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__ m!!±.... �� 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
'°$' BUILDING PERMIT APPLICATION www.cityofdtamondbarcom buddtnggi tamondbarca.gov
JOBSTEADDRESS 7,z-z t/ e4ol/
MOM L47 �— TRACT
OWNER Yu1f7Jtu Lill inf
ADDRESS
CITY ZIP TEL - 7117-ZW
APPLICANT TEL
CONTRACTOR
ADDRESS •'/1 l't LZVC'
CITY Whi1011 ZIP ✓ TEL 1-
ARCHtENG7
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-SURDER DECLARATION
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LICENSED CONTRACTOR'S DECLARATION
f harebywth m under penalty of gOury that I em nothing under proaaona of Chapter B (or mmoing will Seclbn 7000)
of Dlvlmon 3 of MeeLBus/ftu aim alone Code, ew' malign IsInNO fame go eNat
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DATE � Y CDNTRACTOR
WORAN S COMPEN flATgN .... .........—
INEMMYAFRattUNDER PENALT OF PERM ONE OF TeE wmMi0"SMN1NS
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DATE AFTLICANT
WARNING Fmlure In m e Wooers CCmpar ul mange a unkwhi, end egd sped em Milega(Br m chmhal
trades and dwi free up to Ow hundred Mwwd Eder (SIOOOOOL In amdOn w Me Cat of NO mHnponapon
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CONSTRUCTION LENOINO AWKY
I hereby am= under perms, of perjury tlnl area Is a Co mineli en Laming Agarry fen me 00ft 0 Of the work he
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LENDER S NAME
LTNDERSADDRESS
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snNA DATE
APPLICATION DATE /1yi 7
ISSUE DATE 'A AIN 11-T PERMIT#
TYPE COAST
P,'Co TC` a
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OCC GROUP
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Scope of Work 6els,h_ A.�
N DWEL UNITS # STORIES
N BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SFFVADDMEM
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QUANTITY
DESCRIPTION
FEE
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A�F/!AA iN
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CONSTRUCTION
PLAN REVIEW
SO aO
ELECTRIC
fs %
PLUMBING
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MECHANICAL
_ Ti{s • 4'is
INSPECTION FEE
ISSUANCE
1,0�4 • 11.0
SMIP
................_-
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
....
TOTALFEESa:1r•
COMMENTS
3S
P/C +� PAID BY _y__ VALIDATION
REMPTa �S71-3 i T PAID BY VALIDATION
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