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HomeMy WebLinkAbout1176 (5) . �. . , . � . ;. .. . .. _ -� � ' � , �. � � . , , ' � GITY OF DIAMOND BAR PRE�S - DEPARTMENT OF BUILDING AND SAFETY BU[LDING PERMIT FIRMLY DDRESS a-a S ?7 5 � �� / NUMBER p�p ! APN LOT CT DATEE �— �` C � CONST. GROIJP � CROSS ST ET SETBACKS �� '= OWNER ZONING �� � ❑ o AODRESS � � • REAR ❑ W CITY �,`„�i,�.d.��,�,ZIP�'�2�TEL.�o�3� SIDE/SIDE STREET q�W ❑ p APPUCANT TEL SIDE ❑ x � CONTRACTOR SEWAGE ❑ PUBUC PMT# o ADDRESS DISPOSAL ❑ pRNATE SQ.FT./100 GAL W CITY ZI T . a STATE GRADING 0 CU.YDS.EXC. CU YDS FlLL y LIC.NUMBER y ARCH/ENG/ N 'iYPE SQ FAC't�?R AS ADJ. aREM/A UATION 3, � DESIGNER � � U O � e ADDRESS L� 2 L� S' � � ` t.� ,O�j z CITY ZIP TEL. (�j 3 � PROPOSED USE -k Z 4 � � GARAGE � NO.DWEL. NO. NO. � P�� �, UNITS STORIES BEDROOMS � LOT DIMENSIONS � VALUATION ADJ.AREA e NO.OF B�DGS HOW au�rrrrrr DESCRIP'TION. FEE W ON LOT USED � � � • S � � 2� 1 O ~ IICENSEO CONTRACfOAS DECIARATqN:I hrtby dhrm tlut 1 wn kms�d uWx Ormrtwns d CA,ptl�91enmmmcMq � � � � wrch$xoon 70001 d Dniam 3 of qie Busims�mE hoteqwn�CoN.�ntl my li�nse a in 1W�1a�a rk dMc � ' C � ❑ W � OWNER�BUII�Efl OE0.AlIATqN.I MnEy�Ihtm tlu�I�m wmpt hpm be Contnqw'f 4nnm Uw kr M IoYownp I Q D = n+son tSee 703T 5 Bmmess�nd Prohssans Codr�m�ory w eanty wlKh ipdrn i Mrmn ee cmmat. o slu� xnqox.AemoM�h.a np�i�rry eructu�.Mwr p ns nswrc�.Ya n0uiru tlu�pphcant la ash�mm� ' � � n frle a sqnd aaummt w�t M n km�ed purwm�m tM pwnians d tlr Canaator'c Licnae law p�A�Pr � � 9 Icunmennng vnm Se�uon 700�1 of p'insion 3 d Uie Bu�mu ub hola�wiu GoAe}a M�t M q Wmp�9weNmm � �i md trc Ws�s lor Ae YkGed uemDuon 4n�riokmn d Scmn 1031 5 M MY aOW�nm ta�Mrmn aihNeu K IM ppLqm ro�eNJ qnalty d m�mon IAm 6+�hund�ed 1oWn 1f50011. � W /�] � ❑�.�a ow�nar ot th pW�nY.N mr emV�o�ees wim wryn r tlnr wN campe�waon.wiN b Me wwk.rd � � `� me suucmre n nm immmed or offerea fu seh ISai 7Wa,&ainus m0 Rolessam Cade Th�Ganenc�a's lxmse � � L�w does nm�pplr b n ewner ot paperry who YUYd�v xnpiwa iw�on.rnd who po�s wsl�rwk Mmsell. a Miouqh hia awn�mplvyees.pwidW Ifw�nt�mprawm�nts m not Manded v alh�d!or f�w M.Aeweuer. = tln Wild�nq m impm+mmt is wld xnMn oro Yer al compMron.Ihe ownv�6ulde'wi Am 1M 6urdm d pw.p �[ � y IIIN 11!OM IqI dPk M 1111p10N Mf CI!W1p056 M f�l!I .T. 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PLAN REVIEW' o aw� �� , , � Y1qItKERS'COMPENSATNIN OEf1Al1ATqIN I Ime6r�M'rm!ui I h�w�eenfrcm d cmam u�Yt�n�ue.r � /� �an�hcate diAbrkw�'fampnartian Insvarc�.a�ertAiM u0v Nwrol{S�c.3600.Lah.C.I. `1� r D`—' `� r1• o2 7 ❑Grufrd copy s Mn6y lurm�hed. o ❑CrM¢d cucv a tihd w�tl�iM BmWinp Insw�nm O�DrumM a O�Pxm�m� Q (�7���NQ W r� � CERTIfICATE OF EXEMPiqN FROM YYORCERS COMPENSA7fON NISURANLF:71w�rcoen nwd nw 6�wnqkW AN /J1 i y d me Mrmn s far one�wtlre0(S1001 a Yaf.I arNY tlw n tlw y�rfpm�nn d tlr work la w�sh'IM r . permt if ofued.I 1heN rot�mpby rry parmn m any m�niwr se R Io bcane 1ub�at te tlr Nbtkxf'Compemetien M� �.��O s L'wi al CW1amu. W . e ��� - ��� W PARK FEE � rnr�ce m ava�raxr n,dw �y-�n.d e.�w��.r��a e�.,��r w.vw,w«•� u- SCHOOL FEES � CanpmHaan pons�ans o1 dN 1�6m Wdc.1m murt latlnmh awnply w�tl��sh pwsmn w wi��emm�FYI - � Oe AoemM rnokcC J � OMSION OF Wa1SfflWL SAFE����111� � �� � ❑I lnMy anAy tlut ne i5)a man Mt in dpth nW wheh a P��i�nWind m M�rd. � rnll M e�de M tamatlm vnlh worY wiMarvN M hs ynmq rd M ro�yi7inq ieuclvs.Kalloldinq,hltwrak. a h�nlinon a dwnaiNnp Mnwl.wi11e mve C'1^!��R�4 ILGI�1KIl��(WY �.t.G7 2.An 2.S�c W3�1.rtleB.CACI. � '+r ��r'.:�'t:✓.`-' x .,r'.i`sY G� cn,-_�1Y 3 ❑A�oww•Owlder.I � •1�'' 1 i'�-1 r++ . I�b%�ww�'tE•m'aar�whch wuN npun i Mrm1 Mom h 6w�m a C I�smN S�h1Y.u��Yn1qi futll Velon Ns a qrml M M MA wat fiam IM Wi�qa . W �°""�°""°""��°"��'"°. TOTAL FEES .(p � CONS1AUCf10N IEN�NG AGFNI.Y:I ip Mnh'!Mfwm fut IMn u�miutrawn WAinp pp�c►kr M prkmriw SM�h wert far whc�9w pm�a swM ISoe.7�7.Cn.GI. . � �°"�� COMMENTS m �.�.��,�,� r� _ n �, � ctmuirx�o�con�uu�w+o wrwwut�r+o�a+nrc.�mm i p+.w,a a.aw�•w�r�a�m — �-a v� Mn�M nlamumn p�an n cm�n.I qee m camqY wM YI 7me Ws MM uM ad�eu�IYap w WEinp y eannmctm.nd�utlwnx�rpes�m�uw of IM dp�tmem d mdlup wd SofMy r olr iqm f�tepeqr lar whch I Ma �id ler M w'm1 b tlr prpw�d ewYi^Y ipp�ceq�a � X _// !�nL'i o�_ 11 I�,���,�nC� ?I/��„_ RECPT NO. 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