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HomeMy WebLinkAbout10561 (5) .._ - _... ---- ---..._ �.-- -------_._._-- ---._--- --� -..- --,---—.�---- - ---- - - - -- --.._ ...... __.. ` _ . � _ � � - C[TY OF DIAMOND BAR� . COMh1UNiTY DEVELOPMENT DEPA E 2166o E.Coplcy Drive Suite 190. I PR ESS � (909)860-3195�aa(909)861•31I7 ' '�"� BUILDING PERMIT APPLICATION FI R M LY � OBSRE '` APPUCATI / ` .G� PERMIT /�S� P/C o ADDRESS ��$�"IV P�A MD�n �A'� ��✓D DATE NUMBER 71 $ ISSUE TYPE OCC APN LOT TRACT DATE C GROUP p OWNER O �Ol� �1 A J> , . . ADDRESS SS�/ N• D�A J�\DOU D fl P NL 20NING SETBACKS . Z CITY Oh" ZIP`/�l TEL9Gy 3�6-b��:�Sr FRONT R�{y�_O❑ � APPLICANT F AL� TEL REAR __ LL � SIDE/SIDE STREET RW O CONTRACTOR SIDE ❑ o CDDRESS z�P TEL ' .ROPOSED USE .5 Lf'A�E STr�GGY�jit-� .F�� -'r'i1 i U N O � o ARCH/ENG/ TI R.E� C!f/'/Fa/CF W DESIGNER NO.DWEL NO. - •.NO. • a ADDRESS UNITS STORIES BEDROOMS � � CITY 21P TEL y DESCRIPTION SQ.FT. 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' . 0 O IAA1 E%EMPT UNDER SEC. � B. .�OR THIS,REASON � U LL" DA7E ONMER � Z W �Q LICENSED CONTFiACTORS DECLARATION ' w [t 1 HEREBYAFFIRM UNDER PENALTY OF PE0.AIRV THAT IM1 LICEHSED UN�ER PROVISqNS OFCHAPTER V. . � � �(COAIMCNCwG WrtH SECi10N 7000)OF DIYiSpN]OFTHE BUSINESS AND PROfES5iON5 COOE,AND Z X IAY LICENSE IS W FULL FORGE AN�EFFECL m • LL O � � LICENSE CUSS LIC.NO. j V DATE � CONTMCiOR d W � WORKERS'COMPENSATION OECUIRATION Q � U � IHEREBYAFFIRYIdAERPENALTYOFiEiUURYON[OFTHEiOILOWIN00ECUlMTI0N5: � � Z Q � �IHAVE�NDWILLMA�HTUNACERTIFICATEOFCONSENTTOSELFaNSUPEFORWDqKERS' S � COMPENSA710N,A5 VROVtDED BY SECTION]�ao OF TNE UBOR CODE,FOR iHE VERFORAIANCE W OF THE WORK FOR WHIC11 THIS GERMIT IS ISSUEO. � � _I XAVE MID VnLL MAWTNN WORKERS CdA7EN5ATbN INSURANCE./3 HEOURED BY SECTION O ]70o OF h1E LABOR COOE,FOR THE PERFORMANGE OF THE WONK FOH WMiCM TM�S PEWAITIS ISSUEO.MY WORKERS COMPENSATION INSURANGE CARRIER AND POLICY NUMBER ME: CONSTRUCT�ON J -- .- > -- -...uaaea __ PIANREVIEW ' " � aoucrnur�eEA ELECTRIC o �sEcrarr�mr�preEoorwterepocn�pEp.asxaor�EMiwt�oatu�sls+x�on�[ssl PLUMBING Z ICERTIfYTHATINTHEVEiiFOW.�ANCEOFTIEYVORNFOiIWHiC11THi5VEMA1TI5155UE0.1 MECHANICAL (J SMALLNOTEMPLOVANYVERSONWANYYANNERSOASTOBECOM[SUBJECTTOTHE . . y WOPoCERS'COUPENSAiqNUW50FCAlIFORNItiANDl1GREETNATIFISWULDBECOME INSPECTIONFEE S SUBJECTTOTHENA�R�(ERS'COUVEN5�710NPRON51ON50FSECTION]7000FiMELABOR • COOE,I 51U.LL iO�fTIM1MTH WMPLV WiTH T1105E VROVISiONS. ISSUANCE 0 SMIP p DATE; APPLICANT: w ENERGY P/C � WMMNO:FNLURE TO SEpJRE N'ORKERS GdAPEN5AT10N COVERAGE IS UNIAwFl1L.�ND SFIALLBE 6UB.lECTANFMPLAYERTOCRN.1?lALVENILTIESANDCNILfwESUPTOONEHUNDREDiHW9AND � ENERGYPERMIT �� DOlLARS�ftoo,000�,W ADDITfON TO THE C0.5T OF COMVENS�110N,�A.MAGES!l5 PROVIDED FOfi IN ¢ SECTIDN77DeOFiNEUBORCODE,NTEREST,ANDA770RNEY5FEE3. ' RETENTIONFEE: a CONSTRUCTION LENDING AGENCY pRE-ALT FEE: ¢ 1 MEREBY 11FFIiW UNDER iENALTV OF PERNRV THAT THEAE i5 ACONSTRUCTION LENONO AGENCY ,� � aZ- FOR TME iEHFORMANCE OF TY1E WORK fOR WHIp17H5 7ER1.1tT IS ISSUED(SEC.70Y7,CN.C.�. � , . W "' � � LENDER'SN�E v (`; 1\i}`..PJ'�JI':+J _ . \ `. [_'. .. � LFNDERSAODHESS � �� � � , . _ �1�' LJ1:•`- = � /�� W ICER71fYTHATIHAVEREAD711I5AiYUCAiqNANDSTATETHATTNEABOVEWFORMATqNISCORRKT. 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