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HomeMy WebLinkAbout17443 (26) � _�� CITY OF DIAMOND BAA �� DEPARTMENT OF COMMUNITY&DEVELOPIVIENT SERVICES � w .,� 21660 E.Copley Ihive Suite 190 (so9>s6o-si9s F�t9o9>s6z-3ii� PRESS 9�'`' ' BUII:DI1+rn�G PERMrr A N FIRMLY. _ QJOBSITE Z`���� ��4�� C �� APPLICATION I-��,`'1'�1NUMBER�'GT� #,��� a ADDRESS DATE J� � � APN LOT_ TRACT �'/� 9 D TEE � ` TYPE OCC �� � �� � 5 � CONST. GROUP p OWIVER�f��W�l�l�l.� � AbpRESS�i�(���5 "tR=hsAe.►'�c �� '�.✓L StEI°� ZONING SETBACKS . � CiTY S71�n�— ZIP� TEL `E�✓S`7i�i7-�o REART RW O APPiICANT ���C�lD.��, `���a TEL. �j'i'� SIDE/SIQE STREET RW ❑_ � ADDRESSTOR SIDE ❑ p PROPOSED USE ,' -�R'dG�s%I�.� 8✓�" - CI'iY ZIP TEL. � ARCWENGC �� DESIGME3� �r�3�S NO.DWEL. NO. NO. ADDRESS l9'7 . , O ,UNRTS � CITI'�t2klic� ZiP l'EL. „STQRIE,, , S � DESGRIPTION' SQ.FT. ACTOR P5F ADJD.REANALUATION ; � . . ' OWNEE?-6UILDER DECCANATION , SFR/ADa/REM �.����J , .� . . . . . . . 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PLUMBING �"1 \J 6U� ��� � �. I CERTIF'lTHAT IN TtiE FEHFDRMMICE OF THE WflRK FOR WHiCH TNIS PERMIT IS 1S5UE0,I MECHANICAL "*�.",� � C:J'. SNALL NO�EMPLOY ANY PEHSON IN ANY MANNER SO AS TQ BECOME SUBJECT TO THE � (ry�� W09KEA5'COFAPENSAT:ONLAWSOFCA{1fORNIA,ANDAGREETHRTIFiSi'OULDBECOME lNSPECTIONFEE � SIJB.fECTTOTHEIVORKERS'IX7MPENSATIONPAOVISIONSOFSECTION37�OOFhiEL480F 'p �� :.ODE,1 SNAL:FU(itNWITH('AMPLY'MTH77'99SE PROVIulOPdS. ISSUANCE �� �} g��,' DATE: APPLfCANT: �SMiP _ ��'� ' .` ,, , �, - ENERGYP/C �`���7�°� WARNING:FAILURE TO SECURE WP5KER5'COMPENSATION COVEftAGE 7S UNLAW�U4.,ANO SHALL BE ' �y SUBJECTANEMPLCYEflTOCRIMINALPENA�TIESAN�CI�ILFINESUPTOaNEHUN�kEOTHOUSAN�7 ENERGYPERMIT I DOLLARS�SiM,aoO),INl�DI110NTOTHECOSTOFCOMPENSATIqV,�AMAGESASPftQ410E0FORIN -- �I �., � SEC?ION37oeOFTHEl,ABORCODE,MYEREST,0.NDATTORNFY'SFEES. FETENTIONFEE: '�� � '�, Q �� CONSTRUCTION tENDING AGC-NCY PRE•ALT FEE � „ ��� IHE9EBYA�FIRMUNDEEi7ENALTYOFPERJUftYTHAT7HEfl'ciSACONSTRUCTIONLEN�INGAGENCY � 1� , FOA iHE PERFORMANCE OF iHE WDRK FOR WHICH THIS PERM�T IS ISSUED(SEC.3091,CIV.CJ. . , �� LENDER'S NAME ��'�°'� � - � , . 6-�. LENDER'SR��RE55 I�' w��, ICERTIFYTHAFItIAVEAEADTH(SAPPlICA710NA�O5TATETHATTHEABOVEINFORMAT10NI5CORRECT. TP1L�E�S � f{,� ^(p� �I �:��„ IAGFEETOCDMPLYWII"HPLLCITYMJOCOUNTY-OROINANCESANOSTATELAWSRELA77NGTOBUIL�ING ' ✓'��Y�"�� ' �� CdNSTRUCT10h,ANDSiEREHYAUTHORIZEfiEPAESENiATNESOFTHISCOUPRY70ENTERUPONTHE ' . _„�,,,�_ ...--:—''�--" '. ''� '�, �. A90VE�MEN7IGN�PROPEFN FOR INSPECTION PURPOSES. OMMENTS -� —�� � � . �', ' � 4.. - � - ,. ', ' , �� �,, PERPAIiTEE NM1E{PAINT) ' . � ��J � q i ' . . �' � ���� �� ' , � SIGNATUREOFPERMITTEE DATE .�E = FECPT.N0. 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