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1wCITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & Dh;4UOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 861.3117 Building Inspection Hotline (909) $39.7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS ___....___ ..........................._
APN LOT TRACT
OWNER M Mgr
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CITY P TEL
APPLICANT C
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CONTRACTOR �57
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CITY ���] y�ZIPI 1;?Y( TEL CZ0 32-7-110
ARCRIENG7DESIGNER
ADDRESS
CITY �. ZIP ..... TEL
OWNWHPJLDB DEMARATM
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;lotto commuttlon of the improvements comm-0 by this permit I cannot legal star a ehuclure that I ham built as an
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My w uuOan 70mm of the Ontme; and PTchimp0rm Code a avellable open request wten this application is submitted or at
the Ml Nylm Wsb die MlpMww IBgIMa ra gw/caawhbM
SIGN
uCOM CONTRACTOR'S OECLAMTION
I hammy Made urea penalty of penury theta lam hpMWEd water pmxticm of Chapter 9 b anmmWg wM Sahar 7000,
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CN7&MMMNLMMGACENCY
I hereby aRern under Iwmy of panel, that mere is a Demanded laming Agency for Me portom+mlx of the wma for
wMth the pereat N mind ISO, 3097 D, C I
LENOER'S NAME
LEMOER'S ADDRESS
I cony that 1 he" soup the adMicObon anti Itam that the above Information Is correct I agree to win" WO all sky end
aeinencem and ma , laws relating as bullied communism and hereby toaanlm re won Oyu of MW county to
a tiro acme}gelhmal prop to, mildewed papoma uCCar 'P+t V its V`"�•''4'+4''1
SIGNATURE OF PERMRTEE DATE %
" hmsol`mCC men r
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APPLICATION DATE PlCN
ISSUE DATE t11 lL Lf PERMIT# /,r- 0)1
TYPE CONST OCC GROUP
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ZONING SETBACKS
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PROPOSED USE. {
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0 DWEL UNITS 9 STORIES Is BEDROOMS
DESCRIPTION
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FACTOR PSF
ADJ AREANALUATION
SFFEADDIREM
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QUANTITY
DESCRIPTION
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CONSTRUCTION
PLAN REVIEW
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ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY PIC
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ENERGY PERMIT
RETENTION FEE_
PRE-ALT FEE
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BSAF
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TOTAL FEES
COMMENTS
RECEIPT a — AJ__ PAID BY VAUDATCNI
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