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CITY OF DIAMOND BA
DEPARTMENT OFCOMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
„y (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
...°. BUILDING PERMIT APPLICATION Wteraw.cityofdtamondbar.com buddmg(AA) D mondbares gov
JOB SITE ADDRESS Z t 7 00 i1:Y l eZ2 ^Sr J1
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DESIGNER
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OWNER- ILDER MCLAAAMN ''..
I tKKeby athen uatlm parody of poetry that i am mushas fake NO Cormic pr a State thrums taw far the mskerea)
WOcM below by IN cMycMnmkLd, I have impact No M the PCIANNO actual Ishads a 7031{y 8=" aM
PmM58§kW Cody Any May M o ty that m ma period MOWWWot, WW, Mpmye, PemoftA a topotr, any 'i,
structure, poor UNITS k� am Gqulma the a idilam Ax this perms m fN0 a sngeaa st*e tteat he do am
is' lurna'PMS=tto me PrWAenaaef tun CCMUM nSMMt AMOtaly RAPPti gi ConPONCIPT awn Sectors
7000 of OkWlkt3of the Marrow and PMMa Coall or lhal he W NO W exempt from llxnsme and the basis for
the alfamd axemptlan Any violation of Section 70315 by any applpapt far a front the malcant to a flat penalty
of not more than fire Imndmd deism (55m)
U 1, as Owner of the property, army employees with wages a May We come area, was 00 U oil of or U pom005 I
of the work, and the structure Is not Mantled or offered for sale (Sadmin 1044, Canyon and Prdfusimew Cade The
Cmtmdoms State License Law does nor apply to an owner of propmly, who thumh wnpltyees or pma Nil offm bogus
or imprayas Me property, proxlded that fie haoaammenk are rim Intended or dhered for We If however the modng Or '..
mmpmwment Is said wdnw one year at cpnpedm IN Owner Sadder wgl him ON burden of prwh+g that It was as Wal '..
a ImpruxOd Wr the pumOm d sale 1 ',.
U1, 9a owner of the taeperiy, am exbfuamety, fontmdmg wan Iimaretl CommClak TO canstruct the pri OPicam
7044, Ruwwei and ndewWns Code The 0mMcttmW Same Lcense Law days mar algay it an Owner Of pop" wM
buaAkimprweSPw2on ad Orkeds with aommad unuucw gnmumatome CkdkCvs'St er
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ion mrernpi from hcemum kderino Cantrwdk's$lm Lvereae law for the follarwmg mmrgs)
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lackmnd11h.stitheea arememse Mft IcyfiWpbyk imdembaMn s tnum WiatIhavebtait he
thader d A tan 70 been calarxied fo l $em by ode is A ckmwmk m that a d the
e taw SecWk1 TOag d ins aM Padeasfans ChM W avaamN upon memWd when Was MaNceftry Is
e orat WW fikak•9 Wabsda NtOar'www iee4lMmgmYcaiaw ntmi
LICENSED CMRACTON'a OCLARAMN
I affirm WIN, Newly 0 perjury that l ere licensed tmdmmaA%NyOf oww 9maramnG.ng who SWM MOM
d GwsronD3SS
d the Code and myiicensOls inttggeaM ePfad
OArc t 'TRACTOR
x RKER'SCOMPIRSATION DECLARATION
I AFFIRM LWDM PENALTYOFA UVRYON€OFTHEFOLIAWVIGDECIMNTMNS
I hie and wgl malmaln a Ce1 scale of Cm9ent he See -Hour§ Mr Workers CompensaW, sit pravided by
aa..��--��Swmm 37W d the tabor Coact forme perlkmanm d no worktOrwll h the pmml W La IM
ihiaandwMWmadthln Wkker'a .ompansattan lnwmnce As regm ed by Sedlw 3700 of the tank Code Its
the performance of the work for y Ice mis permit Wlmtad My Worker a Currormho minsurnnm Coale+and
Policy Number re
those
POLICY NLWtRFA C+^
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&ubJectM its WkNeis Comps^#ebm isaSdCNiMN NNitl shoed ba:kns mAWd TO he Wakea'e
Cknme Sa'Lai:f a§fMIMiGtC *, wan Gage pr'wg
DATE AFFt Y''��
WARNING FelUe M aortae Worker's eebon care age Wnla uwftd, and SW wood a a t0 go"
pc "n and 04 file§ up I as fti d Mm 1$100,003, at adaam TOthe chat of GIB camNydmmn
depiaNe§w piwdtdfk a7ssB O6dWW+ahatt,�aderesL and AGatmyakea
COWRUCTIONLOWMAGOICY
I atfml miler MMND of penury Okt MOM a a Constudyan Lemlk+iQ AW(pber and MU ad the work far
wnldiUw pmmAWWmWd (Sac 3097 CA, C)
LENDS S twAF
I .ADDRESS
I my" that I ism read thW aNWbr m aid state Wort to sham Information Is vneGt I abuse M cWoy win Of day and
CkadY or&nmeesand srd0 Mws relattrM m did6npmnswda and hamby a0.tkiit rgv�ertiPm§§ d Wiafougto
mud, gam, theprfpety for inspection purposes
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S(O iF PERMITTEE DATE
'.I APPLICATION DATE �n RFC[#
'',,.. ISSUEDATE 71ad-1Ja�, PERMIT#
TYPE CONST ......... CCC GROUP
Scope of Wok
# DWEL UNITS At STORIES --- # BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
''.. ADJ AREANALUATION
Sf WADDYriEM
GeragerCerport
w
PahO(Deck
LL
PaoVSpa
ZRe
-Roof
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Commercial
m
VafaaaNOn ................ ACT Area
QUANTITY
DESCRIPTION
FEE
ca
a
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING ................
MECHANICAL
INSPECTION FEE
ISSUANCE J}6 t
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE-��
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES c7"d'^ ' 1
COMMENTS
PIC / n/L PAID BY +� q VALIDATION
RECEIPT e I DO _ PAID BY I / 7 / VAu DATION r�
WHITE — Department Copy, YELLOW — Flnanc, Catty. PINK — Assessor Copy