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(!$ SHA�L NOT EMPLOY ANY PERSON IN ANV MANNER SOAS TO BECOME SUBJECT'O THE INSPECTION FEE
� WORKERS'COMPE�SATIONLAWSOFCALIFORNIA,ANDAGREETHATIfISHOULDBECOME
SU0.)ECT TO THE WOFNERS'COMPENSATION PROVISIONS OF SECTION 3]OOOF THE LA90R �
� LODE.I SHALL FOR"HWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �
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� I HEREBYAFFIPM UNDER PI:NALTV OF PEAJURV THAT THERE IS ACONSTRUCTION LENDING AGENCV .,
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� IAGREE TO COMPLY WITH ALL CITYAND COUNT ORDINANCESAND STATE LAWS RELATING TO BUILDING �C, �v
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CITY OF DIAMOND BAR� ���"'
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
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PRESS
FIRMLY
APPLICATION� �u_i"1 i PERMIT I� 5�\P/C
DATE � �J NUMBEH <(j y#
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW^
REAR ^
SIDE/SIDE STREET RW^
SIDE ^
PROPOSED USE
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION S0. FT. FACTO R PSF ADJ.AREA/VALUATION
SFR/ADD/REM
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Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES ��, ��
COMMENTS
RECPT. N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Gopy,GOLUtIVHVU--rue copy,t�rtttrv-.