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HomeMy WebLinkAbout14065 (16) � � --- C1TY OF DIAMOND BAA i ------�"�' � I7�PARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � x� 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PR�S� '- 'H�°� � BUII,DING P�RMTi'APPLICATION FIR�UILY � JOBSITE +�� f^ APPLICATIO -l�t"" PEHMITf ) P1C o ADDRESS��- D�„s_—��_' f � � DATE__ �y NUMBEf� J # � —' ' ISSUE TYPE OCC � .- APN__ LOT TRACT DATE _CONST.__ GFlOUP _ p OWNER �' � "" ADD SS� �� � C(Z " ZONING SETBACKS 0 z CIIY E• ZIP� _� L . � FRONT _ RW ❑---- g APPUCAN7 _ � TEL r REAR _ ❑ __ � SIDElSIDE STREET RW_____ L] � CUNTRACTOR_ SIDE'�___ _ l-1___._ __ � ADDRESS ROPOSED USE_ �1_[_�___ � `' � CITY ZIP 1'EL. --- " aARCHIENG! ---- — — _ '— � DESIGNER NO.DWEL. NO. d ADDRESu � i � -- --� UNITS__ STORIES ,__:-- _., BE�ROOMS___ � CITY 'LIP TEL. � y — DESCRIPTIpN SQ.FT. FACTOH PSF ADJ.ARErWALUATION � OWNER-BUILDEF DECLARATION SFR/ADD/REM A p t HEflEBY AFFIflM UNDER PENALTY OF PEHJUAY iHF7 I AN EXEMPT FRDM 7HE CONTqqCTORS LI� Geffl OR W CENSELAWFORhIEFOLLOWINGREASON(SEC./o31.56USINESSANDPROFESSIONSCODE:PNYCITYOR (n / U� COIINTY1MiICHqE�UIRESAPERMITTOCONSTRUCf,ALTEH,IM1IPFlOVE,�EMULIS`I,ORREPAIftANYS(FUC- �8I10/DBCK � /.an �� NRE,PRIOR TO ITS ISSUANCE,AL50 REOUIHES THE APPLICANT FOR SI�CH PEHMIT TO FILE R SIONED �� STATEMENT THA'f HE OR SME IS UCENSEO Pl1RSUANT TO THE PHOVISIONS OF THE CONTRACTORS LI. � "� CENSE LAW(CHAPTeR B(COMMENCINO WIT1 SECTION 7C00)Of�IVISION 3 OF Ti1E 8:151NE55 RND PHO- �'1' PaOVSpe � FESSIONSCOOE)ORTHATNEO�SHEISEXEMPTTFIEflEFROMANDTHEBASI5FORTHE/1LLEGEDEXEMP- (,�} V TION.ANYVqUTbNOFSECTION7a31.5BVANYAPPLICANTFURAPER!AITSU0.IECTSTHEAPPLICAN7T0 y Re-Roof � ACIVILPENALiY OF NOT MORE THAN FIVE HUNDRED DOLLARS�SSOD).); ^ CIt,A30YlNEfiOf7HEPROPERTY,OftMYEMPLOYEESWITHWAGESASTMFIftSOLECOMPENSATiON, C��COt11rt1BIC18I _ ' � WILLDO TNE WOFK,ANU THE STRUCTURE'S NO'f INTENOEO OR OFFEREO tOR SA�E(SFC.704a,9U51- _I N NE55 AND PflOFESSIONS COOE:THE COMMCTURS LICENSE LAW COES NOT A PLY TO AN OWNER OF � � PROPERTYWNOBUILDSORIMPROVESTMEREDN,AN�WMUDOESSUCHWORKfiIMSEIfOkHEfiSE:FOR �C iHRW(3HHISORHEHOLN�EIAPLOYF.ES,PROVID'cOTHpTSUCHIMVFlOVEPAEN'fSARENUTINTENCFDOR m ' W OFFEREDFORSN.EIF,HOWEVERTHEBUI�OINGORIMPROVEMeNTISSOIDWITHINONkYEAROFCOMPLE �0 TION,THE OiVNEfl-Bl/1lDEfl WILL HAVE'Il1E BUR�EN OF PflOVING THAT N:OR SMG UID NO7"BUil9 OH — �,= IMPROVE FORiHE PURPOSE OF SALEI. � , . 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DATE jA�__'."_o� -. . -- _—' —' _ � -- U � W _' •�Q LICENSED G�fi5 DECLARA71 u�I � '�¢, IHEREBYAFFIRIUUNDEHP[NALTYOFAERJURYTHATIA4,LiCENSEDIiNDERPHOVI510N50FCMAPTEfl �i3 *(� 9(COMMENCING WITIi SECT:(NJ 7000)Of DIVISIOt�30F;HF B;151NESE.4tiD PROFESSIONS COCE,hN0 � _ _ _ __ '_�X_, MY IICENSE IS IN fl1i.L FOHCEAND EFFEC7. i LLJ � '__—�—_--'-- �o� LIC'tNSE CLASS ..______—LIC.NG. � , J __— V�� DATE _ CONTMCTO(�__ __.____. � , W: _� __._ ..�; WORKEf�S'C64IPFNSA710N UECIAHATION ¢ �: U ----- —� N� 1 HEREBY AFFlRM UNDEF PFtJALTY OF PERJURV OIJE O:1HE FOLLWlM(;UcCI.ARATh7N5: cn' z 'O�. 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