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HomeMy WebLinkAbout14502 (1090) ��. CITY OF DIAMOND SAR �-� � " --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21660 E.Copley Drive Suite 190 � - (909)860-3195 Fax(909)861-31i7 PRESS ������ BUILDING PERMIT APPLICATION FIRMLY JOBSITE l� APPLICATION � /� PERMR l P/C o ADDRESS Z� �S V( ��• bATE v - NUMBER / # � APN LOT � TRAC 5�Q �SSUE TYPE OCC I,-�- DATE CONST. GROUP g OW NEFi �4.Y WC t. L L—G AODRESS �3��C7 1 bY��A!'VC�,��..��-��� ZONING SETBACKS �� CIT���„RIA�'SIC� ZIPQQ�Q�_ T ������'D REART RW �JO APPLICANT TEL. 51DFJSIUE STREET RW G � CONTRACTOR L �c� � SIDE ❑ Q ADDRESS PROPOSED USE � CI ZIP TEL.Z��l� 8 ARCHlENG/ � DESIGNEFi _ NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CfTY ZIP TEL. y DESCHIPTION SQ.FT. 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PLUMBING Z I CEHTIFY THAT Ni 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE0.1 MECHANICAL C} SHALLNOTEMPLOYANYPERSONINANYMpNNER50A5TOBECOMESUBJECTTOTNE �'\� (� YNDRKERS'COMPENSATqNlAW50FCALIFpqNIA,MlOAGREETHATIFISFIOUIDBECOME INSPECTIONFEE i•' SU&lEC7T0 THE WORKERS'CONPENSA7IDN PROVISIONS Of SECTION 37aC OF THE U1BOF a�• rj cooe.�sw�uFnqr�nicor.�P�rwm�nasErcmvis¢aus. ISSUANCE � O p DATE: APPLICAN7: SMIP J WMNINa:FAILUHE705ECUHEWORKERS'COMPENSATIONCOVERAGEISUNLAWRIL,ANDSHALLBE ENERGVP/C ��� �' � 9UBJECTAN EMPLOYER 70 CRIMINAL PENALTIES AND CIYIL FINES UP TOONE NUNDRED THOLiSAN� ENERGV P 1 L1,fl11k����yR_ DOLLMS(fi00.OW),IN 11001TION TO THE C0.5T OF COlI?ENSATION,DAMAGES AS PFOVIUED fOR IN � SECTIDN37o80FTHELABORCODE,NTEREST,ANDATTORNEYSFEES. 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