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CITY OF DIA IND BAR
DEPARTMENT OFCOMMUNITV & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION wwW.cityofdiamondbarcom buddmg@dismondbarco.gov
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OWNER-MLDER DEMARATNN
I hereby amml Vapor penally It fury that I am exempt how the QMmdm'; Slate Hiodm Law No the reasm;N
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IJCENUD CDN(RACICR'S DECLARATM
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WORIKR'SCDMPSkSATDWL DECLARAnON
I REAM AFRAM UNDER PENALTYOF PERJURY ONE OF THE FOLLOW4teGOECLAnARONS
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APRTICANT
WARNING Talus to more Wmmr's Componarche Cemmge Is Consul Cap shall mnndf ad Compact, to dempat
am not Alms tip b she mmdmd Dmusand donxs dp000DOO In Boom to ma eft at oW Compensation
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CONSIRiL MIBMND AGENCY
I affirm Cher p0hmy at PNNpy I" mom I a Cmsauctlm Lending Agency for AW pe Nona wpklm
cots parma la lee ed {Son 3007, DV C I
LENDERS NAME
1 5ADDRESS
I Dot l Now mad this ap OOM coo step mei the able hammatim a mea I Ogao to=0 with as City wed
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SIGNATURE i�rjj�ia
DATEiT—
APPLICATION DATE Z lP/C#
ISSUE DATE Z PERMIT# Cip L 1 `" -a k k d
TYPE CONST OCC GROUP
Scope of Work ...
# DWEL UNITS N STORIES A BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAAIALUATION
SFRlADLVREM
.........—
Caaragw+Carpon
w
Petkx+Derk
',, PDOI+Spa
..................
Re ROW
.........__
Commacai
....—
a
in
VIaAAraltorr At Area
OUANUTY
DESCRIPTION
FEE
D
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
_.
SMIP
ENERGY P7C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLAT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
PIC PAID BY VALIDATIONS
RECEIPTa%t(05.) PAIDBY VADDATIOD; Y(,�
WHITE— Departmemi Copy YELLOW —Finance Copy,—A.scagar Copy