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•�' CITY OF DIAMOND BAR
r DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
v (909) 839-7020 Fax: (909) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION wwwcityofdLamondbarcom btaldmg@dtamondbarca gay
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APN LOT TRACT
OWNER i Q�,M
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CITY PLA~ Zip' TIE
APPUCANT fti.�TEL gL`iP j (Atq k2r:
CONTRACTOR li iYI�L�Z{� Q
ADDRESS 1AIR
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DESIGNER ................
ADDRESS
CITY ZIP TEL
OWNER,BUILDEA DECLARATION
I In mby aUlrm ender penalty of pegury that I am resume from the Contractor's State Lterwe Law for me rea mein
hi iaeml Malmo by the cc he lemorkhR, I have thwart next to the applab'�.e Itemho ISooram 7lnt G, Suemaas wad
Prolesmmen Cods Arty cry on, term" that raqulms a psmd M wwbuot, Off, rummer, d¢rralIA , ar spar, any
strurhaq pror M Is msmnce, aim mqusl The app6cma is the perarrtin hill asigned star wed that he IN she
a ImmOpmwantin Umprs7anwof the Conh is SUM I.mmree Law tNwpMr 9) rmmmencmg win emblem
7D00 of ONWm 3of the &mar05a and Mmtesmhm raft) Or Mwl he in she t eaemm from Ihoutsum am"basisfor
Mealegooacerlmden Ary Wotftof!M:ftn70315iryaiNNKdkam lorepsrmt au6 L7s Nv appacenLlaativlip&wll7
of"mom BIM five honored dollars {$t>03}
01, as amared the pew", stay employees sawn wow he Poor Mm oampenww, wdt do Owl at sU mum
at the wart, and the stKer a neir tie surd in rNaed An saw Mviotaa w" &rsmros Aim Pmfesamw Code The
CoM=m' SUm License Law Cif net unflym an more, rd piny yEW Mmlgh onamey" m Moron MOM, or"
s sameaea fire IXoparts' Monday Mat Bw lmpmcemmw insect UUmtmo or aNarad fa raw p th6 rial, MB twwo m m
mbinwa+wm a wM YAthb One yeaaat conlpmbm ins Owcer BGPdorwt7l hake Me bourn of (ammo fiat M was him adt
simpmreoya the U'apaa54f seta )
USoree attlwpmperty an eukaMyianescimgwdn Iaonaed Gml#Mria$to GawtuGf the Aaowa tSCIWt
70d4, Do=wW Cade The Caahovem said LPW18a Law, dim nut m ah minor of Anybody were
mladsa awmon 0:0v.MemhadsrMMce prcgcrtwN.nbiao(wain CCaaarMrAmalaniMiheCwivaYma State
Loom all Law)
UiMan warrhptProm ihsamems under ON Laminator's Spate Lwemar raw fair the FOUa ng mA%mis}
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Bymysgn#idobelow lactinesel ift eola for my po&mal Usbosa In which l of hue maiden An M Mast one
year jinxt0 amlde of Me onpnvemmm criminal by the pamH I Grunt Daly sell a otmmure teat i hue built a on
awswrbudder it it has not been Pantrafted in is Usually by knotted Gomtmrbm I underewlle Nat a Copy of the
implicitly saw, Solon 70" of the Raalasc and Pro ealoes Cale or usilame upon mquM when Nt Abitibi Is
am HW a at the fabwMg Web aim htprwww iDAM a godborw Pool
LICENSED CONTRACTOR'S DECTARATION
I arerm under penalty of poetry Mat l am licensed under mindslons of Chapter B trommrmiing Are section7000)
m Didion 3 rd the Beaneca and Promarnons Code, and my Protons Is In (UP tome an# emol,
I cuiss C 56 AC'LIE ENND 1 T ....._`...
DATE` CONPNCIDR
WDBtHPS COMMSATION DECLABA"N P
I AFFEM UNDER PENALTY OF PARODY ONE OF TIE FOLLOALNG OULARATIONE
_ t have and welt rrientah a Cmtl curs N cement m Sam fti for Worker 3 CompnsabM, M mudded by
NuM er 3700 of Me Labor Anne, IN The padommnae of the work he *Wit lilt pond alms
..1d. Ibuy ad wadi margam Worker SCmipenmban thaaeiw8 all rMuosd by Similar 3700of ON Leon Cade La
Me pedama mMe,,Work whomMonwinner tB Myy youdare CoitnInswarrabs Car(w+r Mad
k(p(a fOsred
GAPoER � �!Ciil't� L.ilQ iltkl.iF �'9�tiri. tA)�
HAEYe@dDER-4A— -fib-61
(DOSSECiICNAll NOT HEL?' IDEDIFTIE PEW isFOR ONE ULAUDERn mxtARS Slue ORLESID
I gMgEL Mwiect ofMawokt ad latssL sd empbyamy poiaorMMymaawreotM
Lamreeme,
aMfaU MOw Woko's'.anpar�aorr taws m (iahrNa. Arm ihnt M I ahmuW hecom sublyd M Me Wakere
Cvoasow NSecem 37�INMa Lahrtbtle lslhgp tomtit bull vJh
AaPl.r#yr
WARNNG Falum n MNm WOYAta Cgnpdmatpn cwaapo rs uvawml 94 shall Mb{Mt an ompigrer to o#nlna
menu find r t Agar up to am hundred thousand dotae ($1 W ONE In women M Me Cod M My anermamtp
LtM MMmn"(Grin arcane 3MAdM8 tbocode imeme andahmeystees
CONSTRUCTION lENOINB AGENCY
I mammy Ain twNr penalty d pequry Nat there Is a Construction LoWing Agency' for the performance of the win fa
AM Ma aboard Is issued him 3097,CN CI
LFNDERSNAME
...........
LENOER S ADDRESS
I list I IlmM read this appkaaen and state Nat Me above hdgmmten Is COROCt l agree to comidy who Mi City and
ardmuncee and etas MM rantry; M building construction, and hereby sumonM rgNe%MgIh64 W Me4cdNdy to
enter upon the otm mentioned pramor, fo imedtl popmes
A� VA P6 i
EE RI
axArint OF
PDMMDATE
APPLICATION DATE �{{ l t "t PtC#
ISSUE DATE i t 1 PERMIT#
TYPE COAST i �MpA('{'IL LJyAkSbCCCGROt'UP
Scope of Work td�f I&F- LA k"r-5 POWA{}�Q/
#DWEL UNITS #STORIES-` #BEDROOMS 2
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREANALUATION
SFR/ADD/REM
Garage/Carpon
w
Pabomcck
LL
PobMSpB
............_
Z
Re -Rod
Commercwi
Or
Or
Ad) Am
QUANTITY
DESCRIPTION
FEE
TIF
CONSTRUCTION
PLAN RENEW
ELECTRIC
PLUMBING t1i ire
MECHANICAL
INSPECTION FEE
ISSUANCE - 1�
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE .:1- fails
PRE-ALT FEE
BASF
PLOT PLAN
..................
ZONING CLEARANCE
rp.
TOTAL FEES 1
COMMENTS
Pic PAID BY i VAUDATION
flECEIPT U M / _ PAtDAW "'"1 VAUDATION
WHITE— CreftimiWACopy, YELLOW— Finanme Copy. PINK —Asaaaelor Copy