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' CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
— 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
,,,,� ,,,� (909) 839-7020 Fax: (909) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
�i°� BUILDING PERMIT APPLICATION www.cityofdiamondbarcom bmldmg@diamondbarca.gov
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ON DIA BUILDER DECLARATION
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LICENSED CONNIUCTOR'$ DECLARATION
I be"afem user pw"of penury that tan bmasd War pr ndsiam at Chapter(g3mment'A1g with Section TODIM
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WORILFA'S COMPENSATION DECLARATION
I AFFIRM TINDER PENALTY OF PERJURY ONE OF THE FOLLOWING OECLANATIONS
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DATE APRICANT
WARNING FaSa9 to Wants Rosetta Compensation Cassava is mNWsm Wee shop rendea an enartor m uawei
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SIGNATURE OF DATE
APPLICATION DATE „/ Z ,,,_ztOp i}P r# It a,, 'r`.s
ISSUEDATE 1Z I2 t PERMITN ! ESIIDS 2.t�y;g2�4
TYPE CON ST� OCC GROUP IOU
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DESCRIPTION
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW C✓' S
ELECTRIC
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PLUMBING
MECHANICAL
INSPECTION FEE
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ENERGY PERMIT p
RETENTION FEE
PRE-ALT FEE
S
Ce _ 10
BASF
7 OU
PLOT PLAN
ZONING CLEARANCE Aria • S4
TOTAL FEES S S" �'�
COMMENTS
t,;j E r 6
Pic PAto BY tQo
RECEIPTS "Atitt'C PAID BY '1 ' a 4
VAUOATION
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WHITE--Dapazplent COPY YELLOW —Finance Copy, —Assessor Copy