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HomeMy WebLinkAbout13850 (14) CITY OF DIAMOND BA& � -- �-�! DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21660 E.Copley Drive 5uite 190 �� (909)86a3193 Fea(909)861-3117 PRESS � '��� BUQ.DING PERMIT APPLICATION FIRMLY � AD ESS I��� S/Lr� fi�W� UO DATEICATID���, " NUMBEW v #'� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP g OWNER � f � �' ADDRESS .� ��l ZONING SET8ACK5 CITY ZIP TEL. D^! s�'4 FRONT RW ❑ APPLICANT TEL. REA� � SIDE/SIDE STREET RW ❑ CONTRACTOR � SIDE ❑ � CITY ES ZIP � C TEL, .- � PROPOSED USE t ��'�• � �T i� K+ %�` ---�� � � ARCHlENG! ��—lr�S� c—'�'�,�' p e°��^ai�T ADDR SS NO.DWEL. ' NO. NO. '' � CITY ZfP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. 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ISSUANCE O - �' _ . p DATE. � 11PPLICANT: � SMIP CIT � WAHNINO:FARl1RETOSECUREWORKERS'CAMPENSATIONCOVERNCEISUNLAWFU�,AN03HALLBE ENERGYP/C BU���r:{"� �y SII6IECTAN EMPIAYER TO CRIMWAL PENAlTIESAND GVIL FINES UP TO ONE HUtARE01HOUSPND r'r�'�b���� DOW1A5(f1a0.00G�.MlADOITIONTOTHECOSTOFCOM�ENSATKKJ,UAMAGESASP0.0VIDE�FORIN ENERGYPERMiT � BECTION 970!OF THE LABOR CODE.WTEREST,ANO ATTORNEV'S FEES. RETENTION FEE: OCONSTRUC710N LENDING AGENCY PRE•ALT FEE: � I HEREBV AFFIRM UNDER PENALTYOF PERIURY THATTNEflE IS ACONSiRUCTION LENdNO AOENCY FOR iHE OEHFORMANCE OGTHE WORK FOR WMICH 7HI5 PERMIT IS ISSUE�(SEC.70G7.CI4.G�. Z W � IENDER'S NM1E CS IENDEFTSFDORE53 W I CERTIFY THAT I HAVE REA�THIS APFIJC�TION AND SiATE TNl1T THE ABOVE NFORAMTqN IS CORHECT. TOTAL FEES � � IAGREETOCONPLYWITHALLCffYMDCOUNTYORDINANCESAND6TATELA�NSRELATIN6T06UpAINO � CONSTRUCTION,AN[]XENEBYIUfrHONIZEHEPflESENTATIVE50FTHISCOtMTY7DENTEflUVONTHE �BOVE-4EMqN PWOPEFiT1'FORINSPECfpNPURPO6E8. 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