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1WCITY OF 1 AMOND BAR
DEPARTMENT OF COMMUNITY &.DEN ,OPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861.3117 Building Inspection Hotline (909) 839.702E
BUILDING PERMITAPPLICATION FIRMLY
JOB SITE ADDRESS I166 CNSSI'Jt,M. TALI. DR.
tAP'N LOT TRACT
(J1rcNER �:CR� CiLW+4l
ADDRESS WIG h A.1 Dn.e
CITY L%Yu�nr ZIP A065 TEL �- ?.a'(Z
PPLICANT TEL
CONTRACTOR nPIE RESIbRAttNiAf., SrIC
ADDRESS 3123 El AL :��^,,I..C-Sr.
CITY JAK10i NAniR ZIP ,jtTEL Wfr ilri'a4�
ARCHIENGIDESIGNER
ADDRESS
CITY ZIP TEL
OWNER BORDEN DEWRAM
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SIGN
UCVM CDNTPADTOR'G OECEARAYM
I horeb ,who, sued, handily W penury, that we money untler Provisions of C omor 9;mmmncing with Severn 70001
of Dooms 3 of My BLsores and Protesase sEnds and my leaned Is In Np Ears add edox
DOENSE MASS C 110 UC No $21545
CONTRACOR lZP , ftfe.9 T11<AtC . L_�
WORI®I'SCOMPENSATON DEBLITRRN
'.. HEREBY ARRPod UNDER PEYALTYDP PEIL'URY CUE IFTHERILOWING DECLARATiM
I hay and wit museum a Cerellants W Commt to Sol hate for Woriwe Do m roa on, as proWed by
/ Semen 3700 of the Leber Cade, for the pmmrmzrAwm the wak as which its petMIs mened
I Ihave and We drungdowelmot Cdnarstodl Etworeas m ranted by Somon 37M of the Labor Cade for
the dthewedr for winch this puMt Is muue My Wbrka4Canrensabm bmmanm Tarter and
RNICYNumberereas,.t �a,J ,, t 'pre
CARRIER lF.a+ yr'mEF�ia4e*j uelg� 44�1few
POUCY RIMBER k�Lki: 'v a W. i_iiQlrt ___
M iS SECION teO N3f SEMWL EM F THE PETWST S R }R tthE tEPftSsi OO110R5 (stODt DT tE6y
l aaayaslthde pemnu�WthawaktpreNkhmu audio maned I#�nRmlpsyary pasmsaRyrmuassm
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baarm a h me WaWs Cormesal9an taws W CastpYva. Awl ups Moe la I edam beatw wb�d u tlm WaYwB
;o aMWrsot Seam 37wu("L&OW IenaN IaMnaiaruar#arwmtd a^+doas
APPLICANT
WARANG Ed" be member WaMert Camp"ft damns n ureawhd ate SW adlpe[ an empeomy to pmemal
pmftn am else feed up to net teamed demand eleven SIO003'DR to 4OWym m the rmt m the mrdePdeaad
Gmmpse aepyekief for in section 3708ofDes @bar Code InhmA and aMaeaYeaem
CONA1R<ICiMUMDING ACENCY
I hereby offin mussy peahyof perjury mat hem is a CanMetma uesbag Agammy Set the oermonoom of die work tar
wave Mee ammmauiced iSa 309E Cy C )
LENDER'S NAME
LENDER SADDRESS
I mroh mat hay read thmaPp(eann and emu that the asy mlammks Ilk meet I stye 0.+amah' e+m aN aRv aloe
orEm ca and M ism ra9thq to Wlldlm man door, and ha etry memories mpeve UNa m Om mury to
ender don the abate memlared Peery, for inspur. an purposes
)54 101
V:pHttSEE NAME ---
%WUREDFIERNITTEE _ DATE
APPLICATION DATE PIC#
ISSUE DATE m��as1j.G� PERMFf# >��Il - L:7 r�,. !
TYPE CONST r OCC GROUP ,S
ZONING SETBACKS
FRONT ...... RNy ❑
REAR ❑ I
SIDEtSIDE STREET RW ❑ i
SIDE ❑
PROPOSEDUSE R`tolO WI^M LG f
pt10 Sfly-'l' DGt+ i!'ALV'ES . PLtTMF_ -
_�tlE5rR4Q.gjyCAj til' MWIDIJ& WArEk LJES
# DWEL UNITS # STORIES # BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREA/VALUATION
SF VAD(LREM
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Valuation ART Area
QUANTITY
DESCRIPTION
FEE I
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING / I
MECHANICAL
INSPECTION FEE
ISSUANCE 3S,re
SM)P
ENERGY P/C
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ENERGY PERMIT �p
RETENTION FEE ........... U"
PRE-ALT FEE
RSAF
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TOTAL FEES
COMMENTS
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RECEIPT d �gy-- PAID BY _ _� VAUDATICN f yrEt_
VhRTE—❑apotment Copy YELLOW— Finance, Copy. PINK —Assessor Copy GOLDENROD — File Copy, GREEN —Appkaam Copy