCol , In admen AT me goat At the caryewrion
dam sirs praddOdiorin mctlan 3y0Baaw Mbar ,tmerasi oldnernay'stees
CONSTRUCTION LENDING AGENCY
I Tenons affirm, urtler penalty of perjury Pat them Is a Cm9rursbn Lording Aims M Pre perfamence of the wank for
Mich thin pemm a Blued t9m 3W Cie C )
LENDERR S "E
LENOER'SADDRESS
I cerWy bal l hava real this appllgoal anOsplO that NB oboe Wfamallon or cdrael 1 a8ree m campy dam ell atY ard
OmmanCOs and sae Taws rtlapng to WINnIg wnrtructlpn and herebya Comm seprmentetNes of this countym
emdf span th,8�86yM8 mendOnad WapeilY to Aapaam GurprMea
C"t �M MRZ4'
PERMITTEEa(dJI(PPINNTTT)))E N/A /14
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SIGNATURE £E
APPLICATION DATE of12b11 y r� PtC# p
ISSUE DATE -7 f v^rPJl {a PERMIT# T RI_i0'_Z2"5 3
TYPE CONST OCC GROUP ........
Scope of Work
A tl4VEL UNITS ........................ # STORIES
# BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
Aw AREANALUATION
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Gar ulatCwport
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PmWOeck
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Adl Area
QUANTITY
DESCRIPTION
FEE
Ea
fe
CONSTRUCTION
PLAN REVIEW
_..
ELECTRIC
PLUMBING
PY 50
MECHANICAL
INSPECTION FEE
ISSUANCE
3-to 12
SNIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
_........
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
$Z'
P/C PAID BY
RECEIPT # 3I R '?-q PAID BY f_+
VALIDATION
9a 5 VALIDATION r'
WHITE —Department Copy YELLOW —Finar Copy PINK —Assassor Copy