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CITY OF DIAMOND BA
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fox (909) 861-3117 Building Inspection Hotline (909) 830-7027 FIRMLY
BUILDING PERMIT APPLICATION www.eityofdeamondbarcom budding@dlainondbarca gov
JOB SITE ADDRESS
5 5, BREA moat j
APN LOT TRACT
OWNER
ADDRESS
CITY TEL
APPLICANT TEL
CONTRACTOR
ADDRE
CITY _ } ZIP r
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNFA�amOm WAARfATMI
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or Improved err the pupae or Bye)
U I, a owner of dN ma", are moluaivaly with Ilcwmed Cwbncaeeto woaea-t the project ISwOde
7044 Boston and Professional Code The Co trKta t'stets Lomas low W9e to so* to an owner of property who
Win or Improvesthesmm and who common forme Postal a loosed Comedbrwsu"vetheComm ctore slam
Ucense Law)
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Oft Sign
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UCmSED CONTRACTDR'S DECLARATION
IRan affirm untie, pemltyof poln ft I mn Ilcw under prolt9hore of Cal a(wmmar lop whh Saves ieRK
of DMWm 3 an the Siolsess and PW.s rode aqI my IlsemMQa toRs.4 ethd
UCENSELtfSS
E%P
EV DATE
DATE '� CONIAN:1lNi
WOMER'SODWO&TIONMECCAPATt6il
I HEREBY AFRRR LADEA PENALTY OF PERJURY ONE OFT}E FOLLOWING DEC!"VDNS
_'. have and w;li arremen a Cedr!ab A Edward to Sell more or Alows Germander as provded by
Saew3700uf Its Law Coda farm pe. d me were mrwhleh ilea arrd H lased
_l hemandwm named Wa'ker'a Compensation ,a emmact by Sewa3700ol tin tabu Ulm, for
me" aence of me work iw WHO dim m unt amNme any WoMera Compression buurom Corder aryl
Pat" Number an,
(ANDES
FOUCY NUMBER
frHOSECDON FFID NOTBEPDMeL llD THE POW 6KROE RAM DOl1AA5$140 ORLEW
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aPR1fANT
WARRING yours to save Wodnce Canpwssafian a ouR No umawue ad SW samo l an employer or aimmai
peRWba mm WN Pray Ip to see hwded muaend dame (110000111 as adodm to bN cat of the mmpsNeM
mmW)asaplormadfa in eaDm 370A cline mho min In19reEI, Old atlortNy stem
COIN1wM. M tENplNO AWKY
I hereby amrm under peralty of paRuY matmers to a Com butbon Laldnd ApPYfa the performance of my were fir
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LENDER'S NAME
LENDERS ADDRESS
I candy mat have no tNanpeketlm end 6mm Has me wain infer ' nle meat wu fo W" win all sty and
of Ole wurnto
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FERMITfFE NAME {Pas ej ^ +r j r'�^r'�
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S'GNATJREOFPENMDT DATE
APPLICATION DATE 2 +—
ISSUE DATEE—PERMITN
TYPE CONST
PtCt�,,',.
Ya -7— r)I.I l
DOG GROUP
Scope of Work i
A DWEL UNITS p STORIES
/.
1
Is BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SFR/AOO/REM
OeNDe/Calpod
umi
Pa PMWk
4W
PaW+Sp8
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raw
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Commarcid
m
Yahmgan
Rol Area
QUANTITY
DESCRIPTION
FEE
ad
CONSTRUCTION
PLAN REVIEW
ELECTRIC
.**2s/
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
EMIR
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING p.ERRANCE
TOTAL FEES (an- jvrC 7
COMMENTS
"t`T , 50
P/C _"�.P{�AID aY /, /A�
RECEIPT 0--491.L7!-at_ PA10 6Y _ 114 011
VAUDATION q
VAUOATION Am
WWM — Oepedment Copy. YELLOW — Funereal Copy, PINK—Anaeoor Copy