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HomeMy WebLinkAbout10763 (7) - •- - - - - ---__. _. _ . ., CITY OF DIAMOND BAR � COMMUNTTY DEVELOPMENT DEPARTMENT 21660 6 Copley Drive Suite 190 (909)860�3195I'ax(909)861•3117 PRESS """, BUILDWG PGRMITAPPLICATION FIRMLY oN J08SITE S APPUCATIO ' PEAMIT �� /�j3 p/C' ADDRESS � DATE NUMBER Y ISSUE TYPE OCC ^ APN LOT TRACT DA7E CONST. GROUP p OWNER — p ADDRESS 20NING SETBACKS � CITY o ZIP TEL. C' FRONT RW ❑ APPLI A '' TEL. REAR p � SIDE/SIDESTREEf RW p CONTRACTOR U O SIDE p ADDRESS r o CITY ZIP�_ EL � PROPOSED USE l� G Q �J /J o ARC , DESIGNER �.7 NO.DWEL NO. NO. d ADDRESS � CITY ZIP TEL. UNITS STORIES - �T BEDROOMS � cn DESCRIPTION SQ.FT. 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LL' OATE OYMER F- O U . � UCENSED CONfRACTORS DECIARATION w � INEREBYAFFlRMUNDERiENAITYOFGE0.1URYi/NTIAMLIGENSEDUNO[HPROVISqNSOFCMAFTER � _ p„ ��COMMENCwOYVIMSECT10N70oo)OFDmSqN]OFTHEBUSiNE35ANDVROFE5510N5CO0E,AN0 Z �L W LICENSE IS H iLll FORCEAND EFFECT. m /' � LICENSE CUSS 11C.NO._ �S r' � �J �j DATE CONTMCTOR � a W � � KERS'COMPENSATION DECLARATION � � IHEREBYAFFWJUNDEHVENALTYOFPE0.RIRYCNEOFTHEFOLLOwWGDECURAT10N5: Z � _IIMVEAN0INLLMAINTAINACERTIFlCATEOFCONSENTTOSELF�RISUREFORNORKERS' a WMPENSA710N,ASPNOVDED6YSECTIOf177000FTHElABORCO�E,FORTHEiERiORAIANCE U Oi THE WOiVC FOR WHIGI THIS PERYITIS ISSUEO. W � �I IUVE ANO YnLL MAN7IUN Y/ORKERS CpAFEN5AT10N INSUiLWCE,AS REOUIqED BY SECiqN QJ7000FTMELABOR.�'OOE,FOqTHEPERFORMANCEOFiHEYfORI(FORWHp171115PERIAITIS Q � 65UEO.IAY PEN TpNW RANCEGRWERANDVOLICYMIMBERML CONSTRUCTION /�•�3�...� � euaaEn PLAN REVIEW � POLICYNUMBER C 7�.. 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RETOSE REWORKERSCOMPfNSAT vEMOEISUNUwFUL,AHDSNALLBE ENERGYPlC � sua�ct EMPLOYERTOCRMINKOENALTIESANDCMLFIHESUPTOONEMUNDREOT/qUS.WD ENERGYPERMIT � OOLUR9 ptDo.000�,W AD01T10N T0T11E COST OFCOAIPENSA710N,DAMAGES AS Gf10VDE�fOR IN 9ECTqN]7aOFMEU1BOfiCWE.N7TEREST,AND�iTOfWEY'SFEES. � RETENTIONFEE: ' W CONSTRUCTION LENDIN�AGENCY � PRE•ALT FEE: � INEREBYAFiUWLNDENPEN/L7YOFVERJUMTMATiMEREISACON57RUCTIONLENDHOAGENCY Z FOR iNE PERFOPoAANGE OF T1E WORK PDR WHp/i/u5 PERMtT IS ISSUED(SEC.7ov7,pV.G.�. W � LENOER'9 NiwE � LENDEH'SADDRESS W� TOTAL FEES � . 4 D 1 LERTIFY i/NT 1 NAVE RFID T)p5 APPLILATIOMAND S1ATE TNATTIIEIBOVE HFOHMATION IS COfiRECT. p_ IA�REETOCAMPITWITNALLUfYANUCOUMYOHDINANCE3MASTATEU�NSREUTW4TOBUILDING CONSTRUCTqN,AHD NEREBYAUTVqRIIE REVRESENTATNES OF 7lpS COUHTV TO EHfER UDON iHE ��f�J' J� 5�7. ABOVEaAEHTI0HE07RDVERfYFORINSVECTqNPURPOSES. COMMENTS � OY l� ��a S �tS � �� � !.t- � OEIWI7TEE (P d a � 1- y 6qNATURE EE DATE I � RECPT.NO. 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