HomeMy WebLinkAbout12346 (11) 1�, CITY OF DIAMOND BAIL �"' DEPARTMENT QF COMMUI�IITY&DEVELOPMENT SERVICES �-� � �; 21660 E.Copley Drive Suite 190 � (409)86Q3195 Fau(909)861-3117 PRESS� BUILDJNG P�RMiT APPLICATION FIRMLY p� JOBSITE �7, APPIICATiON PERMIT 2�� P/C ADDRESS iZ�i��,L,dJ���Y�er• DATE ���� �$ NUMBER # � APN LOT TRACT �uE � TMPE �C —T— U�� DATE CONST. GROUP } p OWNER & Y � p ADDRESS �l�1M.o-ON ZONING SETBACKS w GITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL.��� REAR ❑ ; � � SlDE/SIDE STREET RW ❑ CONTRACTOR + SIDE ❑ � AD�RESS PROPOSED USE i� :.�} S �'}RG�/` I o CITYpi�f�.i. � ZIP TEL.q�'� � � w ARCH/ENG/ � DEStGNER � AD�RESS NO.DWEL. . . a CITY ZIP TEL. UNITS STORIES �""` BEDROOMS � tn DESCRIPTlON SQ.FT. 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PLUM6ING � Z ICERTIfYTU71NTHEPEAFOflMANCEOFTHEWOPKFOHWHIC47TH75P£RMITiSI55UED,1 MECHANICAL i �� (j SHALL NOT EMPLOY ANY PERSaI M ANY MFNNER SO AS TO BECOME SUBJECT TO THE �%c (n WORNERS'COMPENSATIONIAWSOfCALif-0pNIpANDAGREETNATIFI5HWL09ECOME INSPECTIONFEE S SI�HlEC1T07V�WORKERS'CDAIaENSRi�IdPROVISKKJSOFSECTION97000FTHELABOR CODE, 6HNlFORTHWITHC(kAPLYWITHTHOSEPROVI510NS. ISSU�4NGE � SMIP � � OATE: APPLICANi:� WARNIN6: RURE TO SECURE WIMKEHS'COMPENSATION COVERA�E IS IJNUWFUt,AND SHALL BE ENERGY P/C � SU&IfCT M!EMPLOYER TO CqSMMhL PENNTIE3 AND CM�FINES UP TO ONE HUN�RED THOUSAND ENERGY PERMIT DOLV�RS(i/00,000j,IN MOI71a!TO THE COST OF WMPENSATIDN,DAMAGES RS PflOVI�ED FOR IN � SECTION 3108 OF THE IAHOR CA�E,iNTEREST,AND A7TORNEY'S FEES. RETENTION FEE: q�. CONSTRUCTION LENDING AGENCY 0 PRE-ALT FEE: � 1 HEHEBY AFFIRM UN�ER PENALTY OF PERJURY THAT TNERE IS�CONSTAl/CT1ON LEN�ING AGENCY Z FOH THE PERFOfiMANCE OF THE WORK iOR WHIGM THIS PEHMIT IS ISSUED(SEC.7087.qV.CJ. � l3J "�C LENOERS NAME � � LENDERSNDDRESS � 1 CERTFV THAT I HAVE READ THIS MPLICRTION AND ST�TE THRT THE ABOVE INPoRMATION IS COflPECT, TOTAL FEES ' � � fA6REETOWMPLYWfTHALI.CITYANDCOUNTYORDINANCESANOSTATEL4WSREUTINGTOBUILAING � CONSTRUCTION,MIO/IERE9VAUTiqRIZEREPRESENTATNE50FTHISCOUNTYTOEHiEqUPONTHE P&]VEYEN�IONEOAROPERTYfORfNSPECT�ONPURPOSES. /� � � � COMMENTS � l� � � �j� a J a PEMMiSEE M1E RBfT) u � � N � 5101UNRE OF AMITTE DATE RECPT.NO. PAID BY VALIDATION WHITE—DepaRment Copy,YELLOW—F'm»nce Copy,PfMK—A.ssessor Copy,GDLDENROD—FiieCopy,GREEN—ApplicenYs Cqry l �I'1"Y C7F [31�►Mt�NE'� �AI� " 1R9�PE�T1CaN FiECO�t� s k � l � � �� �� ��� SET E3R�K • � . 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