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HomeMy WebLinkAbout12163 (14) / r �-- - C1TY OF DIAMOND BAR' '� �' � • COMMUNITY DEVELOPMENT DEPARTMENT 21660 E Copley Drive Suite 190 c�>a6as�9s r•ax�9ov�e6�-3�i� � PR ESS '""'+ BUILDINGPERMITAPPLICATION FIRMLY yy, JOBSITE APPLICATION � sf PERMR Z P/C � Z�j o ,4o�REss �2852 OAK KNOLL DRIVE DATE �d `� NUMBER N�_/'L $ ISSUE TyPE pCC APN LOT '�6 TRACT G7R51 DATE CONST. GROUP p OWNER _ Diamnn�j Rar F.gSr pertilfZs p ADDRESS 3�►HO TorranCe RIVd. St'p_ �OO . 20NING SEiBACKS �. • , � arv Torrance ziP 90503 re�310-540-399 FRONT Rw o APPUCANT Rirharri C;rn�lri TEL.g�P ahmra SID SIDESTREET � • RW ❑ � CONTRACTOR .T_C'_f'_ ('.�Srrt1C L10I1 SIDE ' p ADDRESS same as ownPr g cin ziP TEL PROPOSEDUSE New sin le famil residence oARCH/ENG! S_t_t�ched garage � DESIGNER R. Gn ild & ASenriatP� ii NO.DWEL. '. NO. .. , NO. N ADDRESS cama ac nrunps UNITS 1 � CITY ZIP TEL. 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XIHAVEAN�WILLM�MMNWORI(ERS'COMPENSATIONINSUqANCE,ASREOUIREDBYSEC7qN /w � ]7000FTHEWBORCOOEFOR7HEPERWRMFNCEOF7HENGiLCf0liWHtp/TNIS0ERA11TIS . , /j )„/n`� ��� 65UED.W NOfixERS'OOYPENSA7qN INSURIIHGE GRR�Eq 11Hf VOLICV NUMBER ME: CONSTRUCTION "(!j V' �j GHNIER ('.a 7 i f nrni a (:nm,�ensation PUW REVIEW � 3 • � POLICYNUMBEII wq�Ri liRSn� zd ELECTRIC ZOO _ DO 0 (n�s[crqNr+f�raiBEop�NE'rEoaFnEaEaarGwna+E�al�iFnOau.uGR+�IoalE5s1 PLUMBING I�O . 00 Z ICERTIFYiHAiNTMEVERFORMANGEOFTMEWORKiOkWNIG/TMISPEFW1iI5155UED,1 MECHANICAL I OO� O� C7 51UlLNOTEMPLOVANVPE0.50NWANYYMa1EK30ASTOBECOMESUBJECTTOTHE ' (p - riORKER5C01APENSATIpNUWSOFGILIFORNIA,MAAGFEETW�TIFISHOIADBECOME INSPECTIONFEE . � 6UBJEGTTOTHE WORNERS'COMPENS�TqN V(iDVI5qN50F SECTION 770o OF TNE tABOR COOE,I SM�Il fORTHWI7H GOMVIY WITH TIK15E VRONSqNS. ISSUANCE ✓ � p DATE: APPLIGIM: SMIP � . � ENERGY P/C I � WAiW INO:fAiIURE TO SECURE WOfU(EAS'COMCENSI�TIJN COVEM6E IS UNLANhlA,lUA SHAl1 BE /� � 6UBJECTANEUPLOYEqTOCq141tULPENAl71E5MIOCMLFWESUPTpONEHUNOREDTNOUSANO ENERGYPERMIT 4 ! DOIURS p1o0.000),N/��ITIONTO7ME COSTOFCOMPENSATION.OMMGES AS GfiOVIDED FOq IN J SECT10N770eOFMElA80RCOOE,W7ERE5T,ANDATTOiWEY5FEE5. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE•ALT FEE: ¢ IHEREBV�FFl{WUNOERPEHALTVOFPERIURYTHATTHEAEISACONSTRUCTIONLEN�WOACEHCY dZ fORTHEVERFORMANCEOFTMEWONKWRWH671TMI5FERMIT15R5UE0(SEG]Oi7,qV.G�. W � LEPDER'SWWE . � IEMDER'SADDRESS ,�°F, TOTAL FEES � � -77 f ' 1 LERTiFY TXAT I NAVE qE11D TMIS APCLICATION AND STATE iHAT THE ABOVE NFORA/ATqN IS COi1RECT. d IACREETOCOAIPLYWITIIALLGRYANDCAUNTYOiqP1MlCESANDSTATEUWSPELATINOTO&RAING � CONSTRUCTION,ANONEREBVAUTHOp12EREPRESENTATNESOFTWSCOUNfYTOENTfNUPONiHE ABOVE#iENTqNEp iqpiERTY FOq INSGECTqN PURPOSES. COMMENTS � Il� —j '� D 1_.l(r � v ¢ rv � � - 2 Z • � bq1uT EOFPEIWITfEE . 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