HomeMy WebLinkAbout18057 f� CITY OF DIAMOND BAR
� �� � I�EPARTMENT CiF COMMIINiTY 8c LlEVELOPMENT SERVICES
� � 21825 E.Copley Drive
{�o�>sbo-3 rss F��sos>$�t-3��� PRESS
BUILDING PERMIT A�'PLICATION FtRMLY
} JOBSfTE s1-�:i lf��A1.iJC'�f — APPLIGATIO �.� PERMIT )�t�� �/C�� �'•7
o ADDRESS � ' ,Z_"' �.t DATE +�� t NUMBER [� �
m iSSiJE TYPE OCG
APN _ L(JT_,,_ 7RACT, ppTE � �'"+�` t�I.r CONST. GROUP
p OWNER _ �"I v �c,��j � —
p AdDRESS ��i' C=�S�S�:P�+ _ ZONING SETBACKS
z CITY J•�}vvtC.>+� Z3.'}✓" ZIP TEI�`k''�`/SY'�'���j+� FRONT RW �'_ _
a APPUCAN7 G`c:lA�LY'f�,.�� C�..�+.�>�-- TEL.. REAR [_;
Z SiDE/SIDE STREET RW C 1
m Gt?NTRACTOR Cc':G/"Fs�' =a� u� �'-;;, SIDE � �_.
� ADDRESS /ck.C ��� .✓h fi{�N�,.(o -- n. Js4 PROPOSED USE �/7 �l'�'�'I t r fL�'�"s� � I,.i� � A
cirv �iiJ.c�,r�',Lc.. ziP�s��,,;;� re�._��z-��3a r / ���_"'
a ARCH/ENG!
z ❑ESlGNER_ ��Tl _ — NO.DWEL NO. NQ. �
d ApDRE55
� CITY _ ZIP � TEL UNITS� STORIES �__BEDROOMS
cn
cn DESCRIPTIdN SQ.FT. FACTOR PSF ADJ.AREANALUATIOid
� dWNER-BUILDER DECLARATI4N SFR/ADPlREM
O
0 I NEflEBV AFFIRM UNDER PENALTY OF PERJURV 7HAT 1 AM EXEMPT FRbM THE CCINTftACTOr15li- G8f8JB/C8f(lOfl
lL7 CENSEZAWFORTNEFQLLOWINGREASON(SEC.7037.SBUSINESSANf7ROFES510NSCODE:ANYCITYQft (/�
C.) GOUNTYIMHICHAE4UIRESAPERMiTiOCONSTRUCT,ALTER,�UPROVE,DEMpLiBH,OPPEPFiRANYSTqUC� (,{,� aatiolDeck
W TURE,PRIOR 70 ITB IS5UANCE,ALSQ ftEQUIRES-NE APPIICAN7 FOti$UCH PERMtT 7q FllE A SIGNE� W
STATEMENT THAT HE OR SHE IS LICcNSED PUR5UANT TO THE PR6Vl51oNS OF 1ME CpNTRqCT(7A5 LL
� CENSE lAW�CHAPTER 9(COMMENCING WRN SECTION 1000)OF pNI51pN 3 OF THE 6USINE5S AN�PqO. u" POOUSpB
FESSIONSCODE)�RTNATHEORSNEISEXEMSP7THEREFROMAtYbTHEBA5i5FORTHEALLEGE6EXEMP- (!�
710N.ANYVIOLATIONOFSECTION70�1.58YANYAPPL�CANTFORAPEftMiTSU83ECiS7HFAPPI�CANTTO � Re-Roof
� AGIVitPENALTYOFNOTMORETNANFlVEHUND%EODOLLARS{f5o0�.):
a ❑I,AS4WNERQFTHEPROPEftTv,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION. CJ CO(itm6�Gidf
Z WIIL DO THE WORK,ANO THE STRUGTURE 15 Nti7 INTENDED OR 6FFERE6 FOF SALE fSEC.�tla4,BU51� �
� NE55 AND PROFES510NS GOpE:THE CONTRACTORS LICENSF LAW OOES NOT APPIY TO AN OWNER 4F �
PROGER7Y V✓1�10 OUILDS OP IMPROVES iHEflEON,ANO WHd DbES SUCH WORK HIMSELF OR HERSELF Ofl
