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HomeMy WebLinkAbout15672 (22) � _ .�_.. v �� CITY OF DIAMOND BAR i DEPARTMENT OF COMMUNITY d�DEVELOPMENT SERVICES / Y 21660 E.Copley ihive Suite 190 (909)86Q3195 Faz(909)861-3117 PRESS ����'� BUII,DING PERMIT APPLICATION FIRMLY Y JOEiSITE J y ,�- APPLICATIO /A� PERMR I��7YJ P/C o ADDRESS oZ. -1 e �e I L� DATE v�� NUMBER� �"'11 g issuE NPE o c APN LOT TRACT DATE CONST. GROUP g OWNER �'A �J C � � "" ADDRESS �_�� LtLC.'A `Ji" 1 C7 ZONING SETBACKS � CITY �J��1P ZIP� TEL f - � F��RT RW O APPLICANT TEL. SIDE/SIDE STAEET RW ❑ � CONTAACTOR � _ �+ G. SIDE ❑ g ADDRESS �' CfTY��AL.G�1+T/v1 ZIP�$70 TEL�f N 57J�b70 PROPOSED USE � ARCH/ENG/ DESIGNER S GLG S NO.DWEL NO. NO. ADDRESS 7 . a� � � • * �`�p UNRS STORIES BEDROOMS N crrr Tr ��� " ziP ���TEL.��` -���-�� � DESCRIPTION SO.Ff. 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PLAN REVIEW � POIICY NUAIBER� � �1.�3.v ELECTR�C � � (f/GSCCRNNCEDKI'.BEOC1.REfIDOFTE�Efi1.fT6F0l7ON[N�7Li1ED R�O�OfILE55? PLUMBING W MECHANICAL Z 1 CERTIFY TFUT IN THE iERFO(IAIANCE OF TM[WORK fORYM1iICM iH15 PERMR R ISSUE�,1 � (�' S1IALLNOiEM7LOYANYPER50NNANYIAANNCRSOASTOBECOMESU0.7ECTTOTMC � WOPo(ENS'COYPENSATIDNUWSOFCALIFOHNIAAN011GREEiNATIFISNOIRDBECDYE INSPECTIONFEE S S�ECTTOTHEWOWCER5C06�PENS�TIONPAONSIONSOFS^-TiONf7ooOfTHEUUOf1 � cmE,i s�uu cortrrrrnrncararir vn �+ose vRa�srons. ISSUANCE � �� �pp��M. - SMIP p DaTE: - W ENERGY P!C � WARNIN�:fNIURE TO fiEWHE WOfiKER PENSATION fAVERACE IS UhLAN D SHALL BE Sl1BJECTANEMPLOYERTOCR:MiWLLPE TI[SANDLIVILFWESUPTOONEHUNDREUT110USAND ENERGYPERMIT � DOLLARS(f 100.00D).W ADDITION TO TME COST OF CdAPENS�TpN.D�IIAGES AS GROV:DEO FOR IN � SECfIDN37oeOFiMELABORO00E,IHiEREST,ANDl1T70FNEY5fEE5. RETENTIONFEE: � Q CONSTRUCTION LENDING AGENCY PRE•A F�� � IHERFBVAFFWAUNDERDEN1lTYOFPERJURYTMATTHER[ISALONSTRUGTqNlENO�N(i11GENCV �� nZ- fOR TH[PERFOHAAANCE�F 7NE WORK fOR WHICH THIS PERMIT IS ISSUED(SEC.90o7,CIV.G). - W � IEN�ERY1wAE Crrr��� IENDEH'SADDRESS W ICERTIfY THAT I NAVE READ 7HIS APPLICATqN M1D STATE TNATTME/�BOVE INFORNATqN IS CORHECT. TOTAL FEES � � • � IAGREETOCM�PLYWITN�ILLT'ANDCWNTYORDINANCESMIDSTATELANSREUTIN6TOBU6DIN0 l% � CONSTRULTION.AND MEREBY AUTlqf11ZE REPRESENTA71VE5 OF THIS GWNTY TO EMER UPON iHE � /�BOVE�MENTqNEO iRO0ER7YFOH WSPECTION DURVOSES. COMMC-NTS Q � � �S t� m M TEEWWE(PN�Hn �� � - /D—/L—tYJ N NNEOFGERMITTEE DATE (, � RECPT.NO. PhD BY VALIDATION WHITE—Department Coq.YELLOW—Fnence Copy,PINK—Assessa Copy.GOLDENROU-filo Copy,GREEN—Applicant's Copy �' . ' . S_..':y�..A"-.,�.. .. �. ... .. . , �. .... .... . ......�, � .... .� •�.'�a.n-.. -. p, ... � �. .)���-...'(` n .. .... _ C! I 1' OF QIAP��O��D f�Ai3 . • � . 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