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.+-------- -----_ ---.- _. -- ..._.- --- ---- - --- ---- - � - - CITY OF DIAMOND BAR . . COMMUNITY DEVELOPMENT DEPARTMENT .:,.� . 21660 E.Copley Drive Suite 190 PRESS (909)860.3195 Fax(909)86I•3117 " ��+%'� BUILDING PERMITAPPLICATION • FIRMLY � JOBSITE C`� � ' APPLICATION PERMIT � O�� P/C � o ADDRESS DATE NUMBER x � ISSUE TYPE OCC APN LOZ TRACT DATE CONST. GROUP � OWNER � . " ADDRESS r 20NING SETBACKS � CITY O r ZIP TEL ' ' REAR Rw O APPLICANT TEL SIDE/SIDE STREET RW 'O � CONTRACTOR L. l f SIDE I ❑ O ADDRESS PROPOSED USE 7 �r� � CITY ZIP�1CS1(Z TEIr - o ARCWENG/ z� DESIGNER NO.DWEL NO. • NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL N DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BI:ILDER DECLAFiATION SFR/ADO/REM O p 1 HEREBV AFFIHM UNDfH PEM�L7N OF VERAIRY TMAT 1 AA1 E1fEUPT fROM iMG COMRACTORS L4 GeroQ!/�8f�0It . 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J Q O I/M EIfEMPTUNDEN SEG B.a p.C.FOA TH�S RE''iMJ Q ^ lL F" I , f DATE OWNER V . 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ISSUANC _ , p DATE:�� APPIICANT: • S � ENERGY P!C WARMNO:FAIURE TO SECUfiE WONCf RS'Cd�PEN5A7qN COVERAOE IS UNUN�FIIL.NO SN�I-L BE � 6UBJECfANEMPLOTERTOCWYNAL7ENALT�ESANDCIVILFWESUPTOONEFMORF�7r10U9AND ENERGYPERMI7 DOLLANS Il10o.000).N MOI110N TO TNE COSt Of C047ENSATION,O�U.IAGE5/5 PROVDED FOR W ¢ 6ELfDN 77W OFTHE UbON L�OE,NTEHEST�NDATTOHNEY9 fEE3. R�ENTION FEE: � 4 CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � �—�-z-- - � INENEBYAFFIRMUN�ENiENALTYDFPE0.AlAYT11A7TMERE6ACONS7RUCT10NLEN01NObENCY i0R iME DENfORYANCE OF THE WONK FOR MI/tltl/1H15 PERIAIT IS i55UED(SEG 70Y7.CN.GI.. � lEH0ER9 NAME y}�Y J Ir � IfNDEN'9AOORE55 /� / (/ ICER71FYlHATINAVFRE�1DiHISAPiLICATqNANOSTATETUiTMEABOYE1Ni0iiYAT10NISCORRELT. TOTAL FEES,� ^- i r f� R• f r1 �' / /�f �/ O � IAaNEETOCOMPLYWITHALLUTYANDLOUNT'fORDWANLESANDSTATEUWSREUTW6T00U1LDING l.I ll OI `1�A��:Ci`J [�`��1 ! 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