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HomeMy WebLinkAbout15751 (23) i CITY OF DIAMOND BAR � - - DEPARTMENT OF COMMUNITY 1�DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)86p-3195 Fax(909)861-3117 PRE$$� ,�`'�".f B[7U.DING PERNIIT APPLICATI�N FlRMLIf a ADDRIESS�fS_�p[���/� �j�f APPLICATION �•.-�3�DU PERMR ����/C o DATE_ NUMBER $ ISSl1E TYp�_ pCC APN LOT TRACT DATE CONST. GROUP ¢ OWNEA � O "' ADQRESS 3 ZONING SETBACKS � CITYSA�A-ih2G� P��.L ZIP TEL 7 REART RW p APPIJCANT TEL. SIDE/SIDE STREEf RW ❑ � CDNTRACTO SIDE ❑ ooc ADDRESS ��� CITY���cAAd�._. ZIP TEL. � 3� ��s?� SE US w0 ARCFUENGf DESIGNER NO.DWEL. NO. NO. ADDRESS UNRS STOfl1ES BED OOMS � CITY ZIP TEL. m rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUIWER DECLARATION SFWADDfi3EM O Q 1 HEREBY AFFINM N7DEq PENALTY�OEIW RY iHAT 1 MI E%EMPT FROM TME CONTMCTOpS LJ- GBffl¢BICfitPOfl � CENSE UW FOi17HE WILGW*N7 REASON(SEQ 7aat.58U5ME5S ANO PibFE5510H5 COOE:ANY CITY Op (/� OOUflTYWNCMNEOUIHESAPENYITTOCONS7AUCT,Al7ERIMPHOVE,OFMOLISH.ORREPAIHMIVSTRUC W P0t10tDBGc NH�PRIDN 70 RS 19811MICE,AL50 fiEOUIRES 7HE APttICANT FOR SUq/VERMIT TO FILE A SIGHED W ST�tE4ENT 17UT NE OR SNE IS LICENSEO PU0.Sl1ANT TO 7HE PflOVi510N5 OF TNE CONTRACTORS LF � CENSE LAW(Cf/�PTEq i(COAINENCYJO WI7M SEGTION 70007 OF DIVI510N 3 OF T1E BUSINESS AND PHO. 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