HomeMy WebLinkAbout16-1089i}LI�II1111 RAR
C1 IT OF VIA FN i BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT :SERVICES
21810 Copley Drive, Diamond Bar, CA 91765
(909) $39-7020 Pax: (909) 861.3117 Building Inspmlion Hotline (909) 939.7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS'� t 4+-, .
APNIh
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OWNER ADDRESSCITY arI4 - Z[P __TEL iAPPLICAi.. TEL
CONTRACTOR
ADDRESS , -' �
CITY � �� ZIP TEL-95��221L-
ARCHIENG/DESIGNERA--F—e-v�KttKe&tit t'-/
ADDRESS X (. t � vl >
CITY ZIP TEL S-7
oYYiIE'R-Ilt111 tit 0 ATION
I OMM ulcer petheky of pa*q that I Wt eseared from the Ctr trxcior`a State t k� se Law tar the r t(0)
Indkatcd ,Iaw by Me rlhedvmrkjsl, t dews pke4 neg to the app able isrtt(s) ractlan MIA itualrow ad
"Wom Cade lint elty ar rotatly that ragrrb ow a Vomit to ormbwL soar, bnorrm derarotltdf, or tw1r. err9`
strUclura, prior to It! tx€ + regtfttss Ilia >� fa D» ptrmiito tAs a tlpnMl ax tart ttalt is or ells
fa liserwd ant to tas prevlsImm at On Canbutar's ft& tkesss Law t0wpht t wlth SwOm
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Me Afry0rt%dlonatSocdon7031 5byanyepOWeat bayaahttmrt Ktoft ote 00kw to aOVI0trttd€y
of rick more thanWe aundred doUrs {S.">6liI
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of the wore, and the tdrucLm Is Irtm Meded or trll W htr sale awboo 7044 III== and C,me The
I wIn cmrs' $tabs 1.1conso Lon 6asa not to an Owner at pfepaaty wire, tiv IIII atyt"M ar pe wvd ettel, bW&
w baproves ft Prousny plodded thsi the irapmenw,ere n� krtanded or at Brad tar as x how fire tgrPdtrtp or
Imom emeal h mAd whthdn we yaw of wmpkbw the owner W We w(h him sa Wr*n d pooing fast It retry twt hulfl
at improved for ttxt p wm of sale J
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tka m tax I
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Sy my: tore b tw I kr>rtxsaaElla ttrat except �r my palxw modom In wh6 h l must hard tgsidad IN at Itat ans
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Vw Smft 7044 at the Bug hwas aid P!rOaw t * Cede Je aMI010 Matt regret when rort SAPI a3 w i9 Wwftw to at
metdhming am httwwww [qft ca gowcalawham
DATE SIGN
MENSIM C01411IR tOR'S WAXARATION
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1 CLAM
he's COMK315AMM 0FULARAIM
I WARY AFfi3 l L.NOER PENALTY OF PEti tY ONE OFTHE FOLLOYfx11S OECtkJ{ATIONSS
I have rx1 wiG ffmirtaln a Cetdtica°Oe or Ca wo* to SaT Imm for Wort 1v Canpat9etor€ a Waal at by
Salton 37M of Ito Labor Cods for the perfarmancs of the vs" ftrVA m NO pemtA b Iwo
I have end will malotatt Woftrlo Comprtrt%M hteu my= as remA ed by Soudan 37OU Of the hubs Code, tar
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DATE At�LiC,ANT' .�"S"t�—
rwh" to smrs Vk taet°i C�5'M wtat 00 ardlsct aft ehplapa to orkdnal
Wjealbea acre dux brass a to arts taatdrxd tttMWd dean ($100 o006 to tsfdtaorr hh ft Cost at the carrpemsatlon
darnam as WarIftl car In mom 3M at the tailor cape kdar a amattarfhetfs Rm
6*Tft0ON LOMM AGDV
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which thm Penn`: is laaued tsec 3w Civ G J
t SUME
LENLtER'SADVAE%
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Ctlutlty"names SM BOW Jews mI&VV to bW1dkV OnsuuctIm and hare by arlhartm repwmMa of thls aatrrti'to
ere' u the above 1-e0amed woo Ay kar Iftepac'krit purple
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PEM E NkW 1 r
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REOF 111M1 E DATE
PRESS
FIRMLY
APPLICATION DATE fl PIC#
ISSUE DATE � �/Y j # "- /0
PERM _„,��. !
TYPE CONST t?CC GROUP
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ZONING, SETBACKS
FRONT FiVY Ci !
REAR _ LL...,
SIDE(SIDE STREET TT4V U
BIDE 0-
PROPOSED us
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A DWEL UNITS 4 STORIES. N BEDROOMS
DESCRIPTION
SQ FT
FACTOR PSF
ADD ARE,4NALUATION
SF€UADDIREM
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PstICJCseC11
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Pt Bps
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Vatuat
Adj Ate
t .JANTRY
DESCRIPTION
FEE �
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CONSTRUCTION �� !
PLAN AEVIEW
ELECTRIC
PLUMBING I
MECHANICAL. !
INSPECTION FEE
ISSUANCE , !
SMIP t
ENERGY PIC
ENERGY PERMIT
RETENTION FEE 00
PRE-ALT FEE
BSAI"
1
TOTAL FEES !I� � r A/�
COMMENTS
i
FiEC JFrT s FAfD Y VALIDATION �� I
WHITE -^ Depart nont Copy YELLOW — Finance Copy, — Asss*w Copt; GOO ) — FAe Cogy GREEN — AppicatvNa Copy