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HomeMy WebLinkAbout18204 (17) J� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES ��� 2I825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS ��-�� BUILDING PERMIT APPLICAT[ON FIRMLY } JOBSITE 7��7� /'„��--� �U�� DATECATION r_� I�`�� PUMBER #,C o ADDRESS��,J w-rr�� �a v•q► c� ISSUE TYPE OCC -- APN LOT TRACT DATE CONST. GROUP p OWNER lJ��. ���/ AODRESS ZONING SETBACKS z C��, �. FRONT RW O S APPLICANT TEL. REAR p � SIDE/SIDE STREEi RW O c� CONTRACTO SIDE ❑ � ADO � o CITY ZIP TE � PROPOSED USE` . �� � '� o ARCH/ENG/ �l-� ,r � � DESIGNEFi NO.DWEL N0. .�� ADDRESS UNITS STORIES � CITY ZIP TEL. � � BEDROOMS � OESCRIPTION SO.FT. 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B.a V.C.FORTMIS REASCN � � DATE � OWNER � � ', UCENSED CONTRACTORS DECLARATION w � IHEHEBYAFFlRMUNDERPENALTVOFPERIUNYTHATIAMLICENSEOVNDEROROVISIONSOFCHAPTER Ur � 9(COMMENCINf3 WITM SEGTION 7000)OF DIVISION J OF THE BUSINE55 ANO VROFESSIONS COOE,M1D Z �� MY LICENSE IS IN FUIl FOFCE ANO EFFECt m � UCENSECLA/SS �� ..L� LIC.NO. -� � V DATE L�����CONTMCTOR a W � WORKERS'COMPENSAT�ON DECLARATION a N IHEREBVAFFIRAIUNDERFENAL7YOFPERNRYONEOFTHEFOLLOWINGDfClAMT10N5: U � 6 C _I HAVE�NDVNLL 1.WNTAM ACERTIFICA7E OF CONSEMTO SEIF�INSURE FOR WORKERS' S '� GOM7ENSATqN,ASFROYlOEDBY5ECT10N77ooOiTMElA80RG00E,FORTVIEPERf-0HMANCE U Q OFTHEWORKFORVMIp1THISPEW.�ITI5155VED. � � — _I HAVE AND WILL/AAINTAIN WORNERS'C0IACENS�110N INSURANCE,AS REd/IpED BV SECTION }� Q �7000FTHELABORCOOE,FORTHEGERFORMANCEOFTHEWORNFORWHiCNTHISPERMITIS v ISSUEO.MYWORKERS'CW/PENSATIONINSUMNCECARHIERAN-D,PO`IICYNUMBERME: CONSTRUCTION � cawaiER S'�rr'�r-- ��J�fi� PLAN REVIEW � POIICYNUMBEFl ' � ELECTRIC � (11-55ECf10NN[mNOTBE00AilE'(EDOFhEPERMT5Poi1aNE1Rl�OpED00llAftS(S100IOqLF55? 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SEPTICTANK - .� LANDSCAPE/IRRIG. � SEEP PIT/LL � O"J SITE IP.�PS. GAS AIR TEST � FINAL ZOidING FINAL CONST. � F!RE D�PT. FINA!. FINAL HEATING � �— � I HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FI�JAL PLUMBING EPdERGY :Y'jn"=F'^' rj;#".�F_;�,—."_ — CUMMENTS � � SEPTIC TANK SIZE SEEP PIT/U SIZE ______ I F�� ��+�, � ,� �