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CITY OF DIAMOND BAR I ,
4WDEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
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
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JOB SITE ADDRESS
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WOBInR's COMPLWATM DECLARATION
I HEREBY AFRRM UNDER P3LAi PERJURY ONE OFTFE FOLLDWWG DE"77089
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CMMLCn■I LENDm4G AMCY
I hereby affirm wow peraQy of Emery that them Is a CoNeumen LendingACwcy fat IN bAwmwrce of the wuk he
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LENDER S NAME
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