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- CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
- ' 21810 Copley Dme, Desmond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 BntHmg Inspection Hothne (909) 839.7027 FIRMLY
BUILDING PERMIT APPLICATION w cityofdtamandbancom bnddmg@ducuoodbareagov
JOB SITE ADDRESS
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OWNER-9OIDER DECLARATION
I Mort, a4. arm Pewry, a pcpry Non I eon emnpt ban the Connector, Room Rome Lew for me reMbano
mancesd bem, by the Ltadaam(M, I him, ARM W m the Neamda ra¢) IRaalr 70H18, buebe, and
Premaeona Cam Mytay Psaonp thamgvxyao onmal m pmmmN4 Nmr, aramm, dMNpea, a roar, may
amctute,pga m B2 bwenw,atmregmrn OW taplment M Non �mAmAm a signed ammmerrt tlret ties mho
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a imt mm then gw lumr&ad dada 43'+PW
UI tatook, at thapam", A, Myeavelove, wimwagram"Mae wrdl()Attu Pmlme
of eon work and the ahicaaa is not intention or atoned to no Portion 70141%an, s and Palatinate Cad, The
Cdnefma'Sto I— Lima same Pro tmprm m Date 01 NopNbwWh iM *&T4"a!` Of pwmmiamak tons
no aaymas me area. Waald,d Jam Sam Ark At kw4od a aONad ON ou, O howomor, the u mre
orl"'a MidmmHwMlmemyeNa dN w9rwlr WtMepmda@tImNA�nabAt
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Lew I
Li I am normal form Summers mom the Caafter0 'a State Limma Raw Mon the mOawbP rremM'al
Date Sam
9y my sbrmre bemw l acNnmAodpe the, examl for my pareoral noWe+n In when lmuri raw resided for a own are !.
year prior on complallon ,the mon omeaa Prmte by MIA pemd,l LanrLmLmNy ma aLvamm mat lhew ban m m
mrna bueder If It Ion not bean consbu med In IN emlma by Paned aordladoR I undoamra mat a may at Me
andexhln bw Section 7W4 al ma Onto. and Promotion Cade b atNbNn i men "root wMm ERN "00mibn Is
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LXWM OONMACfOR'x DECLARATION
I Avon affirm not otelly of pePla male Am nsmed maker poetmm 0Omx mr 9 (commencing wtm Sedbn 70pq
aDhidmr0 a the IlrLme>lanl Praaadoni Cade and nrySmae beMN momantl algid.
LICBISE CLASS Bc Ito_ 9a Y R'
ONTEOP CONOWCOL
W0"9 MNPEWAto DECLARATION
i hE RERY AROWm LMER PBNN.tt DF POLUW ONE OF THE FOLLOWING OEdARATIOiS
I new eon wN motto a CMAM, of (tool m Se morem, W Wmiw'a ODMPambn, m pm.tase by
Samoan STOof Am Leat Coon, to on Pw1vmmnmr at We wok IF Mean time aemd a bared
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as athewmk �wtdlM Omapmanm N7Wmiar's GQ$commmawanw CNAdr and
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CAneembmemaabWaNSadon370DdOa LdOmDydk rnNdyalrwimrmplywmta�Pawt�s
DATE APPUCNn
WARI9nfi Fag n, to mmua Wads', Cooperation memory Is nmWd man earl eubjw am sm(tyer b Phnme
WMW And CM Form r to Ore removal ,hound doaam Nno) OR, be,dhber mine ode of At earmea dba,
ftn m Podded aw m emton 3709of" Alexander Immwa, andatmmt/afim.
CDMSTRLICTIONU NOOOAGEKY
i knob olArm under pmnato of perjury met More b a CanApopudn lending Agency MN the pormnnenme of the wark for
wMkh thbparmN la bsuatl CNea p097 Cm C)
LENDER S "1.
LENDER RADDHESS
ZIc d1yon1m; met mpMoon and ymm me AteemwlnbnneCa.^.baonectlapreelo memply mm el LdY end
ly to rdamtaonrordaEnUWAMIngwasautbn and hemnyaummtia mpmmnmtlWS of Ole Laram
ontsapca more rgonibnm PGpey Non mmponh'on payoam.
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APPLICATION DATE pkCE .`
1 ISSUE DATE D Zvi PERMTTA
TYPE CONST OCC GROUP
Scope of Work .�'T� f e
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7 OWEL UNITS ASTORIES AMOROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREA/VALUATION
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GeagaCarport
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Commercial
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Adj Area
QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION .......
PLAN REVIEW
ELECTRIC .............
PLUMBING
MECHANICAL.
INSPECTION FEE_
ISSUANCE
S• �'"%
amp
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
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BASF
......
.......
PLOT PLAN
ZONINGCt.EARAP CE
TOTAL FEES"
COMMENTS
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...........
Pic PAID BY VAUDATION
RECEIPT A_�!-_,-a PAID BY VAUDATION
WHITE—Depatmewl Copy, MLOW—Faunce Ou y PINK —A.. Cagy