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n.� CITY OF DIAMOND BAR
_ DEP.ARTMENTOFCOMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
,.. (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline {909) 839-7027 FIRMLY
w�' BUILDING PERMIT APPLICATION www.cityoldiamondbarcum budding@diamondbarci gov
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APNLOT_ TRAGT
OWNER C"I
CITY V y c—Hf nA (.�. 607...L'Z1P�+
APPLICANT TEL
CONTRACTOR 6-^ € 6 t ("' `? y y a.a k* C
ADDRESS IE,17a-'
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ARCHiENG/
DESIGNER_
ADDRESS
CITY ZIP TEL
OWNER•BWLDEN DEMARATM
i I ramps, Marc, new banner of Ni ON I am exempt ham the CamaCiR 8 State License Law fair ON rea4orRs)
below by me Chembnatk(B} I have traded next to the ARAICO to drama fSeObOn 70315, BP0m0as aid
ftl�Coft Any toy a camtY Ntatt0ANR0s a peYmii m tamDmxt, offs, anPleve, tlWmlMt, R y�ae, WYy
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ftc Wacar's liar tlb pRmtth SehDiretl SlammMf NlBblle Or ihB
'.. nlbelmadpumhmlb am plMlBNn4d4Nre 60nh80mY'a SletOlrena law (Olh�ter 0)Cammenemg WlRs$tlaaah
al DWrmar30f An B oaten ofSa Cam virke haashe BB% ubratmnl4 plecannto ANNpe6tM
'maaikgad essmpbm My w0lallondSW.Doh 703; Say am apPeunl fora gamut sugeUT inesWaMantbAatyN penalty
Of now mine+lien Pya hU!xa'ed Oallele (S5�
U f,aa ew rWtftpropeM, army employees with Watmasthelr sole CDmpeiammn, NIMU WO at or U ponfma
Of the Work, mud the mnscture N tam Intended Or DO" for eels OGeotm 7044 Rdw� aw fyate mom Code The
COnbamors' State License LAW Man rot Apply to an aWcerd propahty who mrouph empgyaes' m pWmnai ONpn, Umipm
or Improves to pramp 1 prowdtt' AM the Improvements pie tam mended or offered tor Move It hareem, the buOdlnP R
hnRmvement is sold'MNs otm year M completion, the Dwna mwder wil have the burden at prow" the tl Was not bum
R h misread far TO papose of see)
Ui, in swot of Inc property, a "cluawmy cummummg wen huread Cantrucime to rnnmuct Ore emitted Odrn
7044 Rrsbwss and Prohnimsltc Cods This Gonbndam' State Undow Law dean mt apply to an ochre! Of Rq>orty who
Y MMONO MOTAM.ad Ann Coconuts for ma prolems with a h Conhacto pursuant to the CRthapmm'S4t0
Law )
tIy66 elt�pi^ fmf prenbyreun the ConbadOrb Slats reaeap(a)
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By Iinj S�gnaONe bemvr I acknowledge that p%fapt loC m/ personal raHtlgTe th whNh i mutt h8r0 mBltled far m b09t One
yemJyk4wcompallan d:mE ImplbreflNn(4{d4ted byONa p0mllll caM01 bgatysati a 8M'Cfi1R mall have aut ae an
bincer R it M Ydi been consatiIXOd In is entirety by IK9n80d corn W3 I N1dervard mat a Copy d Me
aPphi taw Section 7044 of the 91.'airess B(d Comr Is rin labieMov; Cabinet When this sp knifl On Is
submitted or atthe)dbwingWeb site hall"m firi Oa Mclean, Hart
uGENSED ODNnUM S DECLARATION
I hereby Ohio under MWty of Mary that I tam hcR+sed be*,prevtmas of Chapter B lrearmehahg Wei SWIM 7000)
At Di 3 d Me MuMarns, We RCks Code One miry N1��mye Isir NO force and effect
t7C"CIAS LE ti0 =1 `4 'fl D 9
She DATE ? LcK ?acrOk 5o a-y,4e A, a- bra i tea r
WOANEA'S COMPMUTiON DECL TON
I MMERYAFflFW UNDER PENAPYOi PEFULPY ONE Of THE FOLLO'MNG DECLARAAOPS
_ i have and will maxhtam a Dance le of Consent to Sell leisure to Workers CompOnsatlan a0 "Won by
f Sw ten 370001 the IaWr CAtle, to ilia pafamanca of me ii tw whkh tan dent is ImAA d
V Ihue And%it maintain' Audi s Cmnpenscor hm&Nemee as nagArtd by Section 37W d the Labor Code fix
mepepoory,
iNamed CARREr r lAe /work kr wdpcJitiN pefmd L959U8m MY WUW.n SConpHL4abai neUin]
nCe CBRbtad
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POLICY OWNER3ni33-
(IIpSL�rEEDlATRECOMPIETEDIF r)EE rLSFOAOtk HUNDWDOWAFS LIDO ORIES!d
Iumtytsul Ipe ins Porto AAWO(%lthewakhXwLaw misp aimrod!aba0 tad ampkgdma=Tmnderymmneteoa3m
COWWauODn th b of Secm37D dMa L]WsdCOafoWA Akre Ares mad it1shouitl bmcane.oMdjectloins WaMara
h RNmlwadSdthah 3700dme Labs Cade I ateB lRdmith opTNiYwim mine RpA^Lms
APIP RANT
FmAme In secure Work& s Course nbation uvemgo Is Antonio mid s'.ell subject a1 VrOD x to o4neml
peraWn and owl fins up th over Named thousand dallem LBI00 OOC, m admdml to the CAN of me Bpn
dflmape8 W pm#tla0 farm seCdon 37� ddW idtAt cads interest and aaWrmyefees
CONSTNUCFWN LENDING AGENCY
I h" epkm older penalty At Inquiry thm there At a Ocientru(aon Arming Amandry tar lore pedm eR V. me ware to
7daR,nnN I§IUUeO EGac 3097 Ce C)
LENDER'S NAME
LENDER'S ADDRESS
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adi Meabve 9UJelaws rropery fobwera eM btteby pNOPlfie (4WesevteD+eautmle county t0
ankl�upo�n,m/e o3o+C r�ii((C��VAenYla lnaPeCkn
MS YOF PCRMI1Tff PATE
APPLICATION DATE —7 t
ISSUE DATE -T %\ ) I in
TYPECONST _......
I t td P!C#
PERMIT# 1a*71 16 — M
OCC GROUP
$'4-
Scope of WI
# DWEL UNITS D STORIES ... of BEDROOMS
DESCRIPTION
SO FT
FACTOR FISH
ADJ AREANALUATION
SFPIADDIREM
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PatrotDeck
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QUANTITY
DESCRIPTION FEE
Aft
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL'
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INSPECTION FEE
ISSUANCE
3td
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SMIP
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ENERGY PIC
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ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
..........
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ZONING CLEARANCE
TOTAL FEES
COMMENTS
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MAI
PIC PAID BY VALIDATION
RECEIPTA 906 qb PAID BY VALIDATION
.._
WHITE—Oepmsmenl Copy, YED.MV—Fnwm Copy PINK —Assessor Copy