HomeMy WebLinkAbout1600 '''' CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY PRESS
BUILDING PERMIT FIRMLY
JOBSITE ' APPUCATION PERMIT USE
ADDRESS 5�S' ��m�� ��S ��UE N�R �CODE
� APN LOT TRACT DATE 7 � CONST. GROUP
. o CROSS STREET SET ACKS �►�
°= OWNER� L►'1�►f' YG(��f� ZONING ��� � ❑
� ADDRESS 3 S. R� �
W CIT`�1�►_d�L�,� �ZIP�• TEL�� a- SIDE/SIDE STREET RW ❑
o APPUCANT TEL SIDE ❑
z
6 CONTRACTOR SEWAGE
o ADDRESS DISPOSAL � �8� ��
W CITY ZIP_9 t�D�TEL � PR�VATE SQ.FT./100 GAL
z STATE GRADING ❑ CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER
y ARCH/ENG/ � N NPE SQ FT FACTi�R PS � ADJ: AREANAL TION
= DESIGNER W 1
o RDDRESS � 2
= CITY ZIP TEL �r 3
� PROP05ED USE Z 4
� � GARAGE
z NO.DWEL NO. NO. � POR�
�„ UNITS STORIES BEDROOMS m
� LOT DIMENSIONS VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUANT(TY DESCRIPTION ` FEE _
W ON LOT USED 4
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Y with Secnon 700�1 W 6v�um 3 d tlr Bucwv W P�deunna Cade.ind rtry 6cenu is n IuM lau� W
3 ❑ W
�+ OIYNEN�&AIDEfl OEQANATDN�I M�eEy�Itwm put 1 xn t+enpl hom Ihe Lonvntor i lrense liw la tlr ldb.nnp , '
� Z re�son ISet.70.71.5.Busmess ud Roleswns Catrc Any ury a eanry wMch rpuiia�parm m camtr�ct. (� �'� • •�.}'�'1 `�`\_t .- .
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K tne�ppuc�m a i rni pewry W rot mae Uun tne I wdrea aowu It50011:
W
� ❑I.as owner a)Ihe paperry.u my empbyea w�N waqes n IMr soM conµdustqn.w�Y du tla wak.W
� ~ the s��u�iw�u nut mtaded a dlned In saN(Sec 7064.Buunsts and Fotetsions Lode.TM Lmvacmi s lcmu � I
V L1w Co�s!ut�DdY a��^u d p�operty who Oudds a mpmes tlwmn.W who Ooes sucb wnt Aun7tll V •� 1� � ��-
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o )06i.BuHrcu�M Prolessan�WU�.TM Lontrutw's lunse llw does no1�pplr m�n owne�W paperty w �
= buWs w�mpwu thaem.W w6o conuxu tu wch pryau w�N�wnuxw��)kmud p+w+nl m iM Conu�c�w
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o °'° °wn" ELECTRIC
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� O cao�Ka�Y�na����.�a. MECHANI ��
o ❑c«u�Ka��r�a w�n a�e����o�a��a o�;.y,�nt Q GRADING
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x LEBTIFIfAfE OF EXEMPIqN fR01A WURKERS'LOA�ENSATION PISUMNGE:TM satpn rred mt M cmq4kd ��E�' l��,r�7\
GD d Ne pwmn is lu aw hund�td ISI001 r l�i��.1'!aly�'u�n tM D�lamr¢�ol iM wak lor wMch Nu +� {—•���
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R �W�W�1,',D! _�Y minnt[4o u 10 hE[Omt fub�Gl b Y11 NtrYn1'GonW�nsium
S Laws d CalJama. ' - ;`' �1 W
o " ...''-::::-"' W PARK FEE
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� NOTCE TO APRICANT.p.�lur rtutuq tlus Grofuu W E,umpuon.pu snouN Cecm wqect m tAe Mlata'� V- SCHOOL FEES
� Cm�peasaum Wovwms ol 1�6r Cad► M�auu;la M wayty wnA such pwwau a Ilw perma sh�ll
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� OIVISIUd OF WOUSfN1Al SAFfTY PEFUfIi 6ERTFCATpN:
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o ❑I AneEy wWy�t,m ewvnm fne(5)a mu�ket u�dep1A nb whrb�prsm n Ipwtd b OtlCNd.
� wJl be made n cmc�wn wiN wark.s�du¢ed h tlw D�rma.aid tlw au buildYp wupu�.wfkWnp,lahewwk .
a dmn4nan n divnntl�q;iMeal wil 6e.mu�Wa iMrry�m.l36)he�Aph(Oup.lI.Gi➢4.M 2.Ss
W34i.T�a.e.tac�.�.-:...__ ::.... :'.....; �.. .� ,,
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� ❑As wrtw�6wldn.I wJl na empbY mWiy a do wat which wak rpuu��wm�km ir Oiraoa d
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� ❑o.��d nn"oa S't`n�•�'N'. TOTAL FEES �r �
�,p COIISIf1UCfON 1FN016G AGEICl:1 M�bY dium Ilul Ifa�ii�ConsOu[4on Ipi6ip 10ai[y lor Eu pMlamann -
x d�he wwk fa wMch tlos qaml is ics�ed(See 309).Gr.41. .
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� m ��'s Add�ess
6 CERfYICA1E Of LURl1AN[F ANO AUTHOR�UiDI OF ENTNY.1 cruh 1 Aa.�n+d�ha+VPkM�n and�uY
�n tlut the nfam�4on pven o wrM.1 qw b tanpy wq6 M sLY Ir,vs rd ury r8�r�[�nYenp ta bdA�p �
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9a - 9v -
�,�„�.d��,�p�„� , RECPT NO. � PIUD BY VAUDATION �
WHITE—Oepartment Copy.YELLOW—Finance Gopy.PINK--Asseseor Copy,GOLDENROD—FVe Copy,GREEN—Applicants Ccpy
BS106�11l89
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