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CITY OF DIAMOND BAR
DEPARTMENT OF COM M UNITY & 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 wwwcityo(diamandbarcom budding@diamondbarca.gov
JOB SITE ADDRESS
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OWNER—}.t".L'l.'a�E=7fGa.--.n/I. •-'FNsF
ADDRESS
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DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-SUX EA DECLAAATiLN
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of not mole man Net hundred donre DR5DM
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of the won, and Ne WUCWM w rw Intended a d*W M sate (Section 70R tmmm and noiesSam Cade The
LEnualaa' Sere License law May not apply to an owner of properly rate Nrcrph washyen' a pemaOl effort baby
or repress the amparty, pmMee Net to Imphysimenb are not Inmmed or opened for into If l owawp Me Wang a
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or improved fa tle propny of BaIO I
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year ale to confusion or to kproYw%xy, Cdrarld by the "I I mood "Wtf No asupdae that I Ewa mien an
owner adds ii t hoe set bW Cw4WW to 0 #*sty by kwmd ancestor i adaBMnd tat a copy IN fire
applicants law SOMM 7044 of the Brbbety end ft0oohn Cade Is ova.11W open Macau v mo appkabm is
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of Mason 3of ONSesseser am aCsea, and m ikn Is he tars addNa
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i HEREIR AFRRM UNDER PENALTY Or PERA7RY ONE OF THE FOLLOWING OEMAPAT04
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POUCYNUMBER 7
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(THIS MOTION NEED NOT BE CO PIRTED F TIE PERMIT IS FOR ONE MINORED DOU" $100 OR LEM
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DATE AR7IGNT
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APPLICATION DATE 7 j I S 1% se
ISSUE DATE \ 'S i 1 L PERMIT#"?
TYPE CONST
_ P/C# •"�"�
OCC GROUP
Scope of Work
a DWEL UNITS # STORIES
# BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SPWADOtREM
Caratwouport
W
PatldDecA
PodtSpa
2
Re Root
Canmwebl
Valuahtlaur
Adi Area
QUANTITY
DESCRIPTION
FEE
ca
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m
5
i
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
Stj �1'O
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE.
PRE-ALT FEE
C3o
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
p`IR'y, SZ
PIC PAOBY �+ VALIDATION
RECEIPT -�Ya$--Kt PAIOBY 4 >(-Saw vaijoATTONJIF-,
WHITE —Oap6rbmell copy. YELLOW —Finance Copy, —Assessor Copy