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HomeMy WebLinkAbout10770 -" CTfY OE DIAMOND BAR ` �� COMMUNITY DEVELOPMENI'DE r�fE� zi�o�.coPi�y o���so�ce�90 PRESS T (909)860-3193 Fax(909)861-3117 ' . '""'. BUILDINGPERMITAPPLICAT[ON FIRMLY � DD ESS_�//�' 7 �d, vy'��N �� DATECATION 'QJ�I ��NUMB R �p? ` � 1f/C `'C�v / g . ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP g OWNER A/'t.vl.x,�/?9��r�� ADDRESS_27/ Gt�,lfa� ZONING SEiBACKS �RE[� �'�' CITY /�c.+�f�'v�-r ZIP 7�LG3 TEL 7s "G FRONT R1/T ❑ � APPLICANT J'���Lv�s�- TEL_ �'G?c�—SrI S�r R� ❑ � SIDE/SIDE STREET a_p CONTRACTOR � —G+r��'� SIDE ❑ o ADDRES ��.Z � < ✓'t� ROPOSEDUSE � l7r x /�� GJ7�� s/C�y1 Q CITY_ e:�vuM.i ZIP f ' TEL �d) ad=8h /Jj�I�h,� .-��-�.t wo ARCWENG/ � DESIGNEfl S��- NO.DWEL N0. NO. o.. ADDRESS � CITY ZIP ' TEL UNITS STOHIES BEDROOMS _ _N - cn DESCRIPTION SO.FT. 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'� o �� � V DATE � � CANTMCTOR / d W � WORKERS'COMPENSATIONDECIAHATION �/��� U - � IIIEREBYAFFIRNUlDERPENAITYDFPEiW(iYONEOFTMEFOLIDWiNODEGt/IN�T1Cit�: Z . � _IHAVEANDWILL►WNTAWALERTIFICAiEO�CONSENTiOSF1FJN5UREFOHNpiKERS � COMPENSATqN.A4 PROVDEO BY SECTION 770o OF iME LABO(i CCOE,FOR 7/1E PERfORMANCE W �iHE WOILC FOR V/Mlp1 THIS PERAUi 1S tSSUfD. � W _I HAYE AtiO WILL MAINTAIN MfORKERS COMGENSATION INSUW�f+GE,/5 HEOUWED BY SECTqN Q a/ao OF THE lABO(i CODE.FOp THE GERFONJANGE Of TME WO(iK FOfi W/UCH TWS PENWT IS ISSUED.YYMqqNE0.t'COMDENSA7 SURANCECA ANDPOUCYIMrBERAHE CONSTRUCTION . �� � cuw�rt 5�J � � � � PUW REVIEW � � � �«�•�p i'z�l� 7� � ' ` �cTA�c Ci '1. 0 �sccnoNr�mwieEoca�i�cFnf�rtswaa+EH+m�D0al�uis8�aoloa�ss� PLUMBING Z �CERTIFY iW�T N iME PEAFOiWANGE Of TNE WOiiK FOA WHKN iHIS iERAui IS ISSUED,1 MECHANICAL , V' SHALLNOTFMPLOY/WYVERSONW/�NYMANNERSOASTOBEC�MESUBJECtTOTHE � MOqKEiiSCOMPENSAT�ONUW50FCM1FORMIAINDAGREE�TIFISHOU�DBECOME INSPECTIONFEE , � SUBJECTTOTMEWOHKfRS'C04DEN51�TqNVROVISIONSOFSECTpN37000FTNELIBOR mo�,�s+w.�coRrmnmcouRrwm� evaorsa�.sY�� ISSUANCE �- '�� � /J� snnia � . 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