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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELC_ _ 1ENT SE VICES
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax (909) 861-3117 Budding Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION A
JOBSITE
ADDRESS 231 I S bPn OQ rd
APN LOT TRACT
OWNER F411e l q O Q 5 I n
ADDRESS
CITY ZIP TEL
APPLICANT TEL
CONTRACTOR yC
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DESIGNER
ADDRESS
CITY ZIP TEL
OWNER BUILDER DECLARATION
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DATE GINNER
LICENSED CONTRACTORS DECLARATION
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S IOOIWENCfO WTH SECTOII ROIOF OWSIDII 30F THE 9ED W AO PROFFSSOCi QAEMO
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WORKERS COMPENSATION DECLARATION
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aNVL HOT WPLOY AM' PERSON NAM' WwNFA SO AS TO BECOME IRMECT TO ME
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CAOE 31AUrATHATTHC KY WITH THOSE PPOVtMNS
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CONSTRUCTION LENDING AGENCY
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ftll TIF POW@YXCEOi TIE MOM( FOR WNIOI M6 PEPYIT l9 Y91FD ISFG SUR CN G\
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ABOVEJIIXfONFO PROPERTY FOIIIWPFCTON PURPOBE4
I
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W EE DATE
PRESS
FIRMLY
APPLICATION PERMIT re
z P/C
DATE NUMBER
ISSUE TYPE OCC
DATE CONST GROUP
ZONING SETBACKS
FRONT
REAR
SIDE/SIDE STREET
SIDE
RW
RW
(:I
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❑
❑
RP19POSED USE
NO DWEL NO
UNITS STORIES
NO
BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREA/VALUATION
SFWADD/REM
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LL
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ADU AREA
QUANTITY
DESCRIPTTDN
FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC.
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE ALT FEE
TOTAL FEES
COMMENTS
3.(D
RECPT NO
BY
VALIDATION
WRITE—Depemnenl Copy, LOW--Flnanw Copy —AmEw Copy, GOLDENROD-09 CoN. GREEN—Appkanra Copy