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' CITY OF DIAMOND BAR If
DEPARTMENT OFCOMMUNITV & DEV LOPMENTSERVICES
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 wwwantyofdfamndbarcom buildmg@diamondbarca.gov
'.''.., .10R SITE ADDRESS'. 22 9 pa:-.....�e>lu a;/ L!v , sS -4
APN LOT TRACT
OWNER
ADDRESS car- C2 {F 41int . _f q
CITY . Anz.t-.rr4 Aa:.. ZIPa gT 63f TEL 9111 '417 9Leff1117'
APPLICANT t TEL 144 411 - 2 I)T
CONTRACTOR
ADDRESS 2.
CITY %WCfrc ZIP t7f '_TEL Ufr Y?j f.kiO4
ARCWENG/
DESIGNER
ADDRESS
CRY ZIP TEL
OWNER-RUILOM DECIMATION
I Nation order pena2y of Pchun than I Bm exempt Mao the rMWW a State Lxarde Law for has mamma
common happy by Me medmeN(s) I hand placed town to the aMmOble Ibmtg 1Saclm AIDS, B'm and
DfolesaY6 Code MY city Or fooddy apt mguhes B Pam1t to construct, mien, alpmna demelmb. apa reo, alp
aN1¢bae, prim m Ib p9rpnCa, eb0 mqueos the PPDImaP iw tlM permd m Rm B snored aMgmmt apt M as W
p Ifregped paramount totlIsamrpgre of AraCreeactoy'a State federally, law Dame dr BICWMWC lawah Samoan
of Dwsmn 3 of the Bch m and PmtoanlorbCodel nthal he or ON on exempt Mom Ikensum and me bass for
then oMexMPUM Arty Notaom of Semlon 70315 by are mwigad for a ported stands theappGemdmacMi penury
of not mare Von are hundred distant (3500)
U1, as owner m the promery, at dw employees with wages n DdMr sets COmpdMB ien,"I do U OR of orUt porOaK
of the was, and ere SMUMM b nm Inteala) a offered W We {Seeend 7044 Ru l ad Praeasmna Code Tire
CaNagom' State Llfuao Lew deep not today to an o Rat aopmty wits theme emyayeas' Or Km weffect aads
or Improves the Prop", pmltled Pa[ bap Imprmpmanb e0 not Intended of inbred for mN If hppwaser, the W" a
Imgmaatert is sold wdaT are year at t"OM the Diviler BNitla win move Po Damon of no+mg Met it waste may
or orpmxed for ma PUMM at ale }
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aplstoma%ilia WOPeI {Satire
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pur to uanethe con prof" wsn
a pigxmes iheman, am wire �b%g for the pteJNie wire 8laare0d (kerMapw #preset m the Galbeciaa' Stab
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Oy my sgneiae heivwiecknowietlps Uot eIr<Cpt tor`my past in wmdiimuel Msartormleaalara
veer pmrmoa4 It ban adorahMmwasc In IS trytlttr ay4 cd o+ntact Epp a 91dand isat+ham IDNsatse
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astitm mda+irq My alto npyw,w tegmoda�A'ranwAMn1
UCEMSED CONTRACTOR'S DEMMnO i
amml under penalty of paAeytoI am licensed owes Pmicerp of Clppgr B fee ndng who Samar, 7000)
a Ofnamn 3dthc O Wnea and Rm�CabQantlmy L'CertBe s miud terra and s#eq
UCENSECLASS b--c Lie NO _[LD
UP DATE CONTRACTOR
WORM'S OWENSAnON DECLARATION
I NITE.BY AFFIRM UNDER PENALTY OF PFAIUAY ONE OF THE FOLLM NO DECLARATIONS
.� I hasp ®d will mmmab a Cerunm of C;OMM4 in Solt Iwae for wor a's CanympetlM aP In~ per
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DARNER
POUCT RLUM Q(3-72
(M SECTIONNEED NOT BEC06ffLMF The FUND ISFm ONE WMD DOI ARS SI W ORLIS`0.
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bamre PR{ectmMwaFa's4stloepones law 3700aiLandcandy gar Mtleye�Ppidibnarul beam etipcimiMlg4Asae
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APFLrANT
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pmwft &q case ton W to aIN aobmd Aimed deny% 3100,000j Id aulm to Do cost of the mnmmmbm
Months appealed be in second 3708d PM pDcr reds fnWesL end atmrDeY stags
CGNM CTMd tB#MW ACPNCY
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LEMOERSNAME
LOtDEA'S ADDRESS
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Bdl& upon ma poem muPoared pmpeM for Irspephar purposed
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PEAMITIEENAM
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0 E DATE
APPLICATION DATE` at to l r;'.
ISSUE DATE 'a 1 N C3 (ice PERMIT#
TYPE CONST
Pico ,
P'CZ i'i — S tv#b
OCC GROUP
sporpo of waic—as'1-s" 11f
0 OWEL UNITS # STORIES
N SECROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREA"VALUATION
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ELECTRIC
PLUMBING
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MECHANICAL
INSPECTION FEE
ISSUANCE
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SMIP
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ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
ZL t7d
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
a -I e . Z
P/C PAID BY / VALIDATION
RECEIPT a_ PAJOBY N Z!;_pj $lefte VALIDATIONS
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