HomeMy WebLinkAbout10284 __.. __._._... ------ ----- -- - ---- ��, - � CITY OF DIAMOND BAR�. • � ,'?�/' � COM6lUNITY DEVELOPMENT DEPARTMENT fV b �,.0 . 21660 E.Coplcy Dmc Suite 190 • " � PRESS (909)860-3195 Fax(909)861-3117 �'^", BUILDING PERMIT APPLICATION FIRMLY o DD ESS��'!�- ��TG�.1 �- APPLICATION r ERMIT /52 /C OATE NUMBER �O R � APN LOT,�_-TRACT � � ISSUE TYPE OCC DATE CONST. GROUP p OWNE�N T�YYt>� �C " ADDRESS C �OX 4C'C� � 'ZONING SETBACKS ' � CIN�G+��N�`�_ ZIP�D��r TEL. �CJG.•C f$3 �EOR RW . p� . APPLICANT TEL. SIDFJSIDE STREET RW ❑ � CONTRACTOR ['�C»aX/L SIDE ❑ � ADDRESS � CITY. ZIP �L. PROPOSED USE C�� � ��OL w ARCWENG/ ". z DESIGNER NO.DWEL i/ NO. NO. _ a ADDRESS UNITS (e� STORIES BEDROOMS � CIN ZIP � TEL � � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION N � . . . 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B.l V.G fOR iNIS PEASON J � _ u" DATE � OWNER �� Z FQ LICENSED CONTRACTORS ECLARATI fL IMEREBYAFiWMUNDERPENALTYOFPERIUMTNAiIAMLICEN5E0UNDFRPHOVI510NSOfCFiMTER � � . � O�COAIMENCWOWITHSECT�ON7DOOIOFDNIS�ON]OFTMEBUSINESSMI�PROFESSIONSCOOE.AND Z �� I.tY LIGENSE IS W NLL fORCEMID EFfEGL m � LICENSE CU155 LIC.NO. j V DATE CONTRACTOR � a W � WOAKERS'COMPENSATION DECLAHATION —� � � IHERE9Yl1FFWMUNOENVENAL7YOFGER7URYONEOFiN[FOLLOWWOOEGUMTIONS: � C �IHMEANDVALLIAAINTAWACERTIFlCATEOFWNSENTiOSELF�OlSUPEFORNOPNERS � COMPENSA7ION.ASPNOVOEDBYSECTqN77a00FiMEUBORCOOE.FORTMEPERFONUMICE OF iHE WONC FOR N771CH THIS PERMIT IS ISSUED. O W _IHAVEAN�WILL4APITAINWORKERS'C0IAPENSATIONINSURANCE.ASREWIREDBY9ECTqN � i7o00FTMEUBOHCODE,FORTHEPERFORMANCEOiTMEVfOW(FORWHICHiH15PERMITIS 55VED.M�'1WRKER5CWAPENSA7IONWSURANCEGIRRIERANDGOLIGYMA.IBERM[: CONSTRUCTION J j uaw[q PLAN REVIEW Z ra�cYrn�uBER ELECTHIC _ ¢ o I�ucnonr+emnoieEm.��t�EocFn[rE�awisroaa+[fura�noatutSR�m�at�ss? LUMBING Z ICEpTIFVTMATN7NEPERFORMANGEOFTHEWORKFORWMIp1T1115PEIWiT1565UE0.1 MECHANICAL (J SHALLNOTEMPLOYMlYOENSONNANYMANNERSOASTOBECpAESUeJECTTOTIE , N N'ORKERS'COAAPENSAiqNLAWSOFCAIIFORNIA,ANDAGREETNATIF15110UL06EQ7AlE INSPECTIONFEE � � � �` ' ' S SU&1EGTi07MENNRKERS'CO4PENSA7�ONPROVISqN50F5ECTqN770aOFiMEUBOR �� J COOE,16NAl1FORTM41THCdAVLYN7TH71q5EPRON510N5. ISSUANGE Y: L7`�% '�f �� � SMIP p DATE: APPLICANT. . 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