HomeMy WebLinkAbout4182 (16)CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
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FIRMLY
JOBSITE APPLICATION RMIT / USE
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APN LOT TRACT DATE CONST. GROUP —
CROSS STREET LCy L.I 00, SETBACKS I1iP0/EWNIM
OWNER +'. `% S MIN -ZONING FRONT RW
ADDRESS 5i"! L+jFII ii IPL P REAR
CITY S49_ ZIP04126't TEL. SIDE/SIDE STREET RW-0— W
APPLICANTAPPLICANT-T<=n1t, lxa" fl r r (J TEL. SIDE
CONTRACTOR SEWAGE PUBLIC PMT
ADDRESS /? 7Hf Lclt t {/' 'a J : DISPOSAL PRIVATE SO. FT./ 100 GAL
CITY Ld I Un GT'1 ZIP 7r)/fes j ^`
37/;,
STATE m
L l .f GRADING CU. YDS. EXC. CU YDS FILL
LIC. NUMBER
TYPEPE SO FT FACTOR ADJ. AREANALUATION
W IDESIGNERW2 30DADDRESS
CITY ZIP TEL. 3
PROPOSED USE
4
a GARAGE
NO. DWEL. NO. NO. j PORCH
UNITS STORIES BEDROOMS
Lu VALUATION l"9 O ADJ. AREA
LOT DIMENSIONS
1 NO. OF BLDGS HOW Qum DESCRIPTION FEE
ON LOT USED
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LICENSE[) CONTRACTORS OECLARATION I hntry affirm, that I am hcanstd ads prwroars d ChpW 9lwrawlnnM
wnh Secaan '0001 of Otvrswn 3 d the Batme s and Protestations Cob, ad RW IaaRI a m toll foco ad efhtas W
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ONER BUILDER DECLARATION I prep affirm OW Ian oaa%a iron the Contractor'. Licata Law fa alt! faWwmpLn 7S. 10315 Ramer s and Prollavons Cone Any cdy or Carry whth to Wn a Wind lot comewt.
5 aha ,npiove, demfosh of repay arty strata., pro m as s,rha ce, that, rpana the applr+nt fa sah pamd Z
to hk a signed statement Mal be a kceosd Pawma m the Iatdtston d the CmaWdr"s lrrw Law IOMW M3
9 :canmermng with Section TODD) of Onialon 3 d th 81=1 and Park— Cade) a that he a a .rapt thadsan
and Me oasts fa the aaepd e-Nuon Arty vidawt of Section 70315 p Wry haticAut Im a perlm sYOncts D
e the appi"m ro a cad penriY d net mare than fang haaard dollars ISM I
I as owner al the property or IN enip*— with copes n total mie fatttpen "" wa b ft want and
die strature a not intlrwd a offered fa 9ak ISK 1064 Bumams and PTofih wed, Cade This Cmtrearrs Leant
don Such wort rON". CS2
z
Law does rot appal to an owns at pro" who buildit a aramaws thaean ad what
J in through his awn emolovas proidd that sah m%rawatarttas am rat inaebd ce d4md to sal R. luwews,
the tum.N a ,mWmement is sold within one yaws d to -I an. t4 Mw -bW& *10 hews fha fapdm d prow%
ry trial he old net Wild or inpow for life papox of s uta I U
1 ai mwr[r of the Ppea1V lln lrckmwN famfete117 wanlaetgd Imbewl ascaantat tow rated IS"Idol
044 B-ness and Notiasans Cab The Contractors Lranse Law dins rot abaN an m owaw at papaly wit
IE ."Id, II1S there.. ad who contracts to Such pmpttn ..In I I.IIKI r(al hcantad Pring. 10 she C 1— 1
0—seLaw i NSTR
1 am tmnot ..it. SIC B h PC (Anarh Cwducaarl. PLAN REVIEW
Date o— ELECTRIC
PLUMBINGItMUFFSCr*M1LSATIDIONEDECLARATION I It .W aNam Thar I Aare a ferfdicm of C~l xsill-ansae. a
a cerbf_h, al VI kms Compmsawn insasee at a cabad copy ahead (Se NO, Lai. C.)
Cn- MECHANICALlwYsWeftfamishedCaubed
y.RSaj Caln¢d copy ,s bled with Me B W&M IRpWmn Batatment or Depamr I GRAnl
C CEFIT) iCATE If EKEWICN FROM WORKERS COWNSATIN INSPANCE: That fardn amid rW be canepYld
s Ia ane hwWd IS1001 a Ips 1 cWlAy ilia m thin palaweca d tlr wart d whtA qamnnitrateseratobeanoatEeeltodieNhrkariCmpeorImferladpallpeasatiairy
SSUANCEdtheperms
pent ,s .std. shah
S Laws ofCNdaw W PARK FEE3DictiV~/'!1^ nt ' t. SCHOOL FEESNOTICETOAPPLICANTd. after maks% 1Ms Carh1[aa d E wa shwdd hem" sralart ar Vdtber's
Cornpensan. prowsmns of the LSA. Code. You mat fain wart sah paowaw as fie pamt shad
i he d.= rinmaid
DIVISION OF INOUSTPLAL SAFETY PERNYT CERTIFICATION
i t hrehy cer1rfY Ma taw ecavatrm flee 151 of mere hal in depth mar which s palm u reawd n dncad.
y _ icote be mile m cmnectmn with wok mthared p that Permit. and that m Yrdda% sbafas. Widokk4 tdwark.
a demalnt. a Msmat hat theal cow be more dun thary m 1361 M fatgta IChap 3.2. Grp I. An 2. Site
Zy 361. Tibio. CAC)
3 totAsownabuddnIwillnotemdoYIOYatYbwwkwhsAwoaddreaete pans frOutat d
I— IndustrW Salary.. as mid abw, wins sett palm had a pane In da sah weak hat ere
dinaom
r n
D.— of "i°atbnd SaNry Permit Na. TOTAL FEES OCONSIRUCTONLENONCAGENCYIIrehYatUmdalthand mrWraehen WtMnp no"lar M tearMwmco
ea d Ila coat la which dh panes a aaal (Se. 3097. Ga. Q.
Lender': Nat COMMENTS
mLenders ASM
C CERTIFICATE OF COMIAECE AND AUT1S2AT101 OF ENTRY. I QFMV I him rpd On WiMmit ad Wee
H ma Ifs nhariNban grant a loins I spm to chnalk wdh all ala ala had my xdiltdam thilm" a Year%
hc.sbatrm, ad autlwre a a mmffWA of ft Dow"" at ow6n aha Seth Is agar apt " peapaty
hor I hang appled tar law pact (aM Ptelsx d meq teepetaea
A{ .kifJ! f /, RECPT NO. VAUIDAT a
of Apphcmt a Again DeY
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicafft Copy
BS106.11/89