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CITY OF DIAMOND BAR
i DEPARTMENT OF COMMUNITY& DEVELOPMENT SERVICES
21SIO Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax. (909) 861.3117 Budding inspection Hotline (909) 839.7027 FIRMLY
v BUILDING PERMIT APPLICATION wwweityofdiamondbar.com bailding@dtamondbarea.gov
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of ONN 301 ON [WamA mid Rroisenmm Code] of that he W 64 IS O of ironIIWneum Me UM bail$ fry
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or Improved the property awned that the archro mean as nmthdended a offered far Meer d hawevet, the hehing a
improvement of KW wttnn ale year of Cempnlbn, the Owner B eider tell have the twoo t W prawng that If Was na OWIt
a IImproved for the wSpoae of Saw I
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70a Bb mou and FeAmmone Cob The Cmn9da8 Sant LbraOaa Low gage not apply M an Dever of Propery who
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wmor Ditch if It Imo rot been constructed he W ebony by floreed CadhMan. I waeroWnd that a MAY OF the
OPDlkaWe law SOCIM 7044 01 the Bmkws§ are BatWSbns Code N oreamd Roar agen when this app9bMOn It
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UQFNSED CMTX4CM'S DECLARATION
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WORKER'S COMPMUTM OEMARATION
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—APPLICANT
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Thal I fern raga IM apakalkr, and Sine find the above Mamma mir B Ntrect.I Van to mnWy with ml ease
camry adinancea aW nett anal relating to bednq C*4hMm and hereby dubadm taprmerrtWwea of be canny to
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PftRNTT EIPRIN'}
DATE
APPLICATIONDATE
ISSUE DATE
TYPE CONST
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__PERMrr#
PICO
OCCGROUP
Soopo of Work _
0 DWEL UNITS
A STORIES
0 BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
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Garaga/Carport
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DESCRIPTION
FEE
_QUANTITY
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
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MECHANICAL
INSPECTION FEE
ISSUANCEO
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PIE-ALT FEE
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BASF
PLOT PLAN
ZONING CLEARANCE
TOTALFEES
COMMENTS
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RECEIPT a PAID BY -f��
VALIDATION
VALIDATIDN�
WHITE —Department Copy YELLOW —Fmome Copy F4NK—Assessor Copy