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HomeMy WebLinkAbout10056 (5) C1TY OFDIAMOND BAR r ; COMMUNITY DE'VSLOPMENT DEPARTMENT -r,.G 21660 E.Co�ley Drivc Suitc 140 (909)86p.3195 Fax(909)861-3117 PRESS "'"" BUILDING PERMIT APPLICATION FIRMLY JOBSITE /J � AODRESS ZBZZ R NT .-'Y WA DATE�AnO NUMBER �D���� -vJ�4"- � APN LOT__,�2_____ TRACT_ 47851 �SSUE -ryp� �� � DATE CONST. GROUP p OWNER _ �i amnnd Rar Faat Part17Prc p ADORESS R4R(1 Tprranro RIuA Rtg �(L_ ZONING SETBACKS. � ' � CtTY Torrance z►P905Q� rE�.31�-540�99p FRONT � pH, � APPlICANT Richard ould TEL. R� ❑ � S�DEISIDE STR�ET qyy ❑ CONTRACTOR .T_C.C. F.ntarnri�o� SIDE p ADURESS aama ac_nsrnar � Cr7Y Z�P T� PROPOSED USE -�.}1 g e f am i 1 v ra a i r�Pn r P w ARCMJENG/ ��wl�i a aC 2 gdT,�y,e z OESIGNER_Richard Gou1 d W NO.DWEL. NO, yp. � ADDRESS Gam aG ownPr UNITS 1 ' STORIES 2 BEDROiDMS 5 y CITY ZIP TEL. � DESCqIPTION SQ.FT. 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B d PG FOq THI9 pE115pN a � U LL OATE OWNfR W � W R;�� � '�^ � LICE/JSED CONTRAC70RS DECLAAATION W , ,_ ,, ,1 , _, . � 111EREBY AFfIRM UNDER PENALTY OF PfRNRY THAT I W LICENSED UN�ER CROVISqNS pF CHAPTEp � � �(OOMIIENCHN3 WIM SECTION)000)OF DMS10N 3 OF TME AUSINESS�NO PiqFESSpNS COO�Mp Z l J �L�CENSE IS N�ftRl WRCElJlo EFFECL m � UCENSE CUSS— B LIC.NO. �J�J�� � V DATE CONTFL4CTOft -T r r L`r�} a $$$ � WORKERS'COMPENSATION pECLARATlON � � _ � � I HEREBY�FFY��J�1pEN PENALTY OF PEf WRY ONE OF TNE pDLlpWI�DECiAPATqNS� V � C� 6 � .___I/1AVE AND WIIL MMNTAM!ACEflTIFlGTE OF CONSEM TO SELF.INSURE FOq yAqNEFS' _ Q CONPENSA71(N1,ASPqOYWEDBYSECT10H9�6oOF7NElReDRCOpE,FORINE7ERFOWIMlCE U QF THE WMY(ipp WI{Iql THIS PEiWIT IS ISSUEO. W O _ � � _IlLNEANpW1LLl�VJNTANlWpRKERS'COYPENS�TbHINSURANCE,ASREpU�pEDBYSECTqN Q 370D OF THE LABOR COOE,FOR THE VEPFOqYANCE OF THE WORK iOfl WHip1 TM15 PERAfR t3 1- f551lFD.MY M1�RXERS'CAIIPENSATION IN�qAtkE,CA1Rq1ER AND POULY NtAf9ER ARE: CONSTRUCTION � (� j LARRiEq�� ►-� �Tc�-� �1'�"S �U PLAN REVIEW 0 POLICY NUMOER�"..=Q D COC7 I �O'Q � 7a ELECTRIC � ffi6sECmvNE�Noi9EoaREiF�oFilEaErMfsrotlaEhRll+oR�DaW16MOD1oNLffib1 PLUMBING W �/�� 2 �CERTih THA7 W 7HE PFRFORMANCF DF THE WON(FOR WHICH THIS PEPMIT IS ISSVED,1 MECHANICNL ��7- y y_ C7 S�MLL HOT EMPLOY ANV PENSON W u+v MANMEq SOAS TO BRCOME SufllFCf io rNE (/] NOpKER3'OOMYENSA7ll�WUWSOFCAUcoPNI,�Nlo�GNEETIUTIFI5H0ULOBECOME INSPECTIQNFEE � = SUBIECTTOTHEIMD�1KEfi5'COLIPENSAipryPRpY15qN50F5ECTpN3700piTHELA80H � W6E,f SHALL FOR7MVITMCOAIPLY Yf7TH'MOSE PROVI$IONS. ISSUANCE � p DATE; APPLICANT, SMIP lir �lO W J WNwMO�.FFILURETOSEWAEWCNV(ERS'COMPFNSATY7MCOVEMGEtSUNUWFt1�,UA5W1LL6E ENERGYP/C � �`y, SUBJECT Aq EMP�OYER TO CRW MIV.PENALTES M!D CML FINES UP TO ONE HUNURED 7FqU5AN0 ENEftGY PERMIT I� � OOLI.A115(i100,C9D�,W AWITION TO THE COSTOF(;pY�ENSA7IL)N,OMAAOES i1S PROVIDED FOfl IN --� SECTIDN�1u!OF iNE IABON WDE.MTENFS[ANp 11T'fC]qIVEy�S FEES. p�E�ON FEE: � �W CONSTRUCTION IENDIMG AGENCY PRE-ALT F'EE: Q I � lNEREBYAFFINNI%MIERPEN.�LTYOiPER1URYTNATTHEREtSACONSTflUCTqNLEHDMIOAGENCy FOR iNE PEAFOfMfNCE OF iHE YMDRK FOiI WHICH THf3 PEiWITIS ISSUED(SEC.�ea7,CIV.C.). � LEIDER'S NM1E � LFNDER'SADDRESS � W I CEaiKY 7MAT i NAYE 1�Ap 7HI,5 APPLICATqN ANO STATE TWtT THE ABOVE WFORYATpN IS CQFNECT. T�TAL ES � / � � IUiREE70CdAPLYWRHKLCRYANDOOIMT'OqpWANCESNIDSfATEU'NSREUiiNGTOBUN,p7NG '^ COMSTflUCT70N,AA�HENEBY I1UTFqRqE PEPpESENT�TryES OG iXR Cd1NTY TO FNTEN UVON THE ' ��.' ABOVE-MEHf�ONEDPRO�ERTYFQqIN5PECTIONPURPOSES. 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