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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
'" 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
., , (909) 839-7020 Fax ("9) $61-31I7 Building Inspection Hotline (909) 839-7027 FIRMLY
''�'"' BUILDING PERMIT APPLICATION wwwcityofdtamondbarcom bmldmm g*diaondbarcagov
UOBSITEADDRESS S30q I34111
APN LOT RACT
OWNER
ADDRESS
CITY ZIP TEL
APPLICANT TEL
CONTRACTOR v'r�r e
ADDRESS 7- 41' /-r uWLIJOA Ce r,
CITY 4rrdsvS ZIP 19 2 TEL f7 b
ARCH/ENG/
DESIGNER
ADDRESS
CRY ZIP TEL
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LI,ENSEc.ASS C/O UC NO —i 'i
DATE L t CONTRACTOR
WOR1@RRB CDMPMUTWX CEM"TION
I HEREBY *TINT UNDER PENAI.TYDF FEAAMY ONE OF THE POLLOWNG OECtARARONS
t "t, I have wd WO I &OM a CakBcam of Cowen to SON inure Its Worl er'e Conema0a, m mw'mm by
Seaton 3700 of the LAW DNA, Per are performance dim Otero to which pso pent a Patad
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DATE APPUC IT
WARMNS Felurs to am Woryer a Comparmson amega P Prospect, and shad wMacy an manor to croar el
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wnyis at prowled rot In amdwv Neaot the laborwa karat wdanfinWYPieea
COMMUCTION kiXOM AGO=
I taraby arm under penalty of Pwjmp WA Msm Is a Combudmn Unft Agency for am pe0am of by work per
which UP pamrc le Issued r50c AM, OR C)
LENDERSRwE
:INSISTS ADDRESS
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mungardimncas No scree lam Mount; to bWMeD amimam, and horoby whforho, fgp"mamas of this manly m
emir mmpr.' eapwedned pmpo/hy'�for Mspammn pu!pmas
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SONATUREOF PE EE TE
APPLICATION DATE %N l sa i tom-
LSSUE DATE T}I 20)k—;- PERMIT#
TYPE CONST
Pico
\-1 �' QL-a'� Oi
OCC GROUP
Scope of work
M DWEL UNITS P STORIES
M BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
AOJ AREAIVALUATION
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9
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Vatuatto
Atoll Area
QUANTITY
DESCRIPTION
FEE
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ca
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
4sp%
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
sa%aw%i'
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PR£-ALT FEE
'ant 1tl'g.
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
: COMMENTS
P/C PAx)9Y /a.� VALIDATION
RECEIPT M �'Cn + PAD BY •—AP C }T VAUDAT10N _ '�_
WRITE — Department Copy YELLOW — Flnanco Copy , Cagy