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CITY OFDIAMI BAR
DEPARTMENT OF COMMUNITY & , VELOP.MENT SERVICES
21810 Copley Dme, Dsamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861.3117 Building Inspection Rothtte (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION
JOB SITE ADDRES3�j�. J1t ,Q_I,�sL'_.tKv•+� SCl�'.,'_
APN LOTS,, —TRACT
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CONTRACTOR
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ARCH7ENGIDESIGNER
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amm-ButLm OEwmno i
I mool afbra, under suralq of paiuy, that I am aAna Cann GO Cmbectar'e State Oman taw IN the masorgei
kdiwbd t^elow by the chakmaklrl`, I N" p'ecm nest ta IN xrahiprble George (Seat an MI IS Budres, on
Pmamlms Coda Any cgy an couaq that ranges, a pRmY b mnebuucl, altar, Impbae, demollsh, a nook, any
sVu Cn. prior ta Ile mauarere,also neutron the alRlesed tor the "Ias file a aipsdsbdMm Mt N or she
Is Imes,ed purpm Hd the provisions at Me Coft~a Santo Us,me Low fiCharlor 9) Commanm,gwNh Suntan
70M of "Merlon 3 of the Reahmes and Pro Issue Centel a that he or she m Name hem IEensum end do, bade to
the owed eaampron Any nolagon of Serum 73315 Wmy Gemmed far epamA eobleCta the epplkant to awl perany
of Sol teas loan an hundred ddbm (($500)
U 1,aGreater athe property, or my employees wen waam as thdt WIG compensation, edit do U all of a pa'Ima4
of the were and ore whaum is not Intended or GNrm b On (Section 7044 Rudnan and Pmmbwne Cam The
Contractors Stab Unmers taw does not apply to an awrcr of popery who through empWtme' Or W=W offs, beers
or Imprms8 the pmpedd' pawned that the Impnoremmm are no Intended or amred for term It haval the bugging a
mprovermrA is seed w bn are year at prmpmton the Owner Word am hems the burden of owns that d ones rot Wit
or impmvW our am purpose of sale )
U I e9 owner a the paders no, eadgshrery umtrur lnR with bcen69d Contmcbre to pmabua the ga#ea (Gordon
7044 Buahm® and Pras,dow Coda The currencies Stab Lkmnse Law dome no apply on,an Amer of popmdy wN
pr wadmoremees, thereon and ono rAAatc lathe prMeeb Gore premed Conbwwf pUAumtb fdm couraw aE' Serb
Uranus taw I
U l am eaampt ham IlGersum under, the Conbacmr's Sffi Lhrereo taw tar the fdlownt; ms, fol
fly my dpmigre blow I azkroa,mdge that ercep: fo mvps9'xet rs,kknce In whdh I mat Nva re9kdd bratis,d ma
year p�wmcompalmr N lmpfaremeas tovwnebyt2.spwmh 111Wtl�ydwodrd esatNtlNwe makaap
htltlo'.t h!se na been conetrabtl in b emreryhy Iltersed m,trslam 1 andaMmd thdampyathe apakaNe
taw k,Mn 7DW tithe amliscead Rofauuore CodeleavmMMe Wm NAa9f woad tes dpplNada: tsspdnrtbaa at
the fdbwleg Web ante mNw+/wmsdb rrgwidawhmt
SIGN
LICEPMCONTRACMISOECLARAnOW
I tlaeoy eAam genet penatyw palury that lam RCGbeI odarpwblwmansaer Ofammeprcdp wen Saban 7OOD}
a OMaan 3 w the eud7An--essmd Raesaas Cam and my mn,ma a miu&Qi9r�ce1anp/m^�x�S �� y
D3tRPACTOR rr.
WOY MCDMPB6d OR DMLARATON
i WJW AFFMM OLDER PdNAJY OF PIALGAN ONE OFTHE FOl1.MM OELAFATOM
_ I here and ad mamtah a CaDaab of Caesars in Suy Nines for Warka a Canpetartlm as mended by
SaNm 370Dat dui tabs CoOo.for On, Pffft azu ofthe wall for "On man pmntt in human
_ i him, me GO mdaimn Wbraetr Cot aa#m no mom, as MOW by Seaman 3700 Of Me Baba Code W
to pGYmN%B Cr Is war le winch than named b around AN Wwkam C=m,r 0m Severance Cannot Of
Rehr Wmm`
CARRIER ! At
POM WMKR I4
MOS SECTON NO NOT SF CWTLEIEDff RE PMff 15 FOR ONE I And DOLLARS Must OR LESS
I xr"M In that pedw of the Games Nfach fha Imme® tinned I deal ran ennby my name bf any mums, on a to
hsmne&Duct to IN abka/s Canposabn Lana of C&b And agree I led d 19 mare ament in IN we"
maNbs,dSwam 37p0atha (abaCatle idssfwbmhux"y UmewAWl
APPLICANT
WARNNG Felum to serl4e Wooer$ Con impro m premise Is mlaw/ul and Yana sugared an enmbya An ahrdml
pmdnes and ON man up d we Medme Oprad IWWs fill DO 000), in aodmn ta hen pent of IN cmpernadm,
damages as pmNoeo IN in dac#m 37(m of the Grew rude thtarnt No ammey o fees
CONSTRUCTION LENDING AGENCY
I herby On most penalty of every that there is a Commucdm landing Apency in, the tournaments A to work Ax
wealth thU permit Is moues, (Sea 3097 Ov C )
LENDERS NAME
LENDERSADORESS
I costly test I have reed in$ Ouiratlon and Rate that the abws Iaurmaimn Is wnect I agree to campy wdh nil ray and
oalreope, and stab laws rebbng to building rmatuchw, and hereby natures maeaentetwea of Cue oway m
name the IN" mentioned InM Sspxtmn purposes
l rA V,00
PE INSITT E NAME IPWN(K `�""`- ___ �_
SONATWEOFPERM `IDATE
APPLICATION DATE 3 - /1 -1-y PtC# V \' - f+a Yxio
ISSUE DATE a INS PERMIT# Valk X�, ^ to'$t„m �
TYPE CONST OCC GROUP
ZONING SETBACKS
RiONT flW ❑
REAR ❑
SIDESIDE STREET RW ❑
SIDE ❑
PROPOSED USE '
422 S R PT I
i
# DWEL UNITS # STORIES # BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREA/VALUATION
SFRADDIAEM
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC S-1 if'Ct
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY PIC
ENERGY PERMIT ...........
RETENTION FEE
PRE•ALT FEE
BSAF \ Od
I
TOTAL FEES 9-1 �,� 'lei
Np
COMMENTS
I
'3'1to
RECEIPT PAID BY L...'C"JA.iNLLCATON.........� ,
WHITE -Da umneort Cepy YELLOW -Finance Copy,PINK-Astounds Copy Di}LDENFOO_Fam Copy GREEN -Appakmt a Copy