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CITY OF DIAMOND RA
4WDEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909)839.7020 Fax; (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUiLDINGPERMiTAPPLICATiON
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OWNER OS
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ARCEVENG/DESIGNER
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CITY ZIP TEL
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DATE SGx
LIMSM CONTRACTOR'S DECLADATLON
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CAmUER LG. C.-'Y POUCYWMBER �����i�
(NFL SECTION NEED NOT BE COMFLETED IFTFEPERMIT 6 FOR ONE M►UO DOLLARS ISIOOI OR LEM
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O APPLICANT
WARNIN Fadu a tp secure Wakero Cmnp l etlan rammpo I9 unlawful and ahml subject an employer m Ominal
penaft es and CIO] Roes up m Ga9 hundred ussnd dDllare LSIOD 000) In Camara m LAN rest of the CIXMa09nt aq
damages as proVWed for In all 3708 at the labor coda Interest. and atmmey s sea
CONSTRUCTION LENDING AGENCY
I heresy often under partly of pall bet them 10 a rnnstractlon LandingA Wnc7 (Or file performance t Me wink to
which this pemNt Is Issued ISK 3097 CIV C )
LENDER'S NAME
LENDER S ADDRESS
I artly Nat i ham redo the appltratlpn mId ate boat me sate Imm�nadon IB mrtat I agree m mmPy wiN a0 a'IT mW
Clear mnmlcesand tam laws e" fo aagwft nalaxbma and hendsy auTnds retheamobvm t fhb blunt( M
Clear upon the shore mmmmed PIWeM la mapectim pmpaaes
iIEE N _
............ ____ i ......._
MITUREO dOTEE MTE
APPLICATION DATE"", 14 PYC#
ISSUEDATE 91�4/SIN PERMFT# l'i't `1?-I`"'I j
TYPE CONST OCC GROUP '
ZONING SETBACLSS i
RW ❑
REAR ❑
SIDEtSIDE STREET RW ❑
SIDE ❑
-ElFRONT
PROPOSED USE
# DWEL UNITS #STORIES # BEDROOMS
DESCRIPTION
SO FT
FACTOR ESE
ADJ AREANALUATION
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL 7 I R i
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C '
ENERGY PERMIT
RETENTION FEE
PREALT FEE
BSAF ......
TOTAL FEES
COMMENTS
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