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CITY OF DIAMOND BAR RI RATER
DEPARTMENT OFCOMMUNITY&DEVELOPMENTBER I UI�sw�
] <_ 21810 Copley Dnve, Diamond Bar, CA 91765
(909) 839-7020 Fax (909)861-3117 BuildingIns PRESS
pDctaon HOBine FIRMLY
'ate BUILDING PERMIT APPLICATION
JOB SITE ADDRESS 9 c?
APN LOT TRACT
OWNER ILi ,Q •�L( 1'CC?
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APPLICANT TEL
CONTRACTOR
ADDRESS
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ARCH/ENG/DESIGNER
ADDRESS
CITY ZIP TEL
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, �FJI'T'S'.t�� DATES
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APPLICATION DATE t �F$'\ )JAI. P/C# —
ISSUE DATE "i) I�» PERMITp %a`iL 4�^` dry.-71e
TYPE CONST OCC CROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIpE STREET RW CI
StDE ❑
PROPOSED USE
R DWEL UNITS N STORIES N BEDROOMS
DESCRIPTION
$Q Ef
FACTOR, PSF
ADJ AREAIVALUATION
SFWADDMEM
Gerege/cerpon
in
W
Pa1W0erk
LL
Pouspa
ZRe
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9
5
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Valuation Ad} Amer
QUANTITY
DESCRIPTION
FEE
w
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of
it
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETEN TON FEE A- Dice
PRE-ALT FEE
BSAF
TOTALFEES 1r ptd_.
COMMENTS T'
RECEipyo adi•1(� VALIDATION
)AnRTE—Dapmtmary Copy YELLOW — F3rence Copy, WNK —Assessor Copy GOLDENROD— RIe Copy GREEN—AppWard s Copy