HomeMy WebLinkAbout17-9766CITY OF DIAMOND BAR
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DEPARTMENT OF COMMUIP16Y & DEVELOPMENT SERVICES
21810 Copley Drive, Dta rneu y S MCA 91765 PRESS
(909) 839-7020 Fax (909) 8613117 Budding Inspection llotlu a (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION finamcityoYdiaiuondbarcont buddangagriamondborca.gov
JOB SITE ADDRESS ,
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OWNER
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ZIP V1491TE
ARCH/ENGt
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I heeby atom Prefer penaty of palmy that I am etimat Dan the Cordada's Stale Lbose taw for the raaampt
ukaw mow by Vic chock an(s) I be" noun nice in the Ancianyt, in") ISetinar 7m-% 9a9ew9a arin
(htihaearn Coda Any ctyameDp fieragm a Partswe btmtaft, miprove, dmWzhwreWazairy
etnwhve, ptror w its Imams, aaa rwpaw Ow opPlloaft is fiapprnRwRk a slglred abwstwM doer she
ei ICMaed P Wsaani w DIe PrelEwm of its Cmtraowr'tl $�B t t9w {Chapter � DPmmancmg row Sa40an
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PI no more Ba+Rw nan5ed dollars ISBW}
Ul, ice ownerofttm hi m%m MY ertplbyees" expow is their wfa commmerfion, root 00 all ofWU PONmm
at the wart, and lee shuchere a net intended or a ved ton will (SUkm Ines EA a% Prdesslae Cade The
Cantrafts' SM Liberia Law does net apply loan Ov.98rat promdy who, Hoover aoAcUss' or Amemal effort bLft
at Improves the Property, mmim trot me hpmwm" are not Irdanded or offered for sea ff however the budnep By
Improvement Is $No wror," year at comp(etlon, ila Reaper Indoor will have the fission of pmw; that It was not bit
m hProvad for the Meness of eNe I
U L W droner of UP property, am mhbdaNaly MAbeCtlnp wdh Nmnsad f'AnhaMR to overcome the matwd ($Bctlon
TOM, Business and fmassane Code The CMt CtM Slag Heroes Law does not apply w an ewer of Poverty who
Baker eslmPmyesBarren, awwhoco&acelofthe pmace*Ma hwmd Comment purs:nntwUse Camaotma Sale
Liberia Law
UI am OMW hays kentimm weles the Quenoctor'a State Lswnce law UP law following reseemn
Dore_......... Sign
By my s5n tebwI wkreeb a Vet easier by my personal rWbenm to myth I msi lave, mined Am at PUT Des
Year Pont rotpanldwon of Pe tmpmmements Carman by Me, pe"Ll camera legally UP a strectire that I here bikes an
bumer it A Are vA bean =Maw In ha wort' by JiMmed CoWUi rs I unaerstarw Bat a copy of the
applmabla law, SKIM 75ea of the Bumness end PnIsOms Code Is maeable upon mquest wren thin appltgw Is
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LICENSED CUMACTOR'S DECLARATION
I affirm uaaev mrso of pm eery Prat l am licensed under owma of Chapter 9(Gntnm®uiT Win Section IMBA
of 0wdm 3 of me Sharon and Prmassons Seen, lIfew to 0MY f antl effect
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Up Wi7E CONTRACTOR
WORABPSCOMPOWTION OtWM
I HEREBY AFFIRM UNDER PENALTY Of PERA RY ONE OF THE FOLUWNG DEQARKTM
I hate am MN mamam a CerbFi of Cawera to $0 Mews hx Wmtar's Compenetim as pywMed by
Sachs 37M of the Laoor Cone, for Be peAahmtroe of Be weer AM wW BN pennn a mosom
i have avn MllmMan YYoW 0 Cunpa wMwAOM.e 0 regireAby SPNm3700 of Be Lahti 0000,hT
Urr dOw wgrk is wNchDespJer�m%n higeued My WOM1ErsCa/i/pe,�r�reTairrlimumnca Camnt aid
Poky rail
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DARE
POLICY Nts%R
(THIS SECRCN BID NDTBE COMPLETED IF Tye PUM is FOR ORE HUNDRED DOLLARS SIM 00 tEK
IwrOly Urffi IngelamNnaaiwc9�B.„a.�wa�.k.hYMdrA Bic pmtMBlswed l8halnd eon ha0yn ,wmw
smgebt to me Wakxr(Pponsniatm Laws R CaepINa AM a73tQQ ,BJB(1 ial' call WPta WrtMCY6
CarWa On Pm of the tabor Cade l sea #all i fbYNe
GATE w'5=.... %.•
WARNW6 Fail m to sewn, Wanes mWmge is Ionia d, mad shall subject an emplow M ctMftl
perdedis am care Mae do to ono hopLad t ommand don rs ($TOO OR in adMm to Be cyst of the compensalem
damages as provWdlot in section 3708dice ionorwde, Interest, and oftm"sfma
CONSTRUCTION LFADW AGENCY
I emtm W&t PWAY of perjury that Bare Be a 00mmir m Lending Agency f x they pedmnance of Be won ion
MchBle Oe"OMad(Seo MOT Clv C)
I NAME
I S ADDRESS
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PE � PEIaiiTTEE
DATE
APPLICATION DATE �ryP/CCN !")z 1-4rur EP Y�Zy1
ISSUE DATE �� _PERMITR f` L�,� — l'C _
TYPE CONST OCC GROUP
Soope of Wait
A DWEL UNITS_._ #STORIES
P BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAAtALUATION
SFiVADDREM
Garage/Carport
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PahNDeck
PoWSpa
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Ra-fly
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Art Area
QUANTITY
DESCRIPTION
FEE
onrep
L'P
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
2.Z2: �ctS
MECHANICAL
INSPECTION FEE ...
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
LOO
BASF
_
PLOT PLAN
ZONING CLEARANCE
TOTALPEES
COMMENTS
-7
T'
PIO PAID BY
RECEIPT PSR08 PAID BY LC'i
VALIDATION r
VALIDATION I.s,...