HomeMy WebLinkAbout16-16741)I,1510NI) filk
CITY OF DIAMOND BAR iff
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax. (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION wwwcityotdiamondbar.com bmlding@dtamondbareagov
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UCMED CONIRAUM SDECLARATION
I hereby, affirm antler penalty of penury diet I am Mattson uaM pmwWms of Chapter 9(cannNaXg who Semen 7000)
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WORNO'S CDMPENSA'RM DECLARATION
I AFFIRM UNDER PENALTY OF PER)dAY ONE OF TOE FOLLOWTM DECLARAIRRIS
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DATE
APPLICATION DATE -7 ( Imo` I L. PtC# "'—
ISSUE DATE �t\4itt, PERMIT# 'NZI, l'- 110'¢4
TYPE CONST OCC GROUP
Scope of work 94jrl t It WIWS at 2PY1
# DWEL UNITS # STORIES_ * If BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ ARE"ALUATION
SFR/ADA+REM
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION % wit a .. a. t
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP 1 c4
ENERGY PIC
ENERGY PERMIT
RETENTION FEE 00
PRE-ALT FEE
BASF Jp
PLOT PLAN
ZONING CLEARANCE
TOTALFEES c .}
COMMENTS
�� .-yAJ0 BYAUCATNON
( /+
a3 PAID BY V , V
RECEIPT SC.AVAUDAnCN 4;"N
TAFRTE—Department Copy. YELLOW—Fulatce Copy —Assesses Copy