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.- CITY OF DIAMOND BA
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
`' 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
�,, ..y (909)839-7020 Fax'(909)861-3117 Building inspectwnHotline (909)839-7027 FIRMLY
�' BUILDING PERMIT APPLICATION www.cityoidtasiondbarcom baildmga@diamondbarca gov
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OVM]It- UIMERDECIARATidf
f "By am. Under parody DI gap0y Not I am exempt hat the Cadmda'a State LIMMe Lew her the rea5onel
indicated Mon, by the eAakmenls]. I have placed nos to the appilmMe Itomee] ploclawn 70314, Roalneee and
NoWmima Casa Any MAY or extent ma rages a permit to cambuat, ago, mrDtm, deffil in Noun, any
abrr0aaa, prbr to sb iv,. also ne guima ire epp luantfameparmo to DIO a vanes statement that be a ehe
w bmaetl psvrvrt tame prmgkm amp ConbaoM's SblallMmo IAwlCheptar HI COnlmmolrgvN Ssdtn
iDW d Owoml Dar taw Blgbleae tad etM9abm Guile] ainat he a ehe g Byempl iron IlceMurOaM lye been for
lye agegedesemWo, ADyvUaft olSKIbm 70315 bywy apMlcant Wr a pamdt mb]ab Uw appAcmt W adW p"ty
d Ito eve man five hwisredtlollare{0aq
U 1,eaaenern Rre prapeNy,ermt anlNa/eeawithwades AN Deobcampen am,wan AM
CARD The
si the was, tors the m Urn o rwi eWndes a dleeea An CdIB tty who 70M BOdnvs eM nit l i Cane The
Caempas'Stopo" Lae sues norwpmben mwnerdM Me Intended
who WwphlmpWet 0g verNrwiafbulk Man
aenproee Wepro"proves NdfiMpleW theme LBcosIM vAldmatered Mebfa th i ingtherfer Nora" a
orrrumnent radswads of tearatompgsan Ne Drmer-&IHOawle Egad Me hudlnaMoagawtdwas ry WIN
a Improves 7a the RuroWe a sale)
U 1. a9 owner of the property. sum exchis ly eeeindong win MCm wd Co nneaora to apMahC1 Me p" (EKUOn
7014, Budnm ass Profeavons rode The Cmtuctas' Stab Umm Law sae vet apply W an owner of am" v fw
No00a Improves thereon eM who cmtralta for the Meseft with a ttensea Cages, Amount M me Coolmig 'Stria
Lloanse Law)
U I am exempt from Rename under the Coantn(sState L cane law tofrt o0ofiind reforo;
Date Sign_
By my dgnatlue below i Acknowledge ME enalptlot my, pvamd ndrines In wNcR I neat herd MOW to at Woe AM
Year pear Wenmplam at the Improvements Devoted by Cm pernitJ coma bean of a eimcdao Nor I hint dues aan
barn Mine, If It he not No carrffielad in Its emrety by acercea ttaaaztdre i Veist" Nit a copy of taw
applicable taw SecUOn 704/ wl tin Busnew Ltd Prderbne Gale to avalable upon Nudes what Me WOmft to
wbMtled a d lye ttlioNnp web ode a@hvwwdapnMoa gOvllLaw nbN
BCOW CONTRACTWt9 DEWMTHM
i aNan WapgltMyarvyfiNaliam hEmesurdLpmHgawdiaapkfH wan SacU0n T0DN
d Ltlwdco 3 d Uw Budnem Ltd Prdesaiag Casa awl my/acamObN adbte awl oRad
I CLASS tICND 'T=+�l —K6
DATE CWMAUOR r E
AAmaiITSC� 710 dARATIt�
I AFFMM UNDER PENa1.TYOF PERJUM 01E OF TIE FOtLMM DECLAAAMNS
i M1ave eM *it Manville 0 ferbA Of CwaeM to Sot again far WOW a CWPl AWM, as prarWtl at
Sea!ou Urge at ON tabor Calk, foram pliffennams of pre wale for whloh Nis pMmH in beta
r�r7mveLld wi6 talons Wmiv'a losutenca aernitl tlySectlon 3h10dths lzaaCoae to
Nor �rtoral0ne dHt watktawl�rNg Pam[ g Isales fey Wdka'b Catnf800eMRn xgumMa Oartgr 0M
CAREER
po is
Ron%:lM NEED TUT BEfAM1W.IM IF THE FFVM IS FOR WE RMFED D XLW Stop OR LEM
I MIII AMWharnace of" work AN w"ftperiod isLmet.Isend mil em keyarlypaann any ran tab
A&W An as, Worker's Compambor Lawn at CMmtL AM agree Nat M I a beapnea lad Wet Workers
Dragomen aaAYm of Serme Tend Nor Labe Cade I Me ba Do" rNee Pottle,
APPLICANT
WAWSMSG fa" W beaae Wakar's Cola� coverage Is winM and did Woµd 0 tllpsam, to wand
pwwfgs and dal Name W W aw tnm*W a d dogan 4100 GOOF in 9tdidon As lye crA At CAN ampensLbn
darough,am lded to In eacdar 3709 at AM Moe, coda varen. sod aWmey'a foes
C N STRLICnmf U]IDING AGENCY
I seem ender pagey at ganury, Nat them a a Coneeedlon Larding Agency la the performance of the was fa
which Ws Dome IN bound too YAi or C i
LENDER'$ ksA'E
LENDER$ADOrf$$
I VeMh Met i two mad Nn applRaboi and AMR MAN the above ,to... Van Is =ad 1 agree to carmy with all elf eM
Nrlmances and laws totalled to huadng casimcdon awl hereby Authorize nrd"ordhes or We beauty to
Rotor Woo IN NAM mono ed paveNy for kgpauhco purp®a
17 =A» MC"
;EERAME
SIGNATURE OF PIVADI DATE
APPLICATION DATE 7—
ISSUE DATE .2— a
TYPE CONST
`1
PERMITO _Ache-1rr
P/CN
05—
COD GROUP
Scope or Work
urnlionrn
N DWEL UNITS F
OOMS
DESCRIPTION
SO FT
FACTOR PSF
ADd AREA7VALLIATION
SFWADD/REM
GenOa'Carporl
W
PDIgIDeCR
PooVSpa
ZRe
Roof
Commercial
a
m
Vaimatt*M
Ad] Area
QUANTITY
DESCRIPTION
FEE
w�w
C7
CONSTRUCTION
PLAN RENEW
ELECTRIC
PLUMBING
MECHANICAL
6
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE•ALT FEE
g. Lan
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
! �'
P1C ?J PND BY( �TKKv
At1079 _PAID BY t yALiEUN
WHITE— DepartmwtCopy, YELLOW —Finance Copy,—Asummorr Copy