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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Dnve, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.ettyofdismondbarcom build ing@dtamondbarca gov
JOB SITE ADDRESS It I r5s B, k-B-A Far"—� L. Ii. sim,wa,I 8sir
APN %A13-TI—Dail LOT I ILL�4yES_ TRACT
OWNER k4l to I„Paw
ADDRESS
CITY (}la V" Ba.r 2uFftf ios. TEL '-d'd:i^3141
APPLICANT Y.n.ya G TEL L 141
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DESIGNER &"CkauYJ sosw%
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aWNER-WLLBER OECLMAWN
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WORKER'S COMPLWTIO E DECLARATION
I HERESY AFFRM UNDER PENULT( OF PERaAB' ONE OF THE FOLLQWUK3 OECLAPATIONS
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(PHIS SECDON NEED tali BE COMPLETES IFTYEPERM S FORONE"DRED DOUA15$100 CRLCoo
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CONSMUCTMMUWCINSA0ENCY
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LENDER R NAME
LEMOERSADDRESS
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5AgHA7LIRE QF 1 DATE
APPLICATION DATE l"I`)—l�i
ISSUE DATE I"-���� PERMITR
TYPE CONST
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DESCRIPTION
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ENERGY P/C
ENERGY PERMIT
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PLOT PLAN
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TOTAL FEES
COMMENTS 4kN 1 isibri
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P/C D BY
RECEIPTa PNO BY
VALIDATION
VALIDATION
WHITE — DMBUIMent Copy,YELLOW— Rtwlce Copy.—Aeaeesar Copy