HomeMy WebLinkAbout16-2756.Y
9
W
it
Y
W
�i
m
a
N
CITY OF'. 4MOND BAR
ARTMENTOF0 4UNITY& VELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Budding Inspection Hotline (909) 939-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cttyefdaumotidbarcom buddmg@dtamondbarcagov
JOB SITE ADDRESS q(V DL1 E • L / Jl L Qn e-
APN LOT TRACT .
OWNER -lI0 NA
t�rar'
ADDRESS [i�,yLY7.
r n
'T
CITY _ ZIP 0'1 R 9 TEL
��
APPLICANT nC TEL 5I w I'gla— e+--i E!
CONTRACTOR 5 _Tri t
ODOR S 5 0546
CRY Q 0 Ir6rl a— ZIP tjJ.WTEL
11
ARCH/ENG/
^�
DESIGNEE TW+,
}-
ADDRESS
CITY ZIP TEL
_
OWNFa-Bitltifut OFSaDAATNM
I hereby a<firm xxu wMYr of psrpmy NN 1 am arsenal inn the ranbaatal's slate Lt off taw M ma ran"$)
oakolued Nom by ON dftIWedMA I ANN PIa4a' one m Me sylfwaN anent rK*n TWiwk &pima and
Praffi rarer tan New acormip gat rsdpro a parer m twatcL 0", ntnwve, danM#, amps, oar
eeacma, nbm ro mutlee, ebe rsoraaxnant la Oar panmm Rm a MNMrnrt era sea #a
billumadpwrou Caralanc
amtlnaoomarameaubmcorYSmmisatsetaaigrapMpj
et Otataar3m nOrohaa eadRofO¢afaq r4b1 attar tooeanasuff trap IMeneual woff
we vea asobw
WM
Anyvarmdo daatbn7aps SNYa'r/aPnorrtfaapamae#getta #o ewllmnlmedrapmeky'
Ifnao are, Own
If not rtrae oral itm nurxsm ddaa Rs+lDt
U 1, ae maNra#n aeerty, a ay monorm, Md& weds a a mer we mnpeowerk wig 0 U an of NU paaaa
of In waK and Nor ebm.taa Is mt Whammed or dhood for eeo ISectlar 704+ BkohrOoke acre Ad&a91ma Cana Are
Ceaazmre staletaensetawdomrldapdymanowmtdi(amwyMda tlamghenpbaN'aPasaaleaort.msa
or Impavro the Me", pm#ad that the ImnolOmerts are mt Mooed Or offered Ix aaw If however, Me huNdkp a
Improvement Is Ware An* "Bear of aaaymkm, tee Owner 6iAw.11 nave the beam d ao eNor If was no built
or Improved IN the MM of ao I
U L as owner of aw pap", nn aommly mraeMp wren bcensed fmtradam IN convene ea pared fSothm
7041 Businesi mC Prokeelom Coda IN Corowiaa' Stffia Umnse Law mea we any to an rever, of ngfeM who
erimlaava Neaon aawhp taamta to Na Pmlata YAmdCanaatlarpa9aammiilBCmmoSaa'Sate
Loan$$ Law i
Li t mr eaampt farm borrower mar Ca contra is Smm loweartaw to ilor kMJ narma)
8'ymYdpnaiaa blew I MaaMmpa #a[ erGept}a mf peraorrd f8&�IXa m r#adr I magi Ise aMtlm Mat Mara
perm hasdoff Impu trydda 7aa a ebbaMaeat a9he
to war
Ih
o h has rot 0een W an m aM4oly Bid e � bt as
apse below AawNd to Me by lea aso I
lade as amble
T"e Io
la a Bud a opehasn
opPacida ax, Sectiar, 704w d the 9fhftW and Caws a available upon aqutal when Nor ePOMaaen a
Blanre0B1iIX82 an iYlal.'nQ iyfia Nm Aoywww pa.poYraHawlanl
UCO GCWPTRACTRR'8RECI"TWN
I army wean undaowai7 of peyay NMlOm #"JpaN iliac no#dpredCl p(SgnmmCkp wdm swan tonal
dDMNm 3 aGoj&dnassand PMammw Cror^a mYarn6e(m m mp torte proaXai
`a�w
IA'NSELTAIS li'� LC NO 1 io
�"L—`
N-50-t'i rANTBACunt (tyl (TM1ttA eG - i(aPT�
WORKER'S OOMPUZATM DEMARATION SdeQriQtt,j 7?,
I AMRM UNDER PENALTYOFPER#1Rr ONE DPTHE FOU04TNCDW"TMNS
I hue and eda ma'xdaln a CwNwo at Cowl to Sod -bees MWaker's Compensation an wide IN
Sodlon 37DO of tie lnbe Dom MOw mriesnante of ten woof IN with IN, mrrrlt M seed
I haws and wM mao im,WerYer'sCommutm Insurance an aahaoby salon 37DOof ow"C40 far
Nor d Ihs wakMwmch #y8 meat In leaam My WpwataCanPmaalion Mwlmrca CatMwd
AY Numanm
rnetri�n2�ixx�t4��+ s L
PA'�are CNA
Boxy "A"I"
;It6SELTPoNPAID NOTBEWa1RkT®FitE 6FOR 01EtNANiFD OW1A�SIM6m tFSS}
wormoonLmoopmlao I#NInotarpbyonpelVlrmarymenneran®m
caalV@aooIns
woanmdtlo
NapCl m eM rlakNe fampOneeal Lewad CdwaNa AM ¢pm Cat NJ a her8nardg'ar m nee Wayu'C
ndr
CanPasathrr uanNaadSel'a7n370D dlhs tarr Coe Iaetd6ieprmnwlyMAh tla�prwisora
APaKwIT
.........
WARMNG Panae to aware Wakees OwNewa del Womfor a aaaebd no aheP aanett m eopeaser to mmoee
Peusas am ahe loos ip to as tnawrnt Mw* M dOn fEIOD ODD) N addam of on over d Me mmppw#m,
as madded far In seem 3706d drs aft Owe, boawl. an; ei(mnya a®
IRIICnn IMING AGET6,T
I buffer e m rower petaky Of 04" to sus ee a CaahaAan Laomg Apaay IN Me peamarma,of Ore wore fa
Na pemw is boue0 (Sec 3OV 7h C )
tEtitrEASNAML
UJIMERSADDIIEZ
I or" MoI tare how MIS apphabal wel amen apt off Nova oa;z o amoral, I awes mamwly Min of fro Ed
Cady ardefrom and foam ern reatHg m bAft anneftchan,arm hereby areawma renaasnre&as of lea Newly
mMtoen Oa atawe rmrrlload prmary IN uwpwffm meho o,
V
MmA`OF PE&A7FE— DATE
APPLICATION DATE 1113011 W-P/C#
ISSUE DATE t43b�60r'�
PERMIT# i'RI(o- ''7 L7'54-)
TYPE C:ONST DOC GROUP
Scope of work
# DWEL UNITS # STORIES # BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATtON
sFR+AnnmEM
GaogsJCerport
,,,,,,,,,,.
u
!!. Pocusf o
....
Z
',, fl&FbOt
................................
�
', Comoaraai
No
V-etnstioer Adj Area
QUANTITY
DESCRIPTION
FEE
WU
LL
i
:!E
CONSTRUCTION _
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE 2
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES Z13 07—
COMMENTS_
pir PAID BY
PEal;,T a Jl�'L PAID BY 1-M�)i VALIDATION
0 (—
WHITE— Deperlmant Copy YELLOW —Rnenra Cony.—Awassor Copy