LC THROUGN NIS Oft NER OWN EMPtdVEES.PROVIOE�THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m ""
�QOFFEREDFORSPLEIF,HOWEVER,THEOUkQtNC=OR:MPROVEMGM115Sot.OWi7HiNONEVEAiiOFCOMPLE�
� iION,THE OWNER-BUILDER WILL HAVE THE eVRDEN OF PRGVING TNRT HE Ofl SHE D}D YOT BUK6 CtR
� IMPftOYE FOR THE YURPOSE OF 5A!,E)_
LI!,ASOWNER OF TNE PROpEiiTY,AM E%CCUSIVEIY GOMRACT�NG WITH LICENSEO CONTPACTOpS
� TO CANSTRUCT THE PflOJFC7{SEC.�osa,&USINESS hNo AftpFE5S10N5 GODE�.1NF C6NTpACTORs Lt- VHIU2fi0n 1.��
W CENSEIAWDCiE5N4TAPPLYTOANOWNEROFAPRCIVER7YWHOBUILDSORIMPROVESTHERCON,ANO '— ��—ADJ.AREA __ _ _
� WHQC6NTRACTSF6RSUCNPROJECTSWITHR[;41NTRACTORfS)LICENSFOPUpSUANTTOTH�CCNfRAC- QUANTITY DESCRIPTION FEE�
Z TORS UCENSE LAW.1. ,,,
� ❑�AM EXEMPT UNDER SFC.�� _ 8.8 F.C.FCR THIS ftEASON Q `Z ) C.4'(,l,� S a.t�J ��C I�'i�J
� ^
U
� _._ ___ -- � .r'v G�G-,/'t / S�
ZOATE.... ..._ OWNER..�.__—..T�`...«_'_ i- �t "4•'� � (; ^'. \
Cy � !� /Lti /`d'+'"� /' �"✓�.' . lJ
� LICENSED CONTRACTQRS DECLANATION W
Q
Q I HEftEOY AK'FlpAi UNt�Eii PENAi.TV OF PEqJURY THp7�qM LICENSED UNpEF PROVISIONS OF CMAP7E% y/ ('' /
� 9(COMMENC4NC�WlTH SEGTION lO�Oj OF OiVlSpN 36F T•{E BU5ME55 AN�pROFEiSIOfJ$GOOE.AND z ,�U�S J (:�c."7�+.'� �'-A'"'��S� -
�i AIV LICENSE IS IN Fllll FORCE ANf7 EFFEGT m /• ,�T���"{�
' +-� ' � --V �
d LICENSE CLASS_,,.. '��~� LIC.NQ..__ �-�! � ' .., J L.,�c�'✓�- /O r'L r ``�.
W~ DATE_�.� GONTRAC70R_..._ -��i'� '��=�'u'� d q �/
� � / r'�'�=.J L:.�� d�f/')!1.
� WORKERS'COMPENSATI4N DECLARATION d � -" �
L�vt(G:�^'.� ()Lfc=� , �„
� IHEREBYAFF��,RMUNOERPENALTYOFPERJURVONFl1FTHEFOLLOWING4ECLARRTICNS: Z �„ (�. '{COL�� Z, �'� �"'�
Q
� _IMAVEANDWiI[MAINTAINACERTtF�CAiEO'CONSENTTOSELF-INSUREFORWORK'rR5' �
,d COMPENSATIQN,AS PROVIDED&Y SECT10(V 3l0o QF THE IABOft C06E F6F THE PEPFOflMANCE 'U
Q OFTHEWORKFORWHICHTHI5>ERMI?ISlSSUEU. �
<W �IHAYEANDWRLMAMTAINWQFlKERS'COMPENSATIGNINSURANCE,ASqEOUIREDBVSECTIpN �-�y
97900f FNE 1A84R COOE,FOR iNE PEHF6RMANCE O�THE WORK FOFi WNICH THIS?ERMIT IS 'J ��L/
� ISSUFD.MYW�RKEAS'COMPCNSAFI(JNlNSURANGECAHRtERANDPbLICYNUM8ERA32E� GONSTRUCT�ON �, _,�_
j— .�_. ,_�� .__.. ..«_'
oaaai6a. '`�,�,'i.�irj_.V�'��'�'j��'� � � pLAN REVIEW �
� POLICY NUMBFR�_v+._��l� />> �j ' ��� � ���3 � �
�-�--.—.--- E�FCTRIC "[G.. ^S�� �.'?
