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1WCiTY OF DIAMOND BAR
DEPARTMENT OFCOMMUNiTY 8c DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com buddmgAdiartandbarca.gov
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OWNER�MLO iDECLARATION
I tareby alarm Meta gmmiN of gaduly Net I or, assort Son Hm Contractors Stale Lareme Law rar the remains)
Mlceta0 below by the mm aro) I Sawa Plamd aid 0 the makable Person isesse N 7=3 % HlmbmNe and
Rok® Cade ANY City to M MM regeeaa a PPmdto cm*bW. alert, IM Mw, dwwb* at raw. any
MMwMue, PAw to Nl a aMa am Mae*" Nm exthoent tN on P ft M file a elated am we or she
as Iamead ParaueW to the of "as CMubacki SRm Lc Law(Chapw at cmmwmm *in SK O
70M at 0abmin 3 of Rm NugN wW hot9a9rontl GeeejtoMt try or Mre b exempt imm lrmsum wffi Pa tlMN for
Mealebodie ernman A.yvoAUaf Smxun70315byany apWkam#apamH aubiesa Neeppgaadioamvq penalty
c4t�mim wen lNe nuliMe]adars;a50Df
!; EJEeamrrloralmaprgwrtre
ewMedWSySynon
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arm me IS and IX altered # e
(wbo i0aa resrwsa ant Pmtasabfla Caw Tire
Ca
om nw Law
Cmla Stealkense Lea ass tact apply Poan owner re p in M pea adds
iirdtwoanpnyee
of Intywho
or. o emaromments arenot lder" er 9 , A y bO Or
'.. arimmnW iSoldouy,prmmyeed wef tspieW,
dathaan
Meedffirrat nna Met
Imlrre�tmm in Sold wimin arm y�rdcampleAMt, Na Uwrer BupderwNlswe lire aatlaiWpmvtng am Him *dbtdA
me butt
or mory"d V the plame of Siva I
Ul, as mwnw of Ow &many, rum m Wwyaty IsmBteran won howand CmAmvw; m ore" Ne Pr6beat owsheen
70M mashoo Am RN9aabla Colo fin CQMS R Slate Leers taw des rot apply in an owner of annuvey rare
builds or Impto+ds CNredl, and who contractsfa we W*ttwiN a Prom Conifer pursuant to the Contracia5'Siata
Lkaiaf law)
. U l an ea9lnpt from mAmura under a*Camw*u$taca Dcasa law Am the folasomg resme(s)
By my signature bmaw l suba"wee me, areepk# any owner mslderae In wtacn i must Asia meW for at least we
year lmor to connuartn of tho rrdaaemeda crowed by tas pamn l ranair Agatfly Set a 3ttWW Hsi I hers built ae an
! owner bustler I n nos not tmwr Colalmded In la mmm y by donso d CMsecam i undwaare Hat a copy of the
antra law, 5edffin 7044 of the Baamas AN Code a erdable upon repa.M avian ads SAAMSI Mi IS
Dammed or at Me Me" Wan ale MoVorew te0aa toImmems html
EWEN'SED CONTRACTOR'S DECLARATION
I Penalty afimantler armay, of Emery Met l Am hermseel uMsr Wwimw of ompffir 9 icMnmisorm won Seeikn 7000)
of Dhoom 3 of toe B ralnCsa ant PmdE^..aipte Colo and my Areas IS In tug force and elRct
t)CENSECIASS e IJG ND R �
DATE t ! COMi.++`....
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'S n E1xAMTMNRATNNI
I HEREBY AFFIRM MMER PENALTY OF PISMA YOKE OFTNE RJUMNING DE{RAFARDES
...__ I he.n wffi our manlan a CoHfloo, of Consent to Self-mi tM Warkera Cempensadon ae mmelded by
Setters 3700 at Me Labor Coda, to Hw paamlawo at Me wok an *Ann She permit is loped
I has a#teat nerAe r, wadtersQxroareaka Inumbrca, as 2wrod; by Sions, 37W of Me Labor Cow kr
the perbMweadNe war NrwnahiNsparmdw lssuatl My WOWS Cmnpaess]an aeurwaeGxda may
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bmmne wb�bas WMYtt'e CasNaaalkln lased AU ag�Na el slvJd Oemma sugectffi tls Waters
[amp+eresllm As�aaSacam 370Dofaa t'asA IN�WmawW�OMnPN wgh Ol¢e ryvtriuVe
GATE / APPLHXdti _..... .. �pr�—'"�sa���
AMPOSAO slum to secure Wmkx a Car neaMm rardmpa la unM mm snail wblect at e M UMOSl
Pamnla9 and mil Anew an to mm hundred nwuaand mono bil(loIX%y,, M amltlon to Me one of Ha [oiircensabon,
tlalm9ea89 provldetl For ln370R of iha labor MWa rien#t. w�dat�noy'BaeB
CANSIRUCTION EENONi6 AGENCY
I hereby afnml under Paafty of pares maul Oar* I5 a Consrndm Tenting Atermy # the per(ormatme of as on for
*too thin Permit is Issued {Sac 3397, Do C )
LEADERS Nbaff
LDAtER'S ADDRESS
Ipalffiy reef Iltam read Ana dpPlkedM 8nd fiaH die iM BboVO N#nlmion a Larem i spas a cgmpep wpN ai CHy apA
antl ate laws mr*Iq ffi Wlkmig mnetrilesan ant AfelebywD�[e!eaemaatlua9 M tea omngffi
ems upon ea a6me manMnetl propMy# 05p2Ctlra11 pappsae
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PERM NIEM
SIGMA DA +
APPLICATION DATE
ISSUE DATE AZ 1/ PERMIT#
TYPE CONST
P/C#
toll /J-- 4d
GROUP
Swine of Work .......... ._OCC
0DWEL UNITS #STORIES
AS BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
AOJ AREANALUATION
SFwADD1REM
GaRge/Carpon
Patia/Deck
LL Peo45pa
.._
I Ro Roe'
d I Comnermal
mI....................
verfnestNon
Pull Area
QUANTITY
DESCRIPTION
FEE
HIS
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Q
CONSTRUCTION
PLAN REVIEW
..........
ELECTRIC
PLUMBING
MECHANICAL
�
L��7'
INSPECTION FEE
ISSUANCE
.__
SMIP
ENERGY P/C
ENERGY PERMrr
RETENTION FEE _
PRE-ALT FEE
BASF ........
PLOT PLAN
..........
A
Lt. to
ZONING CLEARANCE
TOTAL FEES
COMMENTS
/FEE�7i
1F' W r %
�...........
PIC wy 'y PAID BY
RECEIPT N -_))- PAID BY.,�
VALIDATION
VALIDATION
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