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CITY OFDIAMOND BAR
DEPARTMENT OF COM UNITY FA DEVELOPMENT SE ✓ICES
21810 Copley Drive, Diamond Bar, CA91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hothne (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdwmondbarcom buslding@yadiamandbarcagov
JOB SITE ADDRESS
APN LOT. -TRACT —
OWNER F' iiVl4 1Ait
ADDRESS 'ter: r
CITY A &J t�' ZIP �174 ,eL_ TEL Sssr) SSAS
APPLICANT Do J t"E*6 TEL
CONTRACTOR + 1 U 'IPA bE
ADDRESS 77q
CITY j , O4& Aklrk ZIP Yk_lTEL - i l!wPQ L) er&(
ARCHJENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWat M-ULDEN MCLAunoi
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LBENSED CONTAADTDR'S DEC W UTION
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WO RERSOORWOWTIGN OEV-WimR
I HERIAFRNd UNDER PENALTY OF PEP.XW ONE OF THE FOLLOWNG DECLAFRATTONS
_ I hen! Intl will maintain a Ca.tkato of CaW9rd m Gen humna far Barter a Componaatlun, as prowded by
S of the Labor Cade. for ME,parfotmence of the wok WPAkh To perm,; Meued
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Puldo,NapIN owntoww vl Newart farwN�CA tidspwnm alauad My WpdN�NCo.. van balance Caniprax
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Policy NUMBR4
ITH@SE{(gNIAHiNOT BEDOWLEREDIFTFEP6OATISFOR ONE HUNDRED DOULARS $TDO ORLEW
I wrbCy, PNI In he pwknrNrcRMfN vak fp welchpop pinkb ISRid, I shop rot repay any prison b ary oo ner son to
Memo Pudee 10 Na Bakers Candpeonlon Igoe of CaEAttEa And that I I MmLM beeline P*W mthe W river's
Cwimvomw Pwgrb MSanbn370O of "Law Cane I ehNB tudhMm mmpy war apse PPARpw
DATE APPUCNtt_
WAFH40 Felheo to weans Woew a CaruaNanan con" Is unlawful, aad she subject en mtpbper to ctarinsh
pendiba and d0i Ones up to are hurmled poniard d llars R IDOEM, In aat#ean to the met of TO cMmen nduch
dames as pmkoed for In dedO 3708 ofth t Our cone, ato it and Beamais fine
CONSTRuenDN LFROMa AGENCY
i no" AfMn Mlle• PenNoy of paltry M there N a COnmNael to"AJ3bky lei one pAdpIlTBike Of the wakta
W'in dap peml8 M NxNtl (Sao DOai, tow C)
LENDER SNAME
LENDEWS ADDRESS
I owner Dow l AM methsappoamm and tlaM DNt ow elae b#ofea006 Is Conrad NCMNty wpm aN dty am
munty mOnfllcOs eo sMH Nora reNgnP m tMWsy wsVixBw and Mreby eutlrasa rePteasnbPreeol dais rNrrly b
Beer BOar N08bpremMagHtl pmpmty Mr Yl$atbi
PERMBTEE N RNir ,w„ 7— (,7 = 1
SBNATURF OF PERMITTEE DATE r
APPLICATION DATE 1 .1—:1 P/C#
ISSUE DATE _PERMITN g 1,\1 — Beta
TYPE CONST OCC GROUP
Scope of Work PLAZ1
ROWEL UNITS 0STORIES #BEDROOMS
DESCRIPTION
SO FT
FACTOR PEP
ADJ AREANALUATION
@FRrADDIREM
GorsOo7CeepaT
uMi
PalplDwk
ED
flooeSpa
Z
Re Fkxvf
CommaCbl
in
Valuation 2
O""' Adj Area
QUANTITY
DESCRIPTION
FEE
�i
E
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING 2^70 •
MECHANICAL
INSPECTION FEE
ISSUANCE 3ttT • I
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE Z-
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
Qp �7
TOTAL FEES 30 C�� Z
COMMENTS
PIC PAID BY VALIDATION _
✓ 1 f• RECEIPT#?_J PAID BY VALIDATION Y.L/......._—
WHITE— DoParkwent Cppy YELLOW — rNarnte COW—Maeaed, Dopy