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CITY OF 1 AMOND BAR
DEPARTMENT OF COMMUNITY & VELOPMENT 2YICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) $39.7020 Fax: (909) 861.3117 Building Inspectmn Hotline (909) 839.7027 FIRMLY
`eta" BUILDING PERMIT APPLICATION
JOB SITE ADDRESS z 1117D 41.1A 4,cu_ ",h r _
APN LOT �-TRACT-
OWNER &h Y+% Gil
ADDRESSRl177 COW
CTY_.._MZIP 4.17 TEL xnMrM -712.3
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CONTRACTOR '
ADDRESS
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ARCHIENGMESIGNER
ADDRESS
CITY ZIP TEL
MANERANGUIER 9ECALMATON
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LICENSED CONTRACTOR'S OECLOJLM=
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CARRIER
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CONSTRUCTION LEADING AGENCY
I hereby Mam undo teary of pa{ury Cat them Is a CmusuWan Lending Agency her dw orestown of the were for
warch the an" Is warned IW 3097 Ck C)
LENDERS NAME
LENDER'SADDREM
apmEmbxl and slam that the news er esnra0an Is correct I mNty endurances
l eve wad drle agar m othmer wad all cry end
son the o pan 51Mmosur bus mmhp aa bmpor gat prT a assden and hamY/ aumaae mlaemMadrm df tho county m
tar upon the rebore muted property txlmPectlt Papoma
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PERx`ITTE E(PI11NT)
SIRdonflUnDIF P51 DA
APPLICATION DATE O i"") I
ISSUE DATE Q Q MIS ....,.
TYPE CONST
Wt S" # PJC
PERMfT# PF-k 5 - N
I
OCC GROUP
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ZONING SETBACKS
FRONT
REAR
SIJOE/SIDE STREET
SIDE
RW ❑
C
RW ❑
❑
PROPOSED USE
# OWEL UNITS Is STORIES
I
Is BEDROOMS I
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAANALUATiON
BFWgpI'M9EM
CtoaDa/Carpoa
"kVD ck
FVPVSW
(uW.
Z
A. Roof
CrormT w
Valuaiaka
Adl Area
QUANTITY
DESCRIPTION
FEE
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CONSTRUCTION
PLAN REVIEW
1
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
.3 3
SMIP
ENERGY PtC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
Z. OO
BSAF
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TOTAL FEESy4f1C}
COMMENTS
RECFIPT#_L4� _ PAID BY
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