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HomeMy WebLinkAbout13217 (17) . ;i I �� CITY OF DIAMOND BAR DEPARTMBNT OF COMMUNJTY&DE P 5S I �� 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PR SS � ?�^'" BUILDIIVG PERMIT APPLICATION MLY } J0851TE r��j I��.. `n����� � �s'� • T, APPLICATION.��3i�9(�B NUMB R f 32-17 #�� � ADDRESS� _ " DATE '7 � ISSUE TYPE OCC APN LOT TRACT �ATE__ CONST. GROUP � OWNER _�ov.'y�iPCi'' o ADDRES$2 jZ�'S �rYvr _s, �� - ZONING SETBACKS pt � W CITY i �:�a �Y� ZIP TEL.,�"� ? ���iS3 FR�NT EXf"i��� RW U-- � APPLICANT N�� '�C �-�>�_ TEL. ! REAR _ r l_ � —— SIDE/SIDE STREE� -� RW ❑ __ CONTRACTOR �s I�V�S PC�� SIDE " t I__ Q ADDRESS .S��!�.S"` L�ls..sC v� __ . PROPOSED USE ���:n� P �/� � CITY C'h i rd ZIP `P/7/n TEL. •�%�i_' 7.:�� — �� ARCWENG/ DESIGNER 1�/� Y' } 4 ADDRESS ���'� /�!S ,� � �; NO.DWEL NO. NO. y —r------ , )-- UNITS STORIES BEDROOMS �- CITY �IvnhP i l� 21p `I-�f=C��TEL. �l , -��n-(/d ys �' y DESCRIPTION SQ.FT. 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VAiO�NTRACTSFOflSUCNGROJECTSWITHACONTMGTOR(S�LICENSF�PURSUMTNTHEC(JN7RAG � QUANTITY C!ESCRIPTION FEE Y TORSLICENSEUW.1 _ .�_ oLIIRfAE%EMPTUNDERSEC_ _,____.—d.EPC fORTHISRFASON Q � "— _"'-__.__'__ "- � �y � ' onTE �owr+ea---,-- ---- ------ U Z — --- w � —. �e[� LICENSEU CONTRACTORS DFCL.6�RA710N ` W _ !— (S �NEREBY AFFIHM UN�ER PENnITY OF GERILIRY THRT I AM LICENSED UN[lER PROVISION$OF GHAPTER � d 9(LOMMENGNG W�TH SECTION 7000)OF OIVISIOY 30F THE Bli57NESSAN�PROFESSIONS CODE.ANO G _, _,_ MY LICENSE IS IN FULL FORCEAND EFFECT q � UCENSECLA55 C.�,�p�•S� � LIC NO �_�!`.��r� ]', ' � ; ~ DATE^,S'�LS��/ ' CON7ilACTOR_�C/�'�--1��L_� a - - � —__ ! = WORKEHS'COMPENSA710N DECLAfiATION _�,C/ � � � I HEREBY AFFIRM IiNDEF PENALtY OF PEHJUHV ONE OFTHF�Cl'.OWiNG DeC.AqA?IONS ,�� y Z Q. ----_ - � __IHAVE/JillW1LLMAM7AINPCEN71FICATEOFCON3ENTTO5ELF-INSUREFORWURKERS' � _- _ — ^ CCN.1?ENSATION,ASPFiOV:DE0BY5ECfION37WO�THElAt3ORCODE,FOF;7HEPERFUHANNCf `U _ Of THE WORK FOR WHICH THIS PE{iM1T IS ISSUED � O —"-- '_- -- LV _IHAVEANOWILLMAIPfTAINWORKERSWMPENSATiONINStIRANCE,A5flE0UIHEDBYSECTiO� Q37000F THE L4HOA CODE,FOR THE PF.RFOHMANCE OF'111E WORK FGRVJH:CH 71IIS PERMIT IS ���� _ ISSUED.MY WORKEF7$'COMPENSA710N INSURMICt CAHfilEli ANO P0!ICV NUM[lER AAE CON,�iTRUCTION ._, __'- ' ? "�3I� PLANHEVIEW ��_ • CARHIER_'_Y"_`__- __'_-__ _'_'_''"-' __"�— ___ ,y�c;�,�, ;� a � --- ' -- � POLICYNIIIFBER_�`�_LL-��_�---- ELE(:TRIC @ ���-�- -' __ _'�___ '_ '.,.__' ' p (M68ECf1]NNEFUND78EaDA7PLE7EDOF7}�PEiI�°nISfORUJ[V,a.DREUll�LlARsry7ao) � } PWMSING ----.._. .---.-- .--. � .. � -• -:. - -• *--.---- -- MECHANICAL -- - -- , � i.. � , , .:. y..,;' , .. N .:. )� �� �';�';• ,,�.�, . . :, . . INSPECTION FEE — �,c� r , .f..:', '� h'.� � . • , , � ) � GODE,I5HALLFORTHWe�ITHCOMFLYWITHTNO/SE�,�P OVIS/p NS ISSUANCE _.. �SS' �� � �-�Q-7 /Y I�i(d/fp SMIP /,{"gC,r�er,�----'-- p DA7E �.�_!_ APPLICANT �_____ --�-`,-�-� , •� - - -'-� � �_ _ � , , ENERGY P/C ��� a� Jne titi'�•'.' • � .� :. ' V . �'.���. ' , ^ , LL ,. ;.;...�� � . . .:�.�.�., ... ..,4.. .' , ,.�.. . , . 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RECPT.NO. .�-✓-;��c-- r�AID BY __ VAIIDATION ____ �"" �R WHITE—Department Copg YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fde Copy,GREEN—ApphcanPs Copy � � � � , � <�� n— . �� �- � 'y, � s � �3 .� t � 4 ' s � ¢ � `; r, . ,i �`� � � � � � , � � � '� �{� .� t ''� �, � , € �� � ° ° ,�•���°°� ��,�';�� �� �.� � :, ""^� tt` .! .9, I �� , f:..� �.+ 'L�` C: {-s J' �x � �,..� �� ,�.� �' �: �.�u "��.,�...��� �f �� ,.{� � �' � ,�,� .� . s �.�,�.��.w.------'—'_ �^._._----�—_.�._.