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CITY OF DIAMOND BAIL
DEPARTMENT OF C( KUNITY & DEVELOPMENT DICES
21810 Copley Dnve, Desmond Bar, CA91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PER -MIT APPLICATION www.cityofdiamoodbarcom buddmg(fadramondbarca.gov
JOB SITE ADDRESS._ 2-1[`/r Co{_0mbsa el......... #3
pA1%`F G�TRACT
OWNER
ADDREESS Z2SifGs C6�n N'if]nt` �rf
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APPLICANT Nit C.fip Gl �% TEL 4�
CONTRACTOR 4
ADDRESS
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DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-SULM DECLARATION
I hereby Ann under pe fifty or patvy oral I am exempt form tom Cm rwrud a Gods JIMMY Law far do mosarm)
frame! bbww by no OWWW O), I hove pamd MAW mA maskab'B Imnle) (linden ?=A SSNmm and
Paofemmes CO& Am ony w oft" mat requires a wrat to mroauot ajar, Impose, *m*b , a mpaW. my
stnemoa.prb as Its mAesrem, am mww du appnmdtame pmaileW lie a efanel*Uwff dMRas at afro
is Doeesed Wmmd to Om pm*wn be am Cmdyw 'a SMW ul Law pow 0) Cmmwxmp wmlmdml
7= of 0ammn] of the Buds wd ftvl"OFO ComAathat to a sire m morel am emimAe Mtheboemfa
of mrsoaavrcts, Aldred Whard T001 ribs myaRRs®ntfinepsmaer ecte pwappuCaAmadMip;Mdy
dm4 nibs Man Ow huMmd tlalmm $$OdDl
U1. m affair ofthis, proarty a myempicymooman wagee ae mob aria W.Pmsaft.will do W ofaUPodaas
of me week, and the aatanum in nee Ind a oNered on sale (S=0 70M, Dom and Protasocre Curie Tim
CDM=M'SMI, Urnaw Use one not sham m an owimrd property who, dezph mapsryAea des Perabalelm,oudds
or Irmuwa am prous", pmtidad that the Impmnswo rmo red Intended or dkmd for all If "ever, m8 both%a
Improvement W and Asian Goa year of mmpleLun, any Owner-SuNdef WJI haw the boom of tudd j that a WIN not tool
or Impraed far ^- Wpm Of Gas)
U t M ownerdme, pmperm am, =Win"ca mac}6pwlpr Bcawad Cmcacnora on cmvatW mar project Ydedim
7044 BUNrmae✓Am (title IN LWmocyV M Umnew Law does not appky m m omw of AAGAN rind
buhma lmpvmemaem mwhoCmbmm foram p ok%wMapmrmd(bnlncbr wuW Wtm (eegiadom'SUW
LMetam Law)
U I ear esamptfood nomam woo the corrbactor'e Sum us mmaw bthe mllowkv8 rmamen
CaHe Sign _
By my vorman below I ackvIefedge inn, mo V.. tb my perwne.. rmbM In whkn i must'haw MOW for at meat one
saes Per m ebmpepon of me ImMer le covered by the Mani card stage and a Wature(fort i mare Gone Got an
ovomr budder If I hoe not beat mnWrnTeo in Ie marsty by immd WnVdCm rs I and;stand met a cap, of rib
appftebue aw, Satled 70M at the and Pmmmmm Came a MbbA Am mart when am BAMM m m
Wbmetma;bWt$tUft Wdb MW hAp'Ow'•"w"MMQov/WMwemre
UCERM CONMA=R'S DECIARATLON
mmby emrm wrier pemY.ya PProf andI eme,Armdy4mem, m in boom apt;BHmmmau,np Min 5etibn 700W
of OIvWm ]d dw Bumiau 0ntl Prdemarm Case, a/yN�ymy Ikaree a,In h; fain anti e1aHa-
LICENSE CIASS��. UC NO t 2j� LiCt
DATE i-' CONTRACrOR �/\ �'�"
WOBNER'l COMPBe TA NOECWIATON
r HEREBY AFFRM UNDER PIR N N OF PERJURY ONE OF TE RUMk'G DECLARATIONS
_ I broad end wit mlvM a Cerno to of Ccownt to Sot minas Mir Warner a �nPansaVal, as Avedao by
leCVIXl37m d ma finds Cade tame beftrom sad imwine for whim boasted arm red
_sNawand wIA rlWrruM Waitm'aCorrperttatbnIrraeance aemVmdby Se w37WufU*ta*Calamr
0Wpadwmarc dmAwinkbwWhimpemamIssued MyWakm's ComPlmadm InNpetM Cads am
"Number we
PAW4ER t
POLICY NUMBER
,RHBS SECIEd! NkEO NOTBE CI#AP.FTEO ff Ti PERMIT IS Fipi ONEiiUkgEi€OLXY.tW15 $700 Ofltffij
econv11MIlid to Am nna'm crime woe Comparison wmdrdee pan'[m IAa ee tr de aI molsay oaem Inemym be Vex;W
become sRjaimtlm WDia,b cfere awed�9osea Nat agree tlMt Ml NrouH baton66ubmtlu Um'i#�tka's
Can Ma^r �taTn�00d7dtoarW�M/jsheANmwriA mmyywlbrmompa+aNm
WAAMING�Fa6�um�_m seammWodca I Comps m�m:edide�m whosoid✓d, W S I auW m romYa to normal
pltaamm end chat Im W W ma hundred Icoamd desire 4SIOG 00% In Wbam to Of ,Wee of the commando
mm�a m DaMpm,'tain mGmii 3T08 rims Mbar CP$ Merest 8nd Blamay'f lain
CONSTNUCmNL iNtI AGENCY
I MrWy anon under Peiany d My" that mere Is a CordrucbYm L%&iip ACwmy Wr the paiammds of ON week for
winch So mrmt is moved (Sec 3097. Dv C I
LENDER'S NAME
LENDER'S ADDRESS ...
I uay mat IIm4mrind min bone; rOm;Mama(yet ma Wave In'.amWmmu ttt watofJem win Woweve,
tawny eemnancm end awlra4ulroyfa ewavrmmm, end haWraWrdsm rpreaenWOna;tlAtaumya
irises upm dmebovea eat prApedy for trespecon purposae
_—
PERMOTEENAhff{P
SIGNAMRE OF ERMITIEE ...... DATE
APPLICATION DATE _ r L 2-1
ISSUE DATE 2 PERMIT#
TYPE CONST
Pico '1 P!'tiI L 13 932
F R I -T" It38,72
DOC GROUP
Scope of Work _'f.e ,....
N DWEL UNITS NSTORIES
t ,r
#BEDROOMS
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DESCRIPTION
$O FT
FACTOR PSF
ADJ AREA/VALUATION
SFFVADELREM
''..
Garage/Cerport
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P;IdOmk
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tl
F'; tBPB
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+�
Fte-Fond
_9
Caan;ciai
m
vatMallorr
Adj Area
F—QUANTITYT
DESCRIPTION
FEE
a�
G
ED
Ea
f
d
3
U
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
a'I
SMIP
ENERGYP/C
ENERGY PERMIT
RETENTION FEE
PRE-ALT FEE
13 -i is
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
323.87
Pic ____ _ PPAIB BY VALIDATION
RECEIPT p .'f e:' L..'.: (J PAID BY qj(jtj! VALIDATION LL
WHITE —Department Copy, YELLOW—Fmmce Copy,—AAcesvorCnpy
