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CITY OF DIAMOND BAR ,
DEPARTMENTOFCOM UNITY& ALOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA9I765 PRESS
(909) 839-7020 Fax; (909) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdismondbarcom btiiding@dtamondbarea.gov
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ADORE $6 15-�i?z. 2r •a+ -
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DESIGNER
ADDRESS
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I hereby alomn Mayer pawn, of binary that 1 an aNApt You the Contractors State raaam raw for the rmbepal
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By"sandure bdmw I acknowadAa fret, wilt fa my p rmnd reseencein whmh I mud have wdw tar, at Nest are
Your plat to cmnpNuon of the Improvemaua fAVaea by this perms I carol terry em a i ucWm Net I have Error at
"your buss If it men rat been conatad6d In de mbmly by Brad treatment I mMaMarm that a copy of em
apptkaaa law Smmn M44 of the Alarms and Preka4ns Coal Is ava lit a upon reauea Man this apakaan is
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BCBISFO DDKMACTOA'S BECLAAATNIN
I hereby amen brute pmaty, of pmlay, dal l an, moral busy, aermotd CTMMB errumencong wM Secua1700M
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WORMI CONFE BAAON DECLARArmN
t HERESY AFF1Rh1 UNDER M M.TY OF PSUM UK OF THE FOLLOWING DECLARATIONS
I Aare arm MI M*Mhn a cuorl to or Carmnt a Sm mace to WMrol Competes or aaetlm to
SecUM37MOl tho Lehr Cade fouls paaemara d dawakar MdN tlta porn a Lonbtl
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Neworkhewnkaea9 paad[uapar My WBekara Harnance CardBrmd
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WARNING Father to weun Workers Combination mvomga Is unlawful and Shen mbial m mhorcmt to "You
protons arm chip "a up to wor hundred Debenture mpae ($100 pool N mmdar N the ma of but compar oh m,
dmm0onaa pmvam b mmrdon O7� et err mbaeama Fxmart and eh9rmy s tads
CON08VCM LENDING AGENCY
I he" ohm and* WWI, b penury Nat Nam is a t:aratrtwiwn tamrq Agency Mom pahrmmce of me veers, to
ankh tea pereaf to lumber We; 3097, CN C )
LENDER'S Man
LENDER S AODHESS
I a" hen l here read Nte appeabon a a state Nth tee abase abebtah Is allied. I agree to MM war di pay and
pW data orsreartg it }attlmze teaea^elmatltsaMOasmwUym
per maintainpagaiamam
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DATET
APPLICATION DATE ati itN PtCR '—
ISSUE DATE 3t Zil\) like, PERMITA t to - -7) .+
TYPE CONST OCC GROUP
Scope of Work b O f"'
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N DWEL UNITS tl STORIES
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a BEDROOMS
DESCRIPTION
SOFT
FACTOR PSF
AOJ AREAIVALUATION
SFR/ADarREM
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Adl Area
QUANTITY
DESCRIPTION
FEE
car
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CONSTRUCTION
PLAN REVIEW
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ELECTRIC
PLUMBING
MECHANICAL
........
INSPECTION FEE
ISSUANCE
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
+ CJtJ
BASF
V- tSo
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES'
COMMENTS
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P/C PAID BY
AECEIPER Q4j2,,['1.'iU PAIDBY vi S1'*
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WRITE—Depa4norrt Copy YELLDW—Fkranrs Copy,—Assersaor Copy,