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HomeMy WebLinkAbout13563 (16) i _._ ..... _ . . �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8t DEVELOPMENT SERVICES �� 21660 E.Copley Drive Suite 190 • (909)860-3195 Fa�c(909)861-3117 PRESS ��N�'� BUILDING PERMIT APPLICATION . FIRMLY � . yN, JOBSITE�Ig•c^I�OC,OFif/-�/����5 ��• APPLICATION i • �PERMR P L���Z, o ADDRES �� DATE � �� NUMBER N L ✓ $ ISSUE '"' " � 7YPE `' � � OCC APN LOT�—_ TRACT DATE CONST. GROUP � OWNEFi /�fF-�S !/C.��.d�C' ADDRE ZONING SETBACKS Z CITY / ZIP TEL�/�1o,�7-SK� FRONT RW ❑ g P CANT / -% TEL REAR ❑ SIDE/SIDE STREET RW ❑- CONTRACTOR SIDE ❑ . � CIT( E S IP I DEi TEL�J� �2 PROPOSED USE G � ' / L,d1 GL ARCHlENG/ /+ � � DESIGNER �•-' — ADD SS . (y- NO.DWEL NO. 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ISSUANCE O '" . p DATE: 'ZZ� APVUCAtrt: SMIP / � ENERGY P!C /� � � � 7 � WARNINa fAILURE TO SECURE YYOfiKERS'COMPENSATION COVEMGE IS UNUWFUI.AND SHALL BE •��,� � .. �y SUBJECT/NEUGLOYERTOCR:MINALPENALTtESANDCMLFWESUPi00NENUNDRE0TH0U5AN0 ENERGYPEFiMIT �TY . . DOU.ARS(l100.000).W ADDITIDN 70THf CAST OF COAIDENSATION.DAM�GES AS VROVDE�FOH IN i � SECfqN77000FTM[LABORCODE,MEREST,ANDAiTORNEY5fEE5. RETENTIONFEE: CIIjT1Tf,�.���ilY1V_�!�L�1:�. a CONSTRUCTIONLENDINGAGENCY PF�E-At7 EE� � " ' �� � �� � IHEREBVA�FI0.MUNDERPENIITYOCPERJURVTHATTXEREIS�[ONSTRUCTIONLENDINOAGENCY �� �.�y FORTHEOER�OM�WCEOFiNEWOf7KfORWFIILHTMISPER4RI5155UED�SECloa7,CIV.C.). -�L( � ��- .� � IENDER'SNAYE � lENOER'SI�DORE55 � � `. 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