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_ .��'�`'*..,....... CITY OF DIAMOND BAR
~) DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
µ (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotbne (909) 839-7027 FIRMLY
taFw BUILDING PERMIT APPLICATION www catyofdiamondbar.com buddmg@dtamandbarea.gov
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WORKER'S COMPENSATION DECLARATION
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COMSTIWCTION LENDINOACOOY
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SIONATUM OF PERMITTEE DATE
APPLICATION DATE J? ZR • If I PICN
ISSUE DATE " I 2-q i r-)r PERMIT# 12 `i la4-i Cat
TYPE CONST OCC GROUPP]
Scope of work c o 0 AA.'+T. .0 /mI
# DWEL UNITS # STORIES # BEDROOMS
DESCRIPTION
SO FT
FACTOR PST
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QUANTITY
DESCRIPTION
FEE
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CONSTRt7CTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
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XONtNGCLEARANCE
TOTAL FEESrt-
COMMENTS
P/C ! PAID BY VALIDATION
RECEIPT a PAID BY `ASf'k-1 ks1ElBe_ VALIDATION _
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