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CiTY OF DIAMOND BAR
PARTMENTOFCOMMUNITY&DEVELOPMENT WICES =
21810 Copley Drive, Diamond Bar, CA91765 PRESS
(909) 839-7020 Fax (909) 861-3I17 Building In9pecti on Hotline (909) 839-7027 FIRMLY
�"'" BUILDING PERMIT APPLICATION wwwronyofdeamondbarcom budding@dismondbarca.gov
JOB SITE ADDRESS
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DESIGNER
ADDRESS
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OWNER -BUILDER CEMWTICN
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UMMM CONMACMRS DECLARATION
I hereby afmn under Omuty of penury Net I am eceMed under pwmlow of Door 9 commix'&¢ wear Soetlun I'M
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DATE C9NIMCPoP ..,—..... .—
WDRIOR'SCOMPFNSA �LARATiON
F HE�Byt .M 11NOEfl PENALTY PEiUUflY ONE OF TIRE F4 LOWMDECIAMTIDNS
and will mBkrtaN a ommN of comers to Ser4wers On WPAPYa r4mvenoWn tsa PrMwd by
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d urstme as FravMn form I staQt 3=at Uw labor man, m me, and&mnays Yes
CONMUCMN LINGIND AM=
I INraoyallnn under penally of pek+ry Me More la a COn9hupllCn Usio m Agancpmr Me pwaAmeRUe N the work for
WhO M Pone IS amid (Set 30(1 qv C )
ABDSSWME
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enter upon the flbaw meOMM Pmparly Tor fius cmpun e
FTMdITfEE NAME IPRMR}
$;GNATURE OF PERMTEE
vyDATE..........--
APPLICATION DATE ii rr77 _ C1R _
ISSUE DATE — t 3UI 1
/
TYPE OONST
Scope of Work
R DWEL UNITS
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?D fJ �+"-
M
R STORIES
Y COIL
A BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAAFALLIATION
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QUANTITY
DESCRIPTION
FEE
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55
5
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
e
INSPECTION FEE
ISSUANCE
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
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TOTAL FEES
COMMENTS
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