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....... �!,,,, ___ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fox (909) 861-3117 Building Inspection Hotline (909) 839.7027 FIRMLY
`°eN' BUILDING PERMIT APPLICATION wwweatyoldaamondbaccom budd3ag/@admpnondbarcagav
JOB SITE ADDRESS 044 L�nla.r�AwI... LAO A1'
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OWNER-WILM DECLARATION
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LICENSED CMARACTIM'S DECLAaATON
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LICENSE CLACE4 YIP- tx NO 4 A2 jjan `'8
DATE CONTRACTOR
WORKER-8 CDMPENBAWN DECLARATION
I tE1EDY AFFIWA UNDER PENALTY OF PE91M ONE OF THE FOLLOWS DEC A RTIONS
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POLICY NUMBER
THIS 5111104 NEED NOT 9ECOMRiTEOIFhEPE%YAf SPQR ONE HLwORIM DOLLARS S/OO OaLEM)
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DATE APPLICANT
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CmnTRIMM UNOMDAGENCY
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LENDER S NAME _... ......
LENDER S ADDRIM
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MR" olNnoKm min dam main MiOng as buffing canMicibn and nosey eMfadn mpmmemame at ME, county to
actin, wxa the abmn Poperty for lmpeaMl pmposas
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APPLICATION DATE PIC-#
ISSUE DATE �'i ....PERMIT* �� 1-t -:70 0
TYPE CONST OCC GROUP
Soape of Work
# OWEL UNITS Is STORIES
# BEDROOMS
DESCRIPTION
SO FT
FACTOR PER
AOJ AREAAIALUATON
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QUANTITY
DESCRIPTION
FEE
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PLAN REVIEW
ELECTRIC
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MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES,
COMMENTS
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VALIDATON _
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