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HomeMy WebLinkAbout13636 � �_ CITY OF DIAMOND BAT+i � DEPARTMENT OF COMMUNITY&c I3EVELOPMENT SERVICES 21664 E.Copley Chive Suite i9Q (909)8G0-3195 Faac(909)861-3117 PRESS "�'.... B�IILD[NG FERMIT APPLICATION �1R�11LY pN JOBSITE �...���.��� ! 1� / APf�LICATION PERMIT P/G ADDRESS � t_..�'��j�Sc'-�' 4ATE �� �NUMBE�� #—_���� � ISSUE TYPE OCC APN_„__� �.07_� TRAC'i'�J�'�''�"„7 � DATE. CONST. GROUP 'r� OWNER n.�o�.. �j+�sG.�.._.. _ a o ADDRESS �3�=a� �i{,s C.!.��-_.,5v 20NING SETBACKS � z ClTY�� ,����..�, Z P TEL. '��" FR�HT RW CI_ � APPLICANT_�I.�,t-.�����c� TEL.�_�.`'/_`_{� S DF1SiQE STREET RW ['{ � CQNTRACT+�R cs � SIpE � ❑ � ADDRESS�� � �.,a�.g (f�j r� ,.-- � a CtTY�,0/� ��v�c.s,3 ZIP ,/ 7EL.�,.���"�/� PROPOSEp USE _ �ii ARCWENG( ,9� l�f��P�_ � DESiGNER mCy�,�4r+�, �.' w_.._�, '• Np.DWEL.. - Np. : ADCtRE5S js�t��]�r�l,, �� . �_ CITY �.�j'�G-��.. _, ZIP�7.w7I TEL'.+�'•y'^L.e�'C�+�i�2'(°" -: ��ITS_-- ^� SFORIES __�_,.,_�BEDRQUMS �k c!� DESCRlPTIQN 5Q.FT. 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' .,,. 0 � ISSUED.MY WORI<ER9'�' NSATION INSURMlGE CARRIER AN� Y NUMpEq RE: CONSTRUC7(O - a~�' 6 `•s i �1�+ � -' ��.. . _ - j CARPoER_. �"'�'''"5�-�'u��G t""� .'__ '_.___.. GIAF!FZEVIEW ��' � -_."__ e k __ __ -• q -----'- —�: Z W?LtCYNUMBER � ,�j�Y'�'' . ,rr . „_._.,___,.»........y _-_���9��y"�+_i'..�+,.J- ____ ._- EIECTRlC �r— -----' � � Q --'-- {hlFSSCC'IKkIhEH�NOTBE(XMh'LEl'EDOF7FiEVEPNlit"sFCRONEMJtd1HEDCY.X1AiS )ORlFSS). PLUMBING .. .. .. ....___'___ '_... • �� ^ �_"'__.... _ , •. - Z I GERTIFY THAT IN THE PeRFORMANCE 0F THE WORK F9R WH 'TNiS PER IS I5,^,UEG,I MFCFIANICAL _,._____34:_-�"'"� _.___.__ ,..._. _.___ ,___. � c°} SfiALLNO7EMPtOYANYAER50�11NANYMFNNERSQa 3 'cOME:SU CITOTlIE V---z� � W9RKERS'COMPEM1SATIONlAW50FCA�FORNtA, EE7tfiATi outO6CCUM[ �NSP�CYIORFEE _,_._ _,__,.,_ ,_„_ ,�,�1 Sl1&lE TO 7NE WORKERS'CAMpENSATlO O 5 oF uEG 370o OF 7NE IAyOR 7fT7 ~ �o isH xor?n�v�m+cwsaivxnr� is ISSUAhICE __._. , v�'� O � � , ;' ..��...�.�.._..._..._... �MIP '�`.'. 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' - MIT IS ISSUFD(SEC.30'J7,CIV C.j, � � �'____`- '_"_�...__" '_'__ � � LENDEfl'SNAME,�._.�_ .___�___"". �_.._ --- . _ ,___. � _ � F- LENOER'BADORESS _._._...._..._�"""- '._..____,—_.....—....._ - W IGERTIFYTHATIHAVER[ADTHISAPPLICA710NANDSTATETNATTHEA90VEINFURMATIi1NI5CORRECT, �V I/1� G� , •� � ' � IA4REETOCOMPLYWITHALIClTYANQCCIUNTYOHDINANCESANDSTATEIAWSREUTINGT06UILDMG CONSTRUC7ION,ANDHEflEBYAU7H �7EREPRESENTA7kVE56FTNkSGOl7NTYtOENTERUPONTtiE AEiC7YE-M@NTIONED PqOPERTY FO PECTION PURPOSES. 7�I`_ Q �........--� fJ COMMEdN-7S_#�-V_'Lf/�\ �('�4._�`_�._ �"� �__�___ __ _ J �...+ . �_ -�-t"}N A 1_ ��V'�. •-��=4L--. V VU � '�"—�� Y "_ __""____'____",..�_ _._. __. PERMITCEEN � � Q , ,,. 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