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HomeMy WebLinkAbout13804 (14) CITY OF DIAMOND BAbi � �� -- DEPARTMENT OF COMMLJI�IITY 8c DEVELOPMENT SERVICES � ;,� 21660 E.Copley Drive Suitc 190 (909)86Q3195 Faz(909)861-3117 PR�S$ h'�'� BUILDING PERMIT APPLICATION FIRMLY JOBSITE APPLICATION PERMfTl�j � P o ADDRESS�.�q50 �. GOPLE� RK DATE__ �•�l0-� NUMBEF�✓�� M �� � APN LOT Z�J TRACT �1(�_q DA EE ONST.�—I N R GROUP ,� g OWNER �P115 �,�E�'�Sv"t' �aK t? p ADDRESS�A�t7 [✓�iq �. � �21� ZONING SETBACKS � CITY_�1"�/i✓1 e ZIP �f TEL9�`1'CoZ2•l9sa FRONT RW ❑ APPUCANT TEL9�•