� .—._.. `. ---
♦ ..e !
� (iFXaSE(:i1CXJNEEDhY.JTBEfX:hARETFf10FTHEPERMRISfOHpJEHUf�DflEDUJ11Af1S(510])ORLESS). p�UMB�NCi ,",,, i �' f
,�, __ ` � ��
� 1 CERTIFY?HAT IN TNE�EF{FOHMANCE OF TkE'NORK FOR t4HICH THIS PERF.ttT IS ISSUED,I MECHANICAL _,,, •.
.�_.._�._�.. _
CJ SNALL NOT EMPLOV ANV PERSON IN ANY MANNER SG AS TCl BECOME Sl16JfCT TO THE j- ^ _
(J} WOftKERS'COMPENSATIONLFWSOF(;ALIFORM1IA,ANDAGREETHATIFISHqULDBECOME INSPECTIONFEF ,_�, �^_��{,,,� ��,}`}
SU8JEC7 TO ihiE WORNEft$'COMOENSAT70N PROVIS�ONS pF SECTION 3�ot OF TH�LABQR
� CO�E.ISHALLFCftTHWITNGOh1PLYWITMTHOSEPROVI . „ /� ISS�IANCE
.�._....�__..—.... _�
� ; 2. -t,. ,�.i—rti,_ ^v C'.t` � , sMia � t;`�
p DATE:�" _, APPLICANT: __._.�.._' _' — .._. -�(�'�� _ __"—" �___
� WAqNING�.FAILURE TO 5ECUAE YJOANERS'Gt)MF'ENSATION COV flAGE IS� LAW�UL,AN�Si IAII BE E�ERGY PfC -?....-J=-=—.� � . �� �
� .. _.. �,{� `/_ t
� SUBJECTANEMPLOVEP70CRIMINALPENAL(IESANDCIYILFWESUPTQO EHUNDflLDTN4t1StrN0 ENERGVPERMIT L.��' t�� �
DOLLARS(St0o.000�,IN AODITION TO THE COST OF COMPENSAiIpN,�AMA ES AS PfiUVIDED FOR IN �.—
J SECTION�]oeOFTMELAdOflCOOE,INTEREST.ANDATTOHNEV'SFE[S. RETENTIC}NFEE: � ��r
C[ ' _ —_—... —'__"
� CONSTAUCTION�ENDING AGENCY PRE-ALT FEE:
4 �~
Q i HF.PfBV AFFIFM UNDER PENALTY OF f'EFJUHV THAi iHERE IS A CQNSTRUCTIOW IENDING AG�NGY � ___� _T
FOR THE REfiFPRMhNCE QF TNE WQRK FOR WHICH TNIS PEf2MI7 IS�SSUED(SEC.309�,CIV C.}.
Lztl
y, ._.._ .._.—....`.._.—.. ..__
� IENDER'SNAME_`..�_"__ _..._�...__...
' �� T ._..—. _.—__.�..�_.,__'�...
F— IENDER'SA�UR[55 _ ._,_. ___,_ ,,,}}} ...
� ICERTIFYTHATIHAVEREA�TiiiSpPPLICqT10NAND5TATETHATTHEABOVEl4FORMATIpNISGORRECT TOTAL FEES J�' /'�!� 7� � J G�• ��
w IAC.REE TQ GOMIP�Y WITtt ALi.GiTY RNO G9UN7V ORDINANCES AND STATE LAWS PEUTING 70 P.U0.�ING yt '"7! +
� l"ONSTRUCTION,ANO FEREBYAtITHOHIZE REPRESENTATIVES�F T.IS COUN'YTO�NTER VPON iHE ^
� ABOVE�MENTIONED PROPF.RTY FOR INSPECTION PURPOSES. �� �1
, GOMMENT �
Z �
� �Y/�,�.,�i���.�` �f�, /� (1 c'�G ' - T
� � --'—� --__--- — �--, .—.�--
QREftA1RFEENAME{Pftly,i}" .?' /j}� '�,j,/�j�'��},�/
� •/V v� _____.�l.+/ V'� I ' 4 ""/L��—��.`�- �d.�.� ._ `
_ . � �_.1.._.—..� ____...._
� ATURE6iPERMiTiFF ATE i —W.-�.—'.,�.�-:,�.
Z RECPT NO. ``� � �� PAID BY � �,_VALlDATlON
~ WP E--0epartmeni Copy.YE�LQW—Finance Copy,PWK—Assessor Gopy,GOLDENRpD—File Ccapy,GREEN—AppticanYs Gopy
/
� �n�� � � �z��;
_ a., . � ��� , ��� , .���6
� - -�� ��
��
'� ."� ����.�.�,�� ��� �
� y .���., J . . . _
yN i
� " y { y i ,
E�� : ' > ., a, : e ..-a � .
c ., �.:�. :.-s .. . . � .. ... ..
� .. e� .. . ...
,4 e;... >..i a<r e . �. . . . . . ... . ... ..
�.k' _. ; ' x . . .. . . . . . . . - ��
���-�. �
$�S���
���¢(
/a �Z
�.��-ov �$- _
��-��- ��
l� _ � �-
11��"� . �
, _
i�-�'� � `�'
, . _
.
,D _� _
\� �
� _
��E /Z 1��� � � �4 .
T�. _ ' g t �'�t���""`�''�^'"'`'�t
'C/ '�' , em xkva�"`�.�',m'
�
� �
. , .. ...,... u a .�.,�.,, .� . .
_ .. �ll�Z.C.t ti �
� 2 �-( �7' ' ,�a� �A�- ��c�2-r S� a?��. '� _
`��_� � �--1�a � ,�'��� �
� �,t�n j N�o .4 cc�3_ � v�� _ -
� �
�
� �,y
'.4 -`,. E` "�3 y. � .... .... ... ._.. .. . ..
.�; ry 1� t - �'�'�'k :�'�y'e .. ..-. ... ... ... .... ._
3
� " k�,g, �?s°�4 �F 5"'��}s ....... .. .. .
y d f�:�i �r n� fi-������"��� � .... .. . . .... .. ... .... . .
, �i }�,r'�1�'�a�'*;� Jiy�� 'E�.`� _. __ .. . . -- ...
� ; �,�� � ��;� v.;
: � � �
� u '��,�'� T� � _
� �'e M� r,� .�"�c.�� � ._... . . ... . . _ . . .. . ... � - .
* ;km �� �- ... ... .. ... .. ... . . .
a r I ���'�'�y��'s�'�`'�'����'.�. ... ... . ..._. . ....
. x�' 6 - _. .. . _ ..-
,. , _ � a���,��� .... .... -� . .
, �� k �_ � g��x . ..... ... .. . .. .... ... . .
� e a ' ' . . . ... ... . .._ . _.. ... �� �.
� i £��b" ' . .. � .
. - .' + �r s s�.� .. . .
, i ,a ���- ,����.... . .. . .. . _.. ..
. 1 . ... .. ._'
" .' _�`� ��"��,��t's - �� _ . _ a
WALYLri'VALLEY LiNIFLED SCHOOL DISTRICT
- ' SSO SQUTH LEi�10N AVE�YUE WALNL"T CA 91789
CERTIF[CATE tJF COMPLIANCE
With Fee Pravisions of
Gavemment Code Section 65946
DEVELOPE WNER
834 Cambon Signanue of Applicant
CITY/ZIP Diamond Bar 97765 The person signing represents at helshe is au�l��7rized
TELEPHONE 949.595.3092 to sign on behalf of the owner/de eloQer and that the
information pravided is truc and accurate ro the be�c ot
his/her knowledge.
NEW LOT ADDRESS USE OP BUILDING TOTAL SQ. FT.
ResidentiallCammerc ialitndustrial
City '
HOME iMPROVEMENT OR REMODELING FRO7ECT
ADDRESS DESCRIPTIC?N TOTAL SQ. FT.
g34 Gam�on BedroomLBath/Famity Add'rtion 571
Diamand Bar Walnut (Bedroom, Family Rrn., Kitchen, etc.)
Signature of Su�+erintendent o[Baildiugs � � ✓ Date �.a'� (` `.� 4�.
TO BE COMPLETED BY SCH�OL DISTRICT
FHE SCHBDULE: The development fees ievied by the Walnut Vatiey Unified TOTAL FEES DUE
School District under provision of Government Code§65995 $ �f G'I�, L��
are: (EFF. 8/17/98) Resideatial Develaprnent $1.931sq. ft. Receipt# TS /C�
Commerci,al/Industrial $0.31lsq. fi. Date__�j � �} L
Fees are assessed on TQTAL square footage "Iiving space" of ALL new ar remadeli,ng construction projects C?VER SOU sq. feet
(eliminating garage or uncovered patio).
1J This is to certify that all fees due to the Waluut Valley Unified School Disuict under provision of Government Code Section
65995 have been received and a buitdx'ng permit may be issued.
This is to certify that the abave described deveiapment has been determined to be EXEMP'T from the develnpmenc fees of
Government Code 5ection b5995 and a building pernut may be issued.
Exernption Justificatian: PROJECT IS 500 t)R LESS SQUARE FEET
OTHER
..
�
' s J.�-n�c., J�c z�s rn f
Assistant Saperintendeni
Fiscal and FaciIities Management
il87 Rev. 21$8; 6188; 8l89; 1l9Q; 8/9p; 10/90; 8(92; 6i93; 12193; 8/94; 619b; 1/97; 8/98
PLEASE SEE NOTICE OF 9Q-DAY PERIOD FdR PRQTEST UF FEES C►N REVERSE SIDE
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
ADDRESS
APN LOT TRACT
OWNER !"R«fj,n%
ADDRESS W3-C-AVStiPy
CITY). cM �A Z31k/"ZIP TE1(5+c�'§I S' 3<y'L
APPLICANT 4°L'AVI/"�„*��"C<r./�TEL.
CONTRACTOR G-it6/V i+'4'•-%�
ADDRESS/c4.Q. I'.+re}3i�j�+G�af lli/%
CITY YV'ydifl r LH ZIP fc-„TEL Gam[t. c' 33
ARCH/ENG/
DESIGNER
ADDRESS .E-
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC.7531 5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE,DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)):
^ I.AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUST.
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE. IF,HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN ONE YEAR OF COMPLE
TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
U I,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS
TO CONSTRUCTTHE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI-
CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW,),
U T AM EXEMPT UNDER SEC. 8. &P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE AND E
FFECT
/
4„(
LICENSE CLASS LIC. N0./
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
-I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
CARRIER�' '-'f-^-
r
JJ
� "/,�Cf
POLICY NUMBER
Jc�
(THR SECTION NEED NOT BE ODMPL,ETED OF THE PERMIT IS FOR ONE HUNDRED IXJLLARS($1 W)OR LESS).
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVI !Q .
DATE: 7 T" 2'APPLICANT._,
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COV RAGE IS U/I LAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO OISE HUNDRED THOUSAND
DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGG�ES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C.).
LENDER'S NAME
%_ —
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
I
PERMITTEE NA
,N'Z 4,i
i
f
ATURE OF ITTEE A TE
C,)
w
0
ww
0
Z
cc
0
cc
0
ww
U
Z
W
U
F-
C))
IL
Z
I'1
7C
w
0
U
LA-1
GO
OD
LU
W
0
f�
w
CO
1---
0
w
J
w
w
0
cc
d
Z
W
cc
w
W
d
0
J
DO
m
Cn
��
S
F-
WI jt1E-Department Copy,YELLOW-Finance Copy,PIN
PRESS
FIRMLY
APPLICATIO PERMIT,-' P/C s'7
DATE v 0 Z-' NUMBER�c # �
ISSUE TYPE OCC
D
ATE CONST. GROUP
ZONING SETBACKS
FRONT RW
REAR
SIDE/SIDE STREET RW
SIDE
PROPOSED USE/�/Z i 1C C 0,•�T_�'f j�cj�/��p7;"
N0. DWEL. N0,N0.
UNITS STORIES f BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION
SFR/ADD/REM
Garage/Carport
LLU Patio/Deck
U- PooUSpa
Z Re-Roof
0 Commercial
co
Valuation 0 Z ADJ.AREA
QUANTITY DESCRIPTION FEE
z) GVc.1Sa�7 ! iCA�ti (J
0 fiiS
Z
it 1
w Gti �+"t�Ql L...V
W
Z 4
:D �L
a
J
U
Q ( . "(CnL�� Z . �
W
CONSTRUCTION
PLAN REVIEW_
ELECTRIC
PLUMBING I
MECHANICAL
INSPECTlON FEE C'L% .�.>t-}7
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES
T
COMMEN
dG'
1'
Z
rte-
J
�
3. 5
RECPT N0. PAID BY VALIDATION
7
Z
7I
C-t A*"I
kMAP,PPVMk
WALNUT VALLEY UNIFIED SCHOOL DISTRICT
880 SOUTH LEMON AVENUE WALNUT CA 91789
CERTIFICATE OF COMPLIANCE
With Fee Provisions of
Government Code Section 65996
DEVELOPERYWNER
834 Cambon Signature of Applicant
CITY/ZIP Diamond Bar 91765 The person signing represents at he/she is authorized
TELEPHONE 909.595.3092 to sign on behalf of the owner/de eloper and that the
information provided is true and accurate to the beet of
his/her knowledge.
NEW LOT ADDRESS
City
USE OF BUILDING
Residential/Commercial/Industrial
HOME IMPROVEMENT OR REMODELING PROJECT
TOTAL SQ. Ff.
ADDRESS DESCRIPTION TOTAL SQ. Ff.
834 Cambon Bedroom/Bath/Family Addition 571
Diamond Bar Walnut(Bedroom,Family Rm., Kitchen,etc.)
Signature of Superintendent of Buildings
TO BE COMPLETED BY SCHOOL DISTRICT
Date
FEE SCHEDULE:The development fees levied by the Walnut Valley Unified TOTAL FEES DUE
School District under provision of Government Code§65995$/0.,),671
are: (EFF. 8/17/98)Residential Development$1.93/sq. ft. Receipt# "S/0
Commercial/Industrial $0.31/sq. ft. Date .c/"AD Z
Fees are assessed on TOTAL square footage"living space"of ALL new or remodeling construction projects OVER 500 sq. feet
(eliminating garage or uncovered patio).
This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section
65995 have been received and a building permit may be issued.
This is to certify that the above described development has been determined to be EXEMPT from the development fees of
Government Code Section 65995 and a building permit may be issued.
Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET
OTHER
s lcp�s.n
Assistant Superintendent
Fiscal and Facilities Management
1/87 Rev. 2/88;6/88;8/89; 1/90;8/90; 10/90;8/92;6/93; 11/93;8/94;6/96; 1/97;8/98
PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROTEST OF FEES ON REVERSE SIDE