HomeMy WebLinkAbout17-26427I
r
9
c
a
4
�d
y�y
y.
r
w
a
O
a
z
x
3
y
w
CITY OF DIAMOND BAR
'I ___. DEPARTMENT OF COMMUNITY& DEVELOPMENT SERVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) $39-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 939-7027 FIRMLY
di°Y BUILDING PERMIT APPLICATION we'watyotdiamondbatcom budding@dmmondbarca.gov
JOB SITE ADDRESS O)DG_ tLtJ l . t7l DN't Y1CAt`(7 '1
APN LOT TRACT —
OWN ;R 1
ADDnESS
CITY V1APIIIIIA "0 ZP TEL�S .—���
APPLICANT TEL�S2
CONTRACTOR
ADDp�pESS 000 VfflaT
CfTYDVEato Aifk ZIP Cia TEL .r-�2yi `
ARCHIENG/ LiCE6zi
DESIGNER
ADDRESS
CITY ZIP TEL
DWMM4kRLDFA DECLARATION
I hereby inn unmet peaty Of kaW7 mal I am exempt trap mB Comhma'e Swte LkertM not for the taeomN
Imitated amw a1 As choonant Io, I new paw next to be aPPitamn mmaj fswba NmA, BWMn and
PMfMione Cab Any ART a Mundy Suet"IM a pit" b WM1rUA after, imprara, atpmt,ae
B1ruu'0uM, Ameba �m site tOulM IOe APPBaMfor the OWN" to the a signed sbbn dDN he at the
N examBd PUm nlmGo, proiafwM mini CMh fteoStat,LIM aLaw(CmPiaIO Cmwmwft wNh$option
at Oman 3aRM am Prabumtre Code) In mat a or she Is exempt fmn kourburs, and the beat for
me amgatl exempt" Amy *am01 Section 70315 by any apk¢mlet a Penn whom me appimat oravot peaty
wtd4mv@DianPMhaKy� fS30DI
L�Lo PrCNeerH =moaeaewlmm�eatll�ame ,wl aaa tdaw
of too workan the foructurt,to Mt Passed or passed a SBCda704 BNmN in Paonalloa Cote The
Camamaa'Swa Lknn LawNobpmenInner of psoPeRywM 90aJJt ampmyepn'IneMUM
a Impimee Um PtPBNy' PtMtlm trot 4M tcpt+emsnm art wA IYdef4edapRdM (or sale "Interns,
wewr tlw W bmmYng a
impmrenwm Ie eddwllmn one yea mpwnpmtml mB owner $aide wig tNrepw bwdar a PlpanD 00 n anMs� bind
a 41pn#sd rordw PurWee m 8aB)
1'044 &*Mrm IOe WWBr mWe The C4ntacdnmSb ftL Lonna
Lo m=oapam Bear
ofVamh,p o
bUlk end PrweablmCade itM fantaptPt$Mw LICwltd lap tlam lKf BppNmwi awmraptperty who-
UmmLmpaoalwwmn Bmwlm aaibetiamawpafOem wmell=aNd pasuaamdw Conbbcmt 3tffiB
Llcerm Law)
U lam NWmpl ham Ceawaa under the Caaamara SIBS Udwas 19w roman mbaWmp Mamn(s)
Dale Sbe
yourp or to omoom atteInternment
nter e tashora my par Ismal MUM lnwhkhi muptmnemuI iaatMNlOm
your amr 19 Coan
R If has mind opossoenbtext bypnby BYfUCaromIegmurri I whorwad haveomitms
aWcolo l ar t t on din err BuWp In Its Manny by odeiAnd ponmmwa I a nil *fw pinta poky a IN
eppM?NO row thecaan sofa a bre Buamnn and uamo CA
Code N ayalaNe upon rbAuea wt� this epptatlan N
§:Mnlmd a m mB 1plaMip W� o",s ht�Mrw IBOnim Ca Ipymeaw utml
LICENSED CONTRACTOR'S DECLARATION
I Ii0r06W3of the Br P0m".ym�ipilyitatIBm'1CBPBBdm�she mChNY.Br adopt nnmg wind $BGUai 7COCl
a OAakn 3 m the Busman am FFrAMmn9 Cade, and my(Il�cenN N�}mfva mine antl spat
LICENSE MASS Up! NO 9-ter. -/Cl
SNP DATE CONTRACTOR �'' -
WORKER9 COFWENSRTtON DECLARATION
i HEREBYAFFPRA UNDER PENALTY OF PMURY ONE OF THE NUAWING'DECLARATIONS
I haw am w111 mamaln a Comttte of Cement to Self Iran fer wakara Compeneanon, aB Pro dd W by
AeSacnn 3700 at the Labor Code, for Its panto mca ofthe wok for wWPn be pone a afiued
li row end WA mIOman WorMx a Comedowurl ireumnce, as rendretl by SNdm $700mPa Lacer Code, for
Ihe pedairank9rondo woM Ia whimsdin Pwimis ed My Wbrkmofampnwo h98ana Guduors
Polky Numbaa4
DAMA R i , fP Ct
POM IAWR G
OMSECT6IOd NEMWBE WNRLEIED P NEPBURTISf# W. HJNCPFA WLLAFM SIM CALM
Kamp mxms aaMte the WoWmmwokM TL wrombmOKwNtAnd iw,adi wxamDteManbYDawsonemsNwCrye dto WakaMm'n
ibmPYMMCt$KIM 070DOfe Lan, fade,l W b"*tVIY*MmM
prwlNm
MR APPLICANT
mans FApwx to aeCaB Waberg Camwmum mMtpe In rabtem ad 00 6u yn an woww In OM410
Pemmea smm CAN Pros up Up one mmAMd mo m.v doubt ($100 ODO), In embai m the "of he vmm nsfta
AWm9eo b9IXmndBd rot In aeoekn 37O$a tN robe aide ImerNL end mmlnbf emus
C4k47RttMN LENDING AGENCY
I hershe etmsn Mir perhity of Money tlat arm no a 4 hisepan Laming Aphey rot the Podamhse of the sown for
eieuh mispemthiaPam (Sa 3097,0N C1
LENOMS VME ...
LENDER'SADOIRESS _
i Cemly mats here rw UNaew otmn am nip potdM BmBeUmmwtlon Is CUREpI Iegraamtm Ofthanotyam
=only orblana, and MUM rows rat7ng to bulutim oRgppohn, arm hereby blNba7B of this bounty to
waer upon mo mow mania m"'ty b Inyectn+purpCeae
SIGNATURE OF PERM ME DATE
APPLICATION DATE
ISSUE DATE
TYPE CONST
%' `P/CIO _
PERMITS
OCC GROUP
p
Scope of Work ` B
N DWEL UNITS
IS--06e- i�
0 STORIES
T;JA J L. F1dti'
A BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ ARSANALUATION
SFRIA➢EVREM
...—
Da=Daicaro f
�
tw '....... Pahan) 4K
—
iAi F; oV- pis
2 j Ra Root
command]
Vatutaeion
Adj Area
QUANTITY
DESCRIPTION
FEE
Ib
>i
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
a,
SNIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
.......
TOTAL FEES
COMMENTS
�..^^wyy� �y7yy.yyLt�,�.Sy�,
"! awN W
�,I;,,TNr✓ a
R C - 1"
RECEIPT
pAN� aY _1204
F}— PAJD F
ON
VALIDATION
LLYAUQ4T IO
WHITE— Danuernent Coipy, YELLOW —Panama Choy PINK-- copy