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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGEtE5 BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRE55 21115 E. R
BUILDING , .
ADDRE55 2��.� E. �OCAL�TY
NEAREST
CITY Diamond Bar z�P CRO555T.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT 2 BCOCK LOT NO. �O �3 et ST wal l Z lV �
TEI.
OWNER pi amond Ri d e No. 953-09 2 -u-��-�-
STATISTICAL CLASSIFICATION SEWER MAP
ADDRE55
CLASSNO.�_DWEII.UNITS BK PG
CITY Santa Ana Z�P
NGHNEERT OR NO. VALUATION $ 350.OO
ADORESS BLDG.SETBACK FROM
TE� FRONT PROP.IINE OF !STREETI
CONTRACTOR D�aITW d R� N� - NIGHWAV + YARD TOTAL SEiBACK FROM TYPE OF EXISTING
ADDRE55 ZOO N.. Tustin Ave. NO. fRONTPROP.IINE HIGHWAY WIDTH
LIC. + _
cirv c�ass
CONSTRUCTION LENDER BLDG.SETBACK fROM
NAME AND BRANCH Home Fed S & SIDE PROP:LINE OF lSTREETI
FiIGHWAV + YARD _ TOTAL SETBACK FROM TYPE OF E TING Y
ADDRE55 C�TY SIDE PROD.LINE HIGHWAY WiDTH o
SQ.FT. NO.OF NO.OF CHECK + - V
SIZE STORIES FAMILIES ONE T p�
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DESCRIPTION OF WORK NEW � P.C. Fee 5 Permit Fee � � � �
Retai ni n �val l around ADD ❑ Issuonce Fee � OZ' �
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Edison trans r r ALTER , � z
REPAIR ❑ Tofol Fee ,S ! �
USE OF DEMOL ❑
EXISTING BLDG. Z
APPLICANT TEL �
IPRINTI NO. ~
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BY iSIGNATUREI �
1 HEREBY ACKNOWLEDGE THAT I HAVE READ iH15 APPLICATION AND STATE Y '
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH All ORDINANCES yVj
AND LAWS REGULATING BUILDING CONS7RUCTION.I CERTIFY THAT IN DOING THE _
WORK AUTHOR12ED H REBY I WILL NOT EMPIOY ANY PERSON IN VIOLATION OF 1J
THE LABOR CODE OF STATE OF AIIFORNIA IN RELATING TO WORKMEN S COM- Z
PENSA710N INSUR C Q
o � � 3�,�hs
SIGNATURE OF � � � ��� � .�
PERMITTEE
ADDRE55 2O N. USt I�I V ,Z I " • � �G C
TEL. �
c�TY Santa Ana No 953-0932 Q �, o . i �,���
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