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HomeMy WebLinkAbout15622 (1098) _�� CITY OF DIAMOND BA� �� DEPARTMENT OF COMMUNYTY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)$60-3193 Fax(909)861-3117 PRE`S$ �'°� BUILDING PERMIT APPLICATION FIRMLY , o DDRIESS Z , I7 � D`11�5� DATEICATION�y ,"'" _NUMB R��" � #,C" � � � i I � APN LOTII��.��.TRACT �']���_ ISSUE� TYPE OCC DATE CONST. GROUP p OWNHR s� "" ADDRESS �,"�/'���C�'�'�7G �DMRS'�' t311. ZONING SETBACKS w a FRONT � RW ❑ � CIIY �01�Nfhc%� 137'� ZIP 7J 7L�] TEL.R•� '9• �' �7 , REAR � ❑ , APPLICANT �'S'fL�� �°'G�'"" TEL.9'��"l9•//,i0 �- � -�- SIDE/SIQE STREET RW ❑ � CON7f{ACTOR � D el�'rr �i' SIDE !_T� ❑ � ADDFiESS ' � � CITI! � 1a_! ZIP q�73 TEL.9P'a7�- �'1•1//O PROPOSED USE ��'77{) (o;y� V.�. I� w ARCH/ENG/ z DESia'NER ��'A1(dsP3 G. �� /`�l.� ' w � '� NO.DWEL. NO. NO. a. ADff?RE�S 1I4'�. fY� �,r� J�Y4r✓_ S� UNITS. 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'TO WNSTRUCT PME PHQJECT�(SEG.70H;BUSINE55 kN�PROfESSIONS WDE:THE CONTFACTORS I.I- 11211J3IfOP9 � - ADJ.AREA .W .CENSEUWDOESPdOTAPFLVTOIlaNOWNEROFAPROPERTYWPIOBUILDSORItaPROVESTrlEREON,ANm - , � '.�WN:ICONTRACTSFORSUCHPRWECTSWfiHhCONFFIACTCIR;5)UCENBE�PURSUAWYTOTHECONTRAP (1UANTI7Y DESCRIPT N FEE h—�, ttSpSIJCEHSELAW.). �I Y , J � o' ❑I AM FJ�MPT UNGER SECI� B.fi P.C.FOR?HIS REASON .Q '� � �. . i . �,V � . . 6t- � . �ATE OWNER � Z II W �, LICEN ED CONTRRCTORS DECLARATION � . �',�IHEflE9YAFFiRMUNO@tPENAl7�1'OF?EflJUNYTHATIpMLICENSEOUNDEflPflOVI510NSOFCHAPTER ��� 4� � � p„�' 9�COMMENCIkGWITHSEC71ON7WOJOF�IVI51CN90FTHE8U51NcSSANDPROFES510N5W�E.AN� �,Z . 9G;.MY LiCENSE�IN FULL FORCEAtr�E'FECT. m , Qw �'Z�6 9�' UGEkSECtASS� LIC,NO. � ..e� ��j . v,,��DATE �• IL��. � CONTRACTQR �RN7�i1I �GJB'6// d tJ.l � �� WORKF6iS'GOMPENSAFiON DECLARATtOtd � . 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PLUM69NG � I t � ICfiRTIFYYHATIkTHEPPRFORMANCEDFTHEWORKFORWHICHTW5DER6P.1TlSISSLIED,1 MECHANICAL _ _ � (� 5H:4LLNOiEMPLOYT,PJY�'ERSONINRNYMANNER6DAST08ECAMESUBJ'cCTTOTNE "`^�y y�„�� �, �/j WOPKER3'COMPENSATIO'NLANVSOFCNLIFORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE _ ; _ � � St3&IECiYOTHEVtmRKE�5'CONAPENSATIONGPOVi51ONSOFSECTION37000F7FleLA9OR ��- —�.--__..,,/? � CObE,I SHALL fOR7H4VIT;H COMPLY WITH THOSE FROV:310NS. ISS�JANCE � � � SMIP � p DATE: _ A'�PLICANT: , � WARNING:FAIIURETOSECUflE�'ORKERS'COMPENSATIONC04ERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C 35 ,� c �>_p'a "���� � SUBJECTAN EMPLOYER TO CFIM NAL PENALTIES AND CIVIL FWES UP TO ONE HUN�flED'HOUSANO ENERGY PERMlT �`� DO{.LARS(S10o,o00),INADDIT�DN O THE COSTOF COMPENSATION,OAMAGESAS PFOVI�ED FOR IN � " � SEC71IXN3ta60FTHELABORCO�E,INTEREST,ANDATTOHNEY'SFEE3. ' RETENTIONFEE: v I � Y o, CONSTRUCTION LENDING AGENCY PH ALTFEE: I` "`� � �''�'""`�'"� '` ��4� � � . ���'. 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