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HomeMy WebLinkAbout10621 � j� �kp� CiTY OF D(AMOND BAR � ��`O COMMUNITY DEVELOPMBNT DEPARTMENT 21660E.CopleyDriveSuite190 eT o� PREss (909)86a3195 Fax(909)861-31 l7 � �''"'� BUILDINGPERMITAPPLICATION ?��� FIRMLI� Q JOBSITE // ,�J �¢����. � �� APPUCATION �� �� PERMIT P�C 4 ADORESS �15,l,,J �/ DATE NUMBER # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER � �'. �'- ! ✓* ZONING SETBACKS o ADDRESS ,!',�:1/�! i � � J �.�- i r,� 1 � �j�ZIP TEL. �7� FRONT pW ❑ CITY ^�'�Q�/ APPUCANT TEL. R�R � � � SIDE/SIDE STREET RW ❑ CONTRACTOR -° r�t t SiDE ❑ � ADORESS PROPOSED USE ' CITY,.�G� �9�'1c! ZIP �TE . `/ o ARCH/ENG/ � DESIGNER NO.�WEL NO. NO. ri ADDRESS UNITS STORIES BEDAOOMS � CITY ZIP TEI. �j DESCRIPTION SQ.FT. 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A. � C^" � IHAYENI�MAILMAp7TAtNACERTIfiGTEOFWNSENTTOSELHNSUREFONNbW(ERS 1 C04PENSATION,ASPIIOVIDEOBYSECTION]7000iTHEU180RCODE,PDRTFIEPERPoRYANCE W OF iHE NbRK FOR NMICVI TMI5 PENAl1T IS ISSUEO. � O w _INAVEMAM7LLW�MTAPIWORKENS'COAIP�NSATIONINSUqANCE,A5RE0UiH.ED8Y6ECTION / � d a�aoOF TiE UPOR CODE,Fdi 7NE PERFORMANCE OF TNE WOFK PoR W/11d1 TWS PERMR IS � �Z� � 3J �SUED.MYN�OHKEAS'COMPEN311TIONINSUF�NCEGIRFIERMlOPOIIGYNUM6EPAAE: C�SjAUCT�ON �✓ j CAHiUER PLAN REVfEW t � 7�UCV NUMbER ELECTRiC ! � �SSEC�ONryE�Np7gEdpMRFf�Ofn#pEpdfsiOpp�EMll![1ll�pxiMs�yroo�oqlEss�, PLUMBING ,� Z I CEpTIF/THAT N THE VEPFORM�NGE OF TME WORN iOR NMiCF1 THIS PEiUAR 19 459UED.l MECHANICAL l !' (� SNALI.NO7 EYP�OY ANY VEPSON W ANY IMTYJER 50115 TO BE E SU9JEGf TO THE WOPo(ENS'COAIPENSATqNUW50FCpLIFORN10.AN011�REE iIFISHOULD ME INSPECTIpVFEE �'� � 6UB7£CTT0154EWOR�tERS'CO0.I�ENSPTpNPROVI O ECTION]T00 LABOR � � cooE,is�uuFor�r�+u�nn�ca�r�rwirn� s. 45SUANCE ,� rnn-, l � -���� �-� . QO OATE�J` APPIICANT. .����L./ 9MIP + • e ' � WAPNIHti:FA�WRETOSEWFiENR�RKERS'COYPENSA7X?NCOVEHIU7EISUMAWFUI,MDSH�LLBE ENERGYP/C �y SUBJECTAyENPLOYERTOCPWMALPEWITIESANOCIVILFMIESUPT�ONEHVNOREDTNIXANlD ENERGYPERMIT DOtAARS(floo,o00).Ml ADDITION TO hIE fASiOF COMPENS�TqN,UMIAGES AS VROV�DED FOR IN � SECTION77PoQFiHELA80RC�DE.MITERES7.AND�TfORNEY'SFEES. RETENTIONFEE: q CONSTRUCTION LENDING AGENCY o PRE-ALT FEE: � IilERE6YlIFFli1MlINDEqPENALNOFPEiWRYTHATTHERE1bACONSTRUCTIONLENDINOAGENCY FOR TME VERFORIIANCEOF TNE NiONK FOR VAi1CFf TNIS PERA/1T IS IS9UED�SEC.�OW,C1V.C.�. � � IENDEH'6 NAME i� IENDERSA0DNE35 � tGEX71FYTHA�tHAVEREMTM�SMRJCMIONN�DSTATETH+1TtHEABOVEINFONMATIONISWHRECT, TOTAL FEES a 1 A(iNEE N OOAAPLY NnTN ALL CITY Mm COUNT'ORO�NMICES�N�ST�TE LAWS RELATINC TQ BIl�l0�N6 CON&TR1)CTtON,/�ND NEREBY AUT110RI2E REPRE8ENTATIVES OF TNIS COUNTY TO ENTER UPON THE � ABOVEAdENfIONEDPROOERTYFORINSPECTIONVUHPO$E5. 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