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HomeMy WebLinkAbout12633 ... _. ._. .. . . ._. ._._ ....:--- .'-.. �- ' --��-------.._-.- "--"�. �--•' - --�--�---- --�—�--- ---�-- -_�._ ,_�' .__,-�—_ . . . � , ' CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660&Coplcy Drive Suite I90 PRESS � (909)860-3195 Fax(909)861-3117 4'�"� BUILDINGPERMITAPPLICATION FIRMLY JOBSITE ' APPLICATION �yI PERMIT P!C o ADDRESSIr7 D I D E��(N�"E R DATE II`�0'�d NUMBER I 2633 � � APN LOT TRACT DA EE / D_��'/ TYPE OCC p OWNER l7 I�. D H/s N_D r l-/ a CONST. GROUP ADDRESS 1 S O I ��_it�1 NE�E� 20NING SEiBACKS • . P�" CITIf�A M O NrJfiA/�p �l76 TEL. FRONT RW ' ❑ S APPLICANT"3LC-MEGHANICnG- TELE22�i� 3 `/ REAR ❑ � SIDE/SIDE STREET RW ❑ � CONTHACTOR �L MEC!/A/v/�R L GO� /NG SIDE ❑ � ADDAESS 23! 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B.1 G.G iOR THIS REASON U �=" OATE OWNER . . . . z V . F¢ LICENSED CONTRACTORS�ECLARATION W --- . , ' ' . 2 INEREBYAFFIRMUNDERPEN�LLTYOFOERAIRYT/U71+1MUCENSEDUNDERPROVISiON50fCHMTER V. �p„ 9(CpAMENCWO YATFI SECTqN 7DOD)OF DMSION�OF THE BUSINESS IW'J VROFESSIONS COOE,AND Z X A('I LICENSE 6 P!FULL fOfiCE MIO EFFEGt . m � UCENSEC 55_ � 2O LIC.NO. � � �� � v p,�� 3 'ZoO� conrw�croA � . w � WORKERS'COMPENSATION D ATIO Q F v o a�al � � � IHEREBVJIFF6WUN�ERVENALTYOFiE0.Alth'ONEOFTHEF LOYWIODE4ARATIONS: a (�i�N� KSEr'�' � S T�� O O G �INAVEANDWILLMAINTAWACERTIFlGI7EOFCONSENTTOSELF•INSUR[F011WON(ER4' S �/�QE/�/SEP � � �� I VO � COAIPENSATpN.A9PROVDEDBYSECT10NJ7000FTHEUiBOfiCODE,F0117HE7ER�ORMMICE U OF THE WORN FOR WMICH TMIS PERYIT IS lSSUED. � O r Z C �1 MAVE AN�WILL MAINTAM WORKERS'COMPENSATION MSURANCE,FS REOUIRED BY 8ECTION . O �700 OF THE U1BON CODE,i0P TME FERFORYANGE OF TME MfIXiK f-0N riHIQ/TIUS VERMR IS ISSUEO.A+YWORKERS'COMPENSA710NP1StXiAHCECMRIENAN�POtICYM1MBENME: CONSTAUCTION � � GMRIER CQ'��G�M P PUW REVIEW � POLIC�NU18Ep �'r Z ELECTRIC ' 0 (na55EcrcN1�E�NOTeEmAaEimofilEVERui6KAa$Hl11DRm00l11f�S6�mICaLE561 PLUMBING M Z I CER7IGYTHAT N THE PERFORMANCE OF THE Wd�K FOR WHId1 THiS PEiU1tT 4S I55UE0.1 MECHANICAL D�OV (,'} SMKLNOTEMVLOYN�'/FERSONWANYM�NNERSOAST08ECAMESUBJECTTOTME � WORNERS'COrAFENSATIONUW50FG1UFORNI IWD REE7HATIF15/qUDBECOME INSPECTIONFEE S SUB.IECTTOTHEWORKERS'COMPENS�TIONV IS SOFSECTION7700OFiMELABON coo ^sHui� an�vnn+cauairxnn�t e isar�s. ISSUANCE -� 0 SMIP p DATE'.?� � APPLICAM: W ENERGY P/C WARNiN6:FALURE TO SECUi1E M�OFiKERS' OE TqN COVE E IS UNUIWFUI.AND SHALL BE LL 6UBJECTANEIAPLOYERTOCRWa1+LL0EWLT1 CNIIFWE PTOONEHUIOREDi1Kri13AN� ENERGYPERMIT DOILAM�itaO.Dao�HADOrt10NTOiMFCOSTOF PEI:SA7 ,DAMAGESASPROVDEDFOHW ¢ BECTiON17wOFTNEUBORLOOE.INTERE9T,AN0ATTON�EY5FEE3. RETENTIONFEE: oW„ CONSTRUCTION IENDINO AGENCY pqE•ALT FEE: O Q 111ERCBYAfFwA1UN0ER7ENALTYOiPERrt1RYTHATTIIEPEISACONSTFUCT10NLENDlWAGENCY � d fOq iHE PERFORMNICE OF THE WORN PoR WHId17H5 GEHMR IS ISSUCD(SEG ioq,CN.G.). , .� ��n � LENDER'SNAME � LENDER'SADORE55 � ICERTIFYTFIATIHAVEREADTHISAPVLICATIDNMlOSTATETIUITTXEABOYE►IFORIAA7qN�SOORRECT. TOTAL FEES NOV 10 1998 M r ^ ' � IAGREETOCOYGLYWITH/�LLCT'INDCOUNTVORDIN�NCESANDSTAT[UMfSREUTW4TOBUlDINO - �, / ) �/_ O // CONSTRUCTION.U!D HENEBv At1ri10iLZE REPRESENTATIYES OF iN15 COUNTY TO ENTER UPON THE v S� ABOVE-4EHTIONEDPROPERiYFORwSPECT10NR1RPOSES. COMMENTS C1TY OF DIAMOND BAR J� � � cf,rAP-�c's s.�-i sa►✓7i T�1�'`'1 BUILDING AND SAFET m PERMITTEE (WNn � � � /1 �o ?g . y bKiXA OF i ATE � RECPT.NO. PAID BY VALIDATION WHITE—Dep�rtment Copy,YELLOW—Finana Copy,PINK—Ausseor Copy,GOLDENROD—File Copy.GREEN—ApptkynnCe Capy . . .. .. . . ,. . . �, . . . 'r�. . • '.. �. .. 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