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kaLiHi}ND BAR
CITY OF DIAMOND BAR
DEPARTMENT OFCOMMUNiTY&DEVELOP ENTSERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION wwwcatyofdamondbareom budding@diamondbarea.gov
JOB SITE ADDRESS I1.311T -41`1—' _
APN LOT TRACT
OWNER
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CITY 5� 21P TEL
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DESIGNER
ADDRESS
CITY ZIP TEL
DWNEN MMER DECLARATION
I hereby arm under pantry of DerWly, that I ad inal Iran the Comono'a State Lkerws Law or her r"SW"
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APPLLONT
WARNND Failure to Uwe WWWS Ca("MOmn mremps s warnew and shall sublen an Manuel W skmn d
Penalike am ant Mines up to ins nomad mpmnd dollars ({1000001 W addem to the COA a po a nubm
awapesaspalaMA 7a Museum need Bolaxt wtle IniercaL atl elfwsye MBa
CDNSiMICTRNL LENDMDAOEMCY
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LENDER S NAM&
LENDER S ADDRESS
1 peNty mallhaaeraad psa katlw mid aqN test taaloae Mamatlm geared Taped W=prywithaildtyand
aanaisxsamataW Wish relapng to buMrq mnbbvGm and hereby aimodae dbbacaxnyW
opt tlw ab w MMO W PWNtY N naNccoo MPEaea FEPIMIT
E OF MWIME DATE
APPLICATION DATE Z 211I' i?
ISSUE DATE +�ti 1 \'�^ PERMIT#
TYPE CONST
Pic#
f''(Z
ODD GROUP
Scope of Work Pwsr Pl nt
# DWEL UNITS Of STORIES
as BEDROOMS
DESCRIPTUN
SO FT
FACTOR PSF
ADJ AREANALUATtON
SPR/ADDIREM
GaraplCarpat
Ww
RaYidDeck
Ii
pwvspa
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Re Roof
Cammacel
m
VatuaNtwR
Act; Area
QUANTITY
DESCRIPTION
FEE
i
s7
z
a
CONSTRUCTION
PLAN RENEW
ELECTRIC
PLUMBING
a� �1rl,+ C'm
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE...
PRE-ALT FEE
LIK...
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
A" Les (02..
PIG .Y PAID BY
RECEIPT a 33 '7y i - PAID BY 6CaQ
VALIDATION
t VALIDATON
