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' CITY OF AMOND BAR .
I DEPARTMENT OF Cf1MMUNITY & VELOPMENT IVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 F= (909) 861-3117 Building Inspection Hotline (909) $39.7027 FIRMLY
'w" BUILDING PERMIT APPLICATION www.cityefdiamondbar.com buildmg@dismondbarca.gov
JOB SITE ADDRESS o7 3 SF 3 64546" 4 Dr ,
APN LOT _TRACT
OWNER Otl�U M1'� f
ADDRESS
CITY ZIP TEL
APPLICANT TEL
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ARCHIENGr
DESIGNER
ADDRESS
CITY ZIP TEL
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wORM'S COMPENSATION OKIARATION
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CONSn =nOe IFNDINB AGENCY
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do p7mk is leered (San 3D87 ON, C )
LENDER S NAME
LENDERSADDRESS
I Gray Net l here raw We ad we, Net ones wow trepanation is barren. I" k awmh WM am pry and �.
aMmnoed and ink town mpeng in bdlabg ceromN&oc and away adhod" rtvmntwm daps county, to
ante upon coo;; m specdoo Purposes
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SONATU— fi17E DATE
APPLICATION DATE /0 ^ 40 ^ r r pPIC#--y r+�
ISSUE DATE 10 +a I-7` PERMITS
TYPE CONST OCC GROUP
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Scope of Work �dYe. e'L; I7 %^'J
T7 S 0513
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# DWEL UNITS a STORIES # BEDROOMS .'..
DESCRIPTION
I SO FT
FACTOR PSF
ADJ AREAAYALUATION
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE of
ISSUANCE
SMIP ,2 .
ENERGY P/C
ENERGY PERMIT
RETENTION FEE r
PRE•ALT FEE
BASF I a
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
P10 PAID B;dZ:2t�� VALIDATION
RECEIPT# PAID BY VALIDATION