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HomeMy WebLinkAbout14071 (22) J_ _—^._ — -- -� -- �� �� - CITY OF DIAMOND BAR � f� - DEPARTMENT OF COMMUNITY&D VELOPMENT SERVICES 21660 E.Copley Lhive Suite 190 � (909)860-3195�ax(909)861-3117 PRESS K��^'� . BUII.DING PERMTT APPLICATION FIRMLY QJOBSITE DATE'CATIO ��� NUMBER" / �� p/C a ADDRESS Z S 7A��� � ISSUE TYPE OCC • APN LOT TRACT DATE CONST. GROUP p OWNER _ T��/ 1-��s F Q�C'�-[/J o ADDRESS ���„y�„����� � ZONING SETBACKS � CITY ZIP TEL.�,�f_f�� R�RT RW O� APPLICANT TEL. SIDFJSIDE STREET RW O � CONTRACTOR _ SIDE ❑ ADDRESS e' J � CITY D( !i'S ZIP TEL D _ PROPOSED USE T '�'f� � � 0'� � ARCFUENG/ • � �ti�� . DESIGNER NO.DWEL NO. NO. = CIDnDrRESS ZIP TEL. UNITS STORIES BEDROOMS � v� DESCRIPTION SQ.Ff. 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B./P.C.FOR7H:5REtiSON Q 3 � � � OATE DVMEH V � LICENSED CONTRACTORS DECLARATION W J � I HEREBYAFFlRfA UNDER VENALTY OF PE0.URYTHA71A61 L10EN5ED UNDER CROV15cON50F GIAPTER V, � �(C01.RAENCWOWITMSECTION700o)OFDNISqN70FTHE8USINE55ANDViiOFE5510N5CO0EMl� Z ' YC 4f/LICENSE IS N iUl FORCE/J!D EFFCCT. � � LICENSE CUSS C��9 LIC.N�.�+� ?d,�'Z � �j MTE �7-� ��_CONTiiACTOR� , d � WORKERS'COMPENSATION DECLAFiATlO� —� ¢ N IFIEREBYAFFiWUNDEHPENAITYOfPE0.1URYONEOFTHEFOILOYAN�OECUMTpNS: U ' - � ` ` Q . . , " ! �• _ � � _IHAVEANDWILLIAAWTANACERTIFICATEOFCONSENTTOSELFaNSUREFORWORNERS' 1 - S � \ ' ' ' ' ? - � ' , COUPENSATI0N,A3Vi10VI0E0BY5ECTtONJto00FTNEU30RLODE,FORTMEVERFOfWANCE W OF iHE 1NOHN FOR WMICH THIS PERMiT IS ISSUED. � 0 _IHAYEMAIMLLIMINTAWWOIiKERS'COMPENSATqNINSUfWlCC,ASREOUiREDBYSECTION . ` ,-� O ]7000F7HElABOF1CO0E.FORTHEOERfORMA.vCEOFTMEWO(iKiOpWMICHTi15PERMITIS �,v� ISSUED.AIYYAM(ERS'Cq�AP 'SAT�q,N�WS�UMNCEG.RRIERMV70LICVNUAABERARE: COYSTAUCTION � GMIER (�_H"�(/ t✓t/t/'�� PLRN FIEVIEW r � Z ���"oF� I���� ELECTAIC ¢ � (fF4"sECnor+IdIDMor8Em6stFrEDOFnEaEi7.ttsrORa+E1ua3CDoa1uL5p+rolaH�ESsI PLUMBINCa €P '� �) �n�' i O Z I CEF7:iYTHAT W THE PERFORMANCE OF iME riOnK FOR w11ICM M:5 PER1AiT IS ISSUFD,I NECHANICAL T��J J � rro�ERGOMPENS�qNEUW90FCAll O NEhSµ�ACfiC-E�tic�s�oeEca.�E INSPECTIONFEE j t'll!Ah,�. „� � SU&IECTTOT1EWJfiNER+COGPEN5A710NPRON5lON50FSCCTICN]70o0FTMEUBOR L � '�" S , (VCi QT'�►) •.�r,.._.... � cooe,isrwt�om�+wimcq,r�rwirnn+oserRo s ISSUANCE � �Q/� SMlP / p DATE:��-(1�L. 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