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HomeMy WebLinkAbout14174 CITY pF DIAMOND BAR � r D E P A R T M E N T O F C O M M U N I T Y d c D E V E L O P M E N T S E R V I C E S �t 21660 E.Copley Drive Suiu 190 (909)860-3195 Fmc(909)861-3117 PRE$$ �'�'� BUA.DnvG PERNIIT APPLICA'PION FIRMLY o DDRESS ��S~C7 ���WI�K ��-- DATEICATION/ C'p NUMB R I`�l ��� g� u��(?� l 1 c� ISSUE NPE OCC APN LOT TRACT DATE CONST. GROUP �_ p OWNER " ADD ESS ZONtNG SETBACKS � CITY �i ZIP TEL. — — � REAR Rw ❑ b APPLICANT TE� SIDE/SIDE STREET RW ❑ � CONTRACTpR SIDE ❑ g CITY ES 21 + TEL �Q�u ED'US �1 � , QT � ARCHlENG/ � DESIGNER NO DWEL�1 N0. O. ADDRESS UNITS ST�RIES BEDROOMS � CRY ZIP TEL � � DESCRIP'fION SQ FT. 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B.i P.C.fOR 7HIS REASON U Y S � � o117E oNRiER V . � J UCENSED CONTRACTOflS DECLARA710N W � I HEI�YIIFFII41lINDER PEMALN OF PEM111Y THAT 1 AM lN�N3E0 UNDEP VROV19pN80F CFiAPTER � . � ��OOIMENCNOWfiMSECTWN'lo0o)OFOMSION30F7HEBUSINESSANDPROFESSION9G�E,MA Z M1'lICENSEISWFlAlFO�CEANDEFfEGT. I GI � � � GASS I.IC.M0. � . �j p�r� "��. carrn� a w � WORICERS'COMPENSATION DECUIRATI � � 771EREBYAFFIRAIUTAENVIXLLTY�PERNRYONEOFiHEFOLLOWINOO TIONS��/� — N G _INAVENAWILLMMNi11NiACE111FlCA7EOFCaN9ENfiOSELHNSU WRNK7RKER3' � L �pyyENgATpN,/15 ppphpEp gY SEG710N 77oa OFTHE LABOR CC�E. U Q OF7I�WOPo(i�lYhiR]iTNLSVERMIT�SISSIIm. � � _I HlNE MO VV8I.YAINTM!WOWfENS�COMPENSA710N INSURANCF.A5 RC-0UIRED 9V SECTION �./1�,�/y Q �7pp pF7}�ugOR COpE,FOq TIE PEHi'OPMANCE OF 7HE WORK WR WHICFi THIS PERM �� / V RSU�.MY WOFtlfEN3'COMPENSATqN WSUPANCE CARRIEfl M1D PIX1CY NUMBE � .� CANS RUCTION v�./ � �,� o-o�- o a � E��� � �� — " � e� rRic 1���ln o ��r�roreEoe�.r�r�pF7�pBw�r�sror�a� oou�sKao�oa _ �� LUMBtNG � 1 CERTIFY hU1T N iHE PERFOR1A�ftlCE�TME WORK PoH WHICH TM�S P �s . MECHANICAI SW4LNOTEMPIAY/VJNVEN50NNM1YMMTIEN501�5708EC041E911B1EC 7HE y N.pp(EpgCOMpEqS,{7pWUW50FCN.IFOANL1,MmAOREETMT1fI5FpULOBECOME INSPECTIONFEE ' S �R�Cf 7p THE WOWCERS'COMPENSATION PfqVI510N30F SECTION 3]OOOF THE LABOR ' ' _ �/`�fJ OODEISIWL�RiH1N1HCOMVLYWITHiliOSEPRDV19qN5. ISSUANCE �rm,,... � � �� SMIP ".u�u-i�ti�.�� s J 0117E:��C��_.��APPIICANT: � ENERGY P!C ��L�rg���'��rj���j� � WAq1NNO:pULAMETOSEWREW�qticERSCOMPEN�COVEMOEISUtL1WFllL.MAgF1M.l0E LL 9�g,�E��Eldp�pyEp7p CqpA9iAL PENPLTIES Ml�CNIL FlNES UP TOONE HUNDREp 1TqUSAND ENERGY PERMtT OOIU�AS(f1oo,000).W/DD1710NT0 THE GOST OF OOMPENSATIOt/.DAM�GE9 AS PROVIDED FOR IN � sEcrpN�woFn�ueoa000�,wrERfsr.�vro�rrawers�es. � HETENTIONFEE: a CONSTRUCTION LENDINti AGENCY PRE-ALT FEE: � 1 F1ERE8Y AFFWI UNDEN PENALTY OF PENUNY 7HA77HERE ISA CONSTRUCTION IENDINO/VOENCV Z Fpi THE PEPFORGANCE OF tXE ORK iOR WtRCH 1HI5 V AIT IS ISSUED{SEQ 3087,CIV.C.�. W � LO�DEIYS IiAME �S LD�EFSADDRE � . c W �CEq7�F'(iryA7�lUyEREMiHISMP4CAT10NM105TATETNAT7HEA90VE1NFORNAT10N�gCORNEGT. TOTAL FEES /�G'� '� � IMREE ro�MPLY Wl731 AL.L qN MI��MII'ORDIWNCES MA STATE UN5 R9J1TW0 iD BUlDINO CONg7RUCT70N,Afb NEH�Y AUTHORIZF R�RESEHTATIVES�7HI5 COUNTY 70 ENTEq UPON TNE Z �eovEanEwrqnEo, arrcoanuaEcrnr+wnvosEs. 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