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HomeMy WebLinkAbout10302 (5) CffY OF DiAMOND BAR � �_ � COMMUNITY DEVELOPMENT DEPARTMENT 21660 E.Capley Drive Suite 190 (909)860-3195 Fax(909)861•3IU PRESS "'"' BUILDING PERMIT APPL[CATION FIRMLY o� ��RE APPLICATION / q EHMIT �j P/C ADDRESS��q lS GGCon�,3qtin Z it/ DATE � NUMBE ✓ � APN LOT Tqq� y�s�,Y �SSUE 7YPE OCC DATE CONST. GROUP p OWNER �•- /�n �' .�' p A�DRES b � c'ff- C b ZONING SETBACKS "' CITY � •�r` ZIP o2Yl TEL.��Yi�/X� FRONT RW ❑ � APPLICANT TEL SIDE/SIDE STRE[T RW ❑ � CONTRACTOR 'C SIOE ❑ � ADDRESS PROPOSED USE_ <<'�'s�,�i's'✓G' � CITY ZIP TEL o ARCFUENG/ OESIGNER uzj NO.OWEL ,�f NO. NO, n. ADDRESS � CITY 21P TEL. 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U � � LICENSED CONTRACTORS DECLAf1ATI0N W INEREBYAFFIiWIINDERPENALTYOF0EMIRVTHATIM/LICENSEDUNDERVROV1510N50FCHAPiER � � �L/` p.. �(Cd�wEHGNO Y/�iH SECTION 70ao)OF DIVISION]OF iME BUSiNESS M�O iqOFE55qN5 COOE,MID Z � �X W UCENSE 6 W FULL fORCE�ND EFFECL - m � LICENSE CU55 LIC.NO. � V OATE cONiMCTOR a W � WORKERS'COMPENSATION DECLMATION � NIMEf�EBYAFFlRIAUNOERPENAL7YOF0EiWNYONEOFTHEiOLLOWINnDEftAMT10N5: Z � �IHAVEANDVALLMAMTAINACEIiTIFICATEOFCONSEMTOSELFdNSUREF00.WC11ittEii5 2 Q Cd1GfNSATqN,AS ONOVIDfD BV SECTOH 770o OF iHE LABON LOOE,FOR THE VfRFO1WANCE W Q OF7NEWORKFORNn11G17M15VERMITISISSUED. � � �_IHAVEIWDYnLL1MMAINWORKERS'OdAPEN5AT10NN5URMICE.ASHEWWEDBY5EGT10N � 77ooOfTHEU80RC0DE,FORTHEPEqFORM�f10EOFiHEYlORNFORYMIG17Fu5PERMIT�S ISSUEO.MYWORNERS'WM7ENSA710NWSUFLWCEGIARIERANDPOLICYNUYBERANE: CONSTRUCTION J ,. j fARRIER PLAN REVIEW � V0.ICYNUMB[R � ELECTRIC � (flasSEctqNrE�roiBE¢AHEiEDOFMFEaMT6fOfict��a-wtiED07t1/JKR1m10RLFSSI U - Z �CEflTIFYTH�TNTHEPERFORMANCEOFTMEWW�KFORNT11G1hI15iE1WITI5155UED.1 MECHANICAL C7 6NILL HOT EAIPLOV NJV PERSON W M1Y MANNEN SOAS TO BECO�.�E SUBJECT TOTHE �/j M'OPofERS'CONPENSATpNUWSOFCAl1FOqNt�ANDA6REETXATIFISMOULDBCCOAIE INSPECTIONFEE � ��' '�� �� � SUBJEGTTOTMEYlOit1(ERS'CqAPEN5A710NPROM510N50F5ECTqN]70vOF7HElABOR L- �,.:��L _/�. s cooe,i srw.�Fonn+wirx couv�r wrtr nase vAowsans. ISSUANCE � O p DATE: APPIIGWi: SMIP � WAANINf]:FARURETOSECIIREMGRNERS'CdAOENS�TqNCOVEqA�EISUN.AWFULMIOSHALLBE ENERGYPiC — GA�V � 1O4` � SU6IEGTANEMPLOYERTOCRM�iNALVENALTiESANDCMLFWESUVTOONEMINOREDTHOUSIWO ENERGYPERMIT ����' OOlURS(ttoo.000).H�DDITION i0 THE COST OF CGMPENSATIDN,DA7AAaES AS iRON0E0 fOq W � SECTION77oeOFiNELABORCOOE,wTEREST,pNDATfOiWEY'SFEES. RETENTIONFEE: � CONSTRUCTION LEND�NG AGENCY PqE-ALT FEE: � INEREBVAFFRWIRqERFENAITVOFPEitN�TY1ATiHEAE1S11CON5TRUC7�pMlENDNGAGENCY ' Z fOR THE PERiOiWANCE OF THE WONK FOR Vmlpi TNS PENMIT IS ISSUED(SEC.]007.pV.C.). W � IEnIDERS WJJE C LEnOER'SADDRE55 ¢ ICERTIFTTNATIMIIVEREADTlIISMRIGTIONI{NUSTATEiNATT1EABOYENFORAIIRIONISCOfWECL TOTAL FEES I d I AOREE TO COMiLY WITH ILLL CT'AND COUNTY pRpNANCES AND STATE UwS RELAiINO iO BU40w0 � CONSTAUCTKKLAHDHEREBVAU7/qRRER[PRESEMATNESOFTwSCOIMTYTOEN7EHUPONTHE �60VE�ENTY]NEO 7ROPERTY FOR WSVECT�ON VURP06E5. 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