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CiTY OF DIAMOND BAR
DEPARTMENTOFCOM UNITY& DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Building inspection Hotline (909) 839-70271W FIRMLY
BUILDING PERMIT APPLICATION www,cityofdiamondbarcom budding elmmondbarca.gov
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CONTRACTOR
ADDRESS
CITY ZIP TEL.
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DESIGNER
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CITY ZIP TEL
OWKE MLOER DECLARATION
I adUnt Under parry, Fo sooty Dies I am eim ham The Cmdawa'9 Sam Limma Law to the melon(»)
Routed below 4 they dkdwdbrMW I ham placed rest to OR Values damtp [Sent 71131.5, and
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ro N4tof Mpre 3*t hdin PwwrBmbe ordinCmkxO S�Laxdseisle{Ctuptar Bj fAenYwr an thebe*fis
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ofometthan IQfAny aof Sechm ]6315ay des fINeparmffsuCle%Ore medMi peiceftt
w ma Wise Than pm Aumkad rrs (85IX17
U1. as own Br at the property, armya nauyaee With "an as that sale wffo a 1W, add do(J a of of U Footnote
w the W*F and th$ a ramose Ia nm Waded or posed for sale I5aGdm M44 Sheirom slid Pfit u Wis Coo The
CM*DCtWS Shin LmaRm law Ooes Id apply as en wyrlad mCpeAy wte Wpugd emDkyam' a peAmnat ehart ouhds
or K mass de pt eny prusled that the uppmemben6 We not Intended orffilered Pinta k2 If howbvar, me dxlWng or
ImpmVaDent Isaob WiINn om yWiraf canpkr�, the Owner&sltler will bflve ale barren U GrmMg that IC waa4W tluM
Cr Unpaved for the purpaso mask )
(J 1, as 4WRN of the prop", am 9aauidem m urmi ; with IRakmdi Committee; to mnatrect the pmlem Room
7044 Funds and peanuts Code The Cmtmchor Shia license Lew done not apply to on ended of property who
YIMPMVm themes ad wrgmnVacte forthe try" with a Ilconated CmereWa permanent roue Cmtmdwa' Stare
Lo1nor Law)
U I am eaempt ham possum hear the Camembert Siam Losses row tar the mlkft remorde
Date Soon
By my inquire how I mk¢wAedge that, except for my pamnst msldama kwhch I meal ham mended IN at kart mq
year pox to corrosion d this improrimento mmrbd by Onpa oLt asset Ietaty we a ammeter, met I have oullan an
bwier mhlaor if h nay no been conaduWed In Aa mum by tensed unraCtkd I umwaaM Not a copy or an
arohcatie kw, Seepen Toes of the Bo&sea+ wei Redamenane Cade Is amNffile him room wale dos appoupo t is
or m he woreen g wet a* owners, while an gW4aiaw Red
LICENSED CONTRACTOR'S DECLARATION
i auto mina means o(paQm that I an lamDat urakrpmwaka of ChapterD pxywkkR1q wit S#MmTin}
da Dmaai3wdw amt tCDtle aM myikarsemmipwfmm �A edeU
I Z(he__ LiC ND '71® YctA y
EYP DATE S2 t • 1?-- CONTRACTOR r+ Ari
WO RRR's SATM N OECLANRnON
i NEPFBY AFFIW UNDER PONfiTOF PERARY ONE OF THE FOLLOWING DECUPATIONS
i baud ae Oil ni ma a Carbonate of Count m Sol two tar Worker's ewnp wfbn ea promMd by
,,57tuon 37DO DIMe Latin Deam iw ft presentment tire work mrwhkh this pmmh teaseatl
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the peNbrmellmes Mp wak Nat wa1Gh Mk Pemdhlasuad Niy Worker's Cwnpewatlm ewumnm Comer and
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CARRIER 'y�'I¢ (—
IF
(MIS SIMON NEED NOT BE(X)WLFrED IFTIEPERMIT & FOR ONE FL NDRBI OCUNLS $100 OR LESS)
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Canpammlwl Ivowasww m^d%•1pn 3]Dp Atha LehmDak,lsAMi mMwNt cempywM them tVPapbllS
DATE _........... >>sRPi%'ANT
WARNING Fmkre to septa WIXPar a Cadpw m coverm, k ulaawloi. srA Muff simp t an tromYor he werso
mmmw and Ford Am Up m cox No" 74=0 deliam T5100,000), in soldtdm to the aoa of any monsem,
dames an provided twin men" 3705 at Ma area dons, w host ea ensure my
CONSTWtCM LI NDDIS ADM"
I border aMrm umkr peek} at pridery that #rare Is a Somewhere L ere Apmcy for de peraismon, of Fore Vwah he
Oft peanut N RSM 000 3097 OR C)
LENDERS NAME
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IeMtlty RiFaremad emdit�mand tmmehmelmwmaDm emmyd Iagrenmobmpy w,m aU GUYam
mlyOanMato The, mtut;museum
etmrcsen the ve-mndmPwege.nsowThemoyM wbtemdy wthwlsr esmYadVeaalMbcwmym
PER TTEE WLPRINn
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ROOF119MITTEF DATE
APPLICATION DATE 5' `?,& 0 P/Gt
ISSUE DATES • Z (-' 7"? PERMITth M " —
TYPE CONST CDC GROUP
Scope of Work
N DWEL UNITS
N STORIES If BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
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MECHANICAL
INSPECTION FEE
ISSUANCE
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
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ZONING CLEARANCE
TOTAL FEES
COMMENTS
PIC n{,�y�� PP&IID BY .��.•a VALIDATION
RECEIPT p •" '•'/ PAID BY VALIDATION