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HomeMy WebLinkAbout10575 --- - _._-__� \ _-_;--�_---- ------ ---�--�--, � ' CITY OF DIAM�ND BAR�: COMMUNTTY DEVELOPMENT DEPARTMENT ;., ' Zi�o�.coP��y nriY�s��c�i�o . � . ESS (909)86a3195 Fax(909)86l•3117 ' '�". BUILDINGPERMITAPPLICATION FI LY . �...� -�RI� �7'��� I J�m OR� � 1.>1Y0. DAPE CATIO �1 NUMBER/OS7� �� .. � ISSUE ' ' O TYP�E OCC APN LOT TRACT DATE� '3 C005 . GROUP g OWNER � Y'O DA �'` ADDR S OY1 V ZONING SETHACKS '. •� FRONT _ O C T (I .`;��_ ❑ CfTY ' r ZIP TEL � ��jAPPLICANT C TEL. L .• - l l0 REAR O � SIDE/SIDE STREET RW ❑ CONTRACTOR SIDE ❑ o ADDRESS � 3� ' s. _ � PROPOSED USE � �n PL � I o CITY�aYi "1��mriS. ZIP �1l��TEL �� o ARCFUENG/ , � . . zW DESIGNER NO.OWEL. O, - - NO. a ADDRESS UNRS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. 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' � �� �(COYYEHCWOWITNSECT�ON7oao)OFDMSIONlOFTHEBUSINESSANOVROFESSqNSCOOEAW Z YV UCENSE IS N FUIL fOi1CFAND EFFECT, m � �e�12..�� . � � LICENSE CUISS LIC.N0. � � V OATE CdRRAC70R C�� �h�' � . W � WORKERS'COMPENSATION�ECLARATION a _ � U � I HEi1EBYAfFlRA1 UNDER PENKTY OF iEM1RY OME OF THE FqlOM7N0 OELLMATqNS: � • y Z . a O �I MAVE Mq IMIL IMNTAlN A CERTIFICATE OF CONSEMT TO SELFJILSURE Fdi NIOfKERS' _ Z COAIPEHSATION,A9PROVIDEDBYSEC710H77ooOFTHEL�BOHCODE,FORiHEPERPDRMN7CE U � � OF iME YYORK FOR YVMICN 71Y4 iEHuIT IS ISSUEO. � 0 � 1 NAVE AND WILL MAIHTA�N WORKERS CdADENSAT10N RSIIRANC£,AS REOl11NED BY 5Ett10N / (� t Q 77o00FiNEU180RtO0E,fORTHf7ERFOiM1ANCEOFiHEWOitKFOHWMLHiHISPEfMeT15 //�G � �J -ISSVEO.MYWORKE COMPE ATqNINSURANCEWRNERANDPOl1CY1MIBERME: TF'1UCTI � 0 oaK.w�efn ��11f�E'-h Fc�,P� ' �, - -PLAN REVIEW._ —-- � ELECTRIC � (I}65EG710Nt�rqTBEOOLitETEDOfhEFEaMRSR7fi0NEHt1aqED0aiNGR��1��I PLUMBING Z I CERTIiV THAT N TME PERfOHMANCE OF iHE Y1CMK F00.WNICH THIS PERYRiSISSUED.I MECHANICAL (� SMILLNOTEYVLOVANVOEASONN�NVUANNEN50A3TOeECOMESUB.IECiTOTHE . . , � MVRNERS'COYPENSAiIONUW50FCA1.IFORNI�ANOAOREET1UTIfIS110UlDBECO4E INSPECTIONFEE S SU&IECTTOMEWDIi(ERS'COMPENSATqNPROVISqH50FSEMqM770oOFiHELABOR 1S u h . M,;,\ -�" COOE.ISHALLiORTHWI7MGOMPLYYnTNTF1D5EVROV15�G/5. f. J G � SMIP —� � � p DATE: APPIIGNT: � W ENERGY P/C WANArq:FNLURE TO SECURE NONKER5 COMPENSATION COVEMOE i5 UNUWFUL,M1D SNALLlE � ^ n � bl18JECfANEMROYER70CRMNALPENALTIESANDCMlFNE3UPTOONEMINDREDT�W3AND ENERGYPERMIT ��I ��' 1' �UO7 DOUARS(f1 W.0001.W ADDITION i0 iME COSTOF CqAPEN511TI0N,OAYAGES AS PROVDEO iOR N ���,��7�,, � � 6ECTiONf7wOFiMEU1BORCODE.NTEREST.ANDATiORNEY'SiEES. � � RETENTIONFEE: . . d CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � . 1 MEREBY I1iF WY LINDER VENALTY Oi iER1URY TW1T MERE lS A CONSTRUCTION LEHD�q AOENCY iOR TME 7ERFOiWnJ10E OF iME WORK FOR WHK71 T115 VE W.11T IS ISSUED(SEG]M7.CIY.G► . . . � .�. . � IENDER'S WWE ' � G.ErOER'SADDRE55 - � , , W ICERTIFYTHATINAVEREADMSAPPUCATIONANDSTA7ET1ATTIEABOVENFOiIMAT10N1400RNECT. TOTAL FEES �j�lf� '3�� � IMiREETOCOMPLYWITHILLCRYAMDCOUJTYORDwMrCESANOSTATEUWSREUTNCiTOBUIDING v � CONSTHUCTION,AHO NEREBY AUi110WIE REPRESEMATNES OF THIS FOIRIN TO EHTER UPOH THE , S� 11BWE�EOPRDPERTYFq11N5PECT RVOSES. . COMMENTS � � � iEW1iTTE Mn ..- . e � �(� ;pN� E ♦ OA7E � .,�, .�• _'. �- :.�. , �. ;'•`' RECPT.NO. a Q P,VDBY �K Y c-3 VIWDATION WHITE—Mp�nm�nt Copy.YELLOW--Fimno�Capy,PINK�Mwwr Copy,OOLDENROO—FfM Capy,aREEN�11pp0anCs Copy - ' � � . � . - . �� ._r r .�. . ..' i.. � . .. . . , . .. � �.. . i .. .,. . . � . �� . . ....�. ... �j�' ., . . '� -.:.I: :1'�.�:v.. +.1„'].i..;. � � � CITY OF DIAfY01�lD':C3AR �: '��'- r�"' - � ,; ,,.•�., : r,•�::�� i :.:��•..;.... :�.i •�' 'I 'I �•"'� ' ' . � _ .;�`_ �'' II�SPECTION RECORD': _ :' ``" _ `� - . � .. . . . � . 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