HomeMy WebLinkAbout16-2725CITY OF DIAMOND BAR
4wDEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 961-3117 Building Inspection Hotline (909) 939-7027 FIRMLY
BUILDING PERMIT APPLICATION weew.cityofdiamondbarcony building@deamondbarca.gov
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OWNER BURGER DECLARATION
I Milan ahlm liner penalty of perjury that I an eaempi hied the CDnhaaa'e Sims LlGaree Law W IRS reawN,df
Inakdow alm try Ole d urnmarkno I here paam rest to Pre apolmhle 11900 ISwmn mI &Okm and
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UCOM CONTRACTOR'S DECLARATION
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WORKER'S COMPOISAR04 DECLARATION /
I HERERYAFFINM UNDER PENALTY OF PERJURY ONE OF TIC FOLLOWWG DECWIATIDNS
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POLICY NUMBER _
fries SECTION 43 kW BE COMM IF IT PERMIT 0 FDA ONE RMFED DOLLARS $1DO ORLE3S)
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—APPLICANT
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LENDERS NAME
LENDEIM ADDRESS
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tEE NAME 1PnNii
9CaNAitnE9F PONAIRFE �' '1,� DATE
APPLICATION DATE u C z--81 to PICIN
ISSUE DATE "i l i) bI t" PERMiT11 ...... o�ii
TYPE CONST OCC GROUP .....
Scope of Work iiYl qC' i"
N OWEL UNITS A STORIES A BEDROOMS
DESCRIPTION
$O FT FACTOR PSF
AOJ AREA/VALUATION
SFFVADOMM
G&aaWCBrikua
POINVINKA
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PrwpSpa
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Pt Awl
Cammacui
03
"VaftCWr
Adt Wes
OUANrtTY
DESCRIPTION
FEE
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f/1wj
LEA
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CONSTRUCTION
PLAN AWEW
ELECTRIC
PLUMBING
MECHANICAL (caL . taR
INSPECTION FEE
ISSUANCE +ate . it
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE _ Ors.
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES iC3'�, -+3
COMMENTS
P/C PANDEPY VAUCWnON
REGOPTA!2w'4'�PAIDaY J2a2o4ta VALIDATION �'v