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HomeMy WebLinkAbout14614 . � • _�� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES - 21660 E.Copley Drive Suite 190 � (909)660-3195 Fsa(909)861-3117 PR ESS " '�'� BUILDING PERMIT APPLICATION FlRMLY ' o ADDRIES Z C Da�CATlO �i 1�1 PERMIT p ,r�/1� � NUMBER #� I � ISSUE 7yPE pCC �[� APN � LOT �, TRACT pATE CONST. GROUP �_ cj OWNER� o ADDRESS ZONING SETBACKS "-' ciTv'P��ti!�.��6/3►aiP TEL. � REAR FW ❑ APPLICANTs�Actr�l-� �� TEL.71,'� 21�351 SIDE/SIDES7REET FW p CONTR/1CTOR -S SIDE p � ADDRE " " � _ pROPOSED USE_11_1�R21ic 1�'fc�fL0�1 ItiIv,�I 17,�uK1L CITY G �v � ZIP G+ Z TELX'� � �S �� ARCH/ENG/ O�G �:a.oF o M1- / �'1 a Sag,T DESIGNER NO.DWEL NO. NO. ADDRESS UNITS STORIES � CITY ZIP TEL. � BEDROOMS �� u� DESCRIPTION SQ.FT. 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A,l� � � .W OATE � •7�i'�(J � CONTMCTOR �r , B ' . � WORKERS'COMPENSATION DECUIRATION , � 1 HEAEBYAFFlimA UNOER PENAITY OF VENUHY ONE OF hIE FOLLO`MNG DE TIONS: N ._ 0 ����� INAYEIHDYALLMAMTUHACEiRIF1GTEOFCONSENTTOSEtFd REFOR KERS' �� - + � . .- � . - .. . ' • , •. �i CdYPENSAT70N,A3PROV1�E�8YSECTIONf7o00FiNEUBOR E.FORTHEVEPFORM W � � � OFTMEWORKFORN�HK7NTHISfERMITISISSUED. i \ � � � "'-,�'�' ' ,�_.. .. ._f ' . '._ '".: Q �I/UVEANDYALLMAMTAWN'ORKERS'COMPENSATbNINSUitANCE, IREDBVS �10N �7000FTMELA80NCOOE,FCRiHEVERFOqA1ANCE0FTHEYVORKfOHWHIpITMISV ITIS _. , � - RSIED.L/YYIOfiKFRS PRlS 10NWSUR CECARHiERANDPOIIl.'YI.UMBENAR�, . 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