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HomeMy WebLinkAbout15911 (15) F CITYOFDIAMONDBAR� ` � � EXPIRED ����� �� DEPARTMENT OF COMM[JNITY&DEVELOPMENT SERVICES - � zi�o�.c�i�Y nr;��s���90 MAR 19.2002 , ,.._�,._ i' , .;� (909)860-3195 Fax(909)861-3117 . , , . PRE$$ �� BUII.DING PERMTi'APPLICATION ' ' _ FIRMLY o DDRESS �/ ���_�r�l��� !7'I,iJ�= 1�4l1C�. DATE Cp� �- — �r.. ��n NUMB R/ � �� �t� � _ . ISSUE TYPE OCC APN �'LOT TRACT � DATE CONST. GROUP p OWNER '! ''� � c �J "" ADDRESS' �' �� � � '.� 'ZONING SETBACKS �' CITY • , ..ZIP TEL L • ,E� �f'� FRONT RW ❑ � APPUCANT� ' TEL REAR ❑ � SIDEJSIDE STREET RW ❑ CONTRACTOFi '' ,o �► SIDE ❑ � o ADDRESS . - � PROPOSED USE � � ' CfTY� ZIP� TEL � � =� • � ARCH/ENG/ ' • � DESIGNER ' NO.DWEL NO. NO. ADDRESS UNITS STORIES BEDROOMS � CIIY', ZIP TEL. y DESCRIPTION SQ.FG FACTOR PSF A0.1.AREANALUATION � Q � � '� � OWNER•6UILDER DECLARATION �: � . 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B.l P.C.FOq THIS REASON a t� 3 �� c� LL � OATE . . . ONNER � . . . . . �¢ , LICENSED CONTRACTORS DECLARATION � OC � W IHEREBYAFFGWUNDERpENAINOFGEM1AIMTHATIAAIIICENSEDUNDERPROVISIONSOFCWIPTEH � � �(Cq1YENCNO WITH SECTION 7000)OF DIVISION S OF iME BUSINE49 ANO iPOFE55lON5 OODE.AND X AfYLIGENSESWFULLFORCEANDEFfECT. � � � (� �.) I LL � UCENSE CUSS C �`� UC.NO. � � � DATE �)Z ' �'���� �� CONiMCTOR ' a WORKERS'COMPENSATION DECLARATION -� � U N IHEREBYAFFlPMUNDERPENALTYOFPERRIMONEOfiHEPoLLOWIN(70ECUMTqNS: � 2 Q � _IMAVEANDWiLLNAM1NN�CERTIFlGTEOFCONSENTTOBEIF-INSUREFORNGiLCERS' _ � CpAPEN;A7qN.A5PilOViDE08Y6ECilONe7ooOFiHEU�RCO06.FORTNEPERCOi1MANCE W OF iHE WOq7(FOR WH1CN iN13 VERMIT IS ISSUEO. � Q 1 �I HAVE MID MALL YARRAIN WOPo(EHS'COMPENSATION INSURANCE,AS REMIIFED BY SECTqN ��qy //�� Q iT000FTHELABONCOOE,FORTHEPERFORAUNCEOFiHEWqiKWHYYNICHTNISPENMR�S � T1 y�'� ISSUED.AAYWJRKERSCOMPENSATqNINSUfUNCECMRIERANDPDLICYNUMBERME: CONSTRUCT�ON V�� V' � GVWER �t�'�.1��('.�r�,�� J O rO(� Z va�crr�waEn.�,L� ,�.��-'tL�°.. r�i ELECTRIC ' _� .�7 .� o m+3sEcnonroc�raTeecorsa�oarn�rEn.�rsxna�H.ra�ooawusa+oo>oa�ss' . 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