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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 Building Inspection Hotline (909) 839-7027 FIRMLY
'°s"� BUILDING PERMIT APPLICATION wwwcityofdwmondbareom bmlding@diamandbarca.gov
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of not �mv man S'R rumored donate t3SCO
U I a a aware aft gepoity, or my wmWeywn WRN wager as Udr Able pampa%tab, wN1 do U all of or U portions
of the Wal. and AP sm,ctse 10 el iMmdn Or exempt for sale lordlier 71)14, Bmmoss and %9asNons Ohio The
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drimproam the property. Framed ern the Ww era h,amOedaakrat masaa Rho f,hMbWdnga
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I Improved fa lab papnd of am;.
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70K Busmen and PmWWom Code The Connctore' Sure Items Gw does not worN is an ovnxr of poy aR' Who
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pdarto complaint at the Impnaemems operated by me pemlit I a1i a shostme 1MI I have eons as An
parent dulder d it her hot boon romdrucad In ra eMNmty, by IX&Pod cranoetndm I usarstand hat a copy B Am
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of DrAdom 3 YiM Suldraders and Protestant Code, and my SCP'a Is In RON force end dead
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UCENSE CLASS UC NO 7 i
DO DATE .D CONTRACTOR n�.P �L..J 'rt A1i7f OE
WORM'S eaAipF Tm DECIARMol
iWARY AFRRM UNDER PENALTYOF PERAIaf ONE OF THE FOLLOWED DECLARATIONS
I have and wN oamMn a Comments of Consent n Sad PPa9 for Wahfl 9 W mpenerant, do pmvaed by
7 $�n3700of Me Labs Code, M IN podomsnceur mom vans for welch Its perm Is Named
have and WIN maintain WwYer'a Campenntlon hwrande, saturated by Sopan 3700 of ma LaWC4Z9 for
ma PATormenn NiM w/oiiskr WrlChmP PerTA by Wed My WIXeerh Campmxmat/lnfmrann ranardW
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POLICY MIMBER
OM SECuM NEED NOT BE OCATUITDF Re PEROT IS FOR ONE IAMM OOUARS $100 OR LESSI
I Donty, as m the petFanreace of the wont for wNci, tell Why abroxtl, Ishal has employ aj Parson Ili any meter in 9)
belabored warm a the Wdaa a Component Layer On CWWb A Ard agree Oat d I aaAN Daum &lifer! to Las Wxiona
WmpenaWon pvvAora of Sedddt 3700 of del UM Cade; Neat ex is fth windy, wth 0458 p,vddoms
DATE APPULW
WARNING FtlhPd or edam Wa te's Comport Wti Wmaga a unavtul, as swi inexact an a apher to o well
PoWM and CM Ana# to a as strode tMuaaM do®aa (BOSS 000f, Or eddlown be me east at as mmpandson,
dahm tern pannJad for in insider 3708 of iM labor body, Inareat andetlam4y a apes
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I hadJy emrm armor deputy of papery theft last# N a Contractors Lemmj Agency for TO portotiran".e Pf IN Work for
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LENDER SNANCE
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SIGNATNEDF --� DATE .........—
PPLJCATION DATE „a.,t r ,7, I Y PP�j/C#
ISSUE DATE � .(�k RMIT# Y i� ^ d ro
TYPE CONST OCCGROUP
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DESCRIPTION
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QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING i0 �-
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGYNC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
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TOTAL FEES
COMMENTS
P/C PA@ BY y ri VAUa'MTIC#v _
RECEIPT P �_ PAID BY _.,,]_i_i- VAUDATIOM AV—
WHITE - Dep artOtent copy YELLOW - Finance Copy, PINK - Annotator Copy