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HomeMy WebLinkAbout16615 (9) . i . . .._.._ .. _. J� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRES$ �'*"� . BUII.DING I'ERMTI'APPLICATION � FIRMLY o DDRESS �� �I L.O ��D�W�� `''�' DATECATION ����` NUMB R�� �/C � APN LOT TRACT ISSUE TYPE OCC ��--�- DATE CONST. GROUP � OWNER M.4/CK �!K�l C�i 1 p ADD ESS NtVCet� �C�V• ZONING SETHACKS � CITY Z�pq/7�9 T Q y FRONT RW ❑ APPLICANT TEI. C REAR � � SIDE/SIDESTREET RW ❑ CONTRACTOR r � FI2 .Vc. SIDE ❑ � ADDRESS u' CITY D�s/S.ni... �.. ZIP TE� � PROPOSED USE � ARCH/ENG/ DESIGNER NO.OWEL NO.. NO. ADDRESS UNITS '� STORIES +-- BEDROOMS � CITY ZIP TEL. N v� DESCRIPTION S�.FT. 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O�AA1 E%EYPT UNOEN SEG 6.i V.G FOR THIS REASON Q U �=" DAiE OWNER r" � � W LICENSED CONTRACTORS DECLAHATION w � iHEREBYAFFIPolUNOERPENALTYOFPERRIRYTHAT1lUALILENSEDUNOERPRONSION50FCHACTER � . s �(COW�ENCUWW17HSECT10N7000I�OMSiON]OFTNEBUS,NESSMOPROFESSIONSCOOE,AND Z W LICENSE IS N FUII FOqCE AND EFFECL m � uc�cuss �- 20 f. ��c.No.7� � � � �"j o�h /�t �n / COMRACTOR�QL��� a W �r T � WORKERS'COMPENSAnON DECLARIUIOrf/S �"' a �. ��,M N IHEREBY/�FiIRMUNDERFENAL7YOFPC0.MttONEOFTNEFOLLOWINOOECUMTIONS. Z a St• S_ � _IluVEANDVAILWMTAwACEPTiFICA7EOFCdNSENTTOSELFiNSUHEFONYVORKERS' S ��, � CO�PENSA7ION,ASVROViDEOBYSECTOH]7ooOFiNEUBORCOOE,FOi1TNEPEHFOMIANCE W Of TME WOFlK FOR YMlpf TNIS VEA�IT IS ISSVFD. . � O �I HAVE M10 N'ILL W VNTAN wORKERS'COMPENSATION INSl1RIVJCE.►S RC W�RED BV SECTqN � 97ooDFiNEL/BOROODE,FORTIEPERWFAIMICEOFTHEWORKiORMMICNiMISPERURIS � LSSUED.MYWORKE C,CLl�VCNSIRrIONINSUR/WCELARRICqANJGOLICYNUMOERAlIC: CONSTRUCTION � uwaER�,C� /`V��' PLANREVIEW � POLIC`fM11ABER '�'7 9�!1 / �itJi _f1 I_�7_]/� ELECTRIC —���-rr� � �sEcrorr�wreeoa.s�ermanevEw,+rrswau+eHror��oat,vsK+oo;ora�css} PLUM��NG � �CERTIFYTHl1TINTf1EVERFIXIMANCEOFTNEWORNFORV.NICHTHISPERMITI5t55UED.1 MECHANICAL SH�ILNOTEUPLOVM1VVER50NINANYMANNER50A5TOBECOMESUBJECTiOTHE �� '�"^�+- � WOPKERS'COIAPENSATqNlAW50FCALIFO�UIUTANOAGREETFWTIFISMOULDBELOYE INSPECTIONFEE �� ��I��������w • S SU6IECTTOTHEWOwcERS'C01.1PENSATbNPROVISWN50F5ECTqN]7ooOFTHGUUOA T•�7 I caoE,�sw�conn�vnrn coua�r wirn rrasE rnowsioys. ISSUANCE �J.V � SMIP p DATE: APPLICANT: - . � ENEFiGY P/C WMNINO:FALURE TO SECURE WORKERS'C01.1PENSATION OOVEMCE I i VNlAY1FUL,AND SHALI BE � � EU&IECTANEMPLOYERTOCAIMINN.PENALTIESANDCMIFINESUPTO0NEINPIDREDiTKrilSAND ENERGYPEAMIT OOLL�HS(f 100.000).M ADDRION TO THE COST OF COMVENS�TIDN,DAMAOES AS PFlOVIDED FOR ml ¢ SECTIONf70lOF7HEUBORCODE.NTEREST,AND�TT01iNEY5FEEi RETENTIONFEE: -- - a CONSTRUCTION LENDING AGENCY PREALT FEE: O � IHEREBYAFFlR/AIM�ERiENALTYOFPERNRYTHA7THEREISACDNSTaUCiIONLFNOwC11GENCY Z iOR THE FENFORMMICE OF THE Wd1K FOR NM1CFf THIS PERAIIf IS ISSUED(SEC.]oY7,CIV.C.�. . W � IENDERS NAME � IENDER5A00RE55 W ICERTIFYT1uTINAVEREADTHISAPFLIGTIONANDSTATEiW�TT1EABOVEPIf01iMAT10NI5CORRECL TOTAL FEES ��'�+ � � IMREETOCOMPLYWfT1iALLCRYANDCOUNTYOHOINANCESMI�STATEUNSRELATMIGTOBl1LDIN0 CONSTAUCTION,M!D NEFEBV AUMORRE RCPRESENTATNES OF TW S COUNTY TO EMER UPON 7NE S� ABOVEd1EMqNEDFNOPERTYFORINSPECT10N7UAPOSES. 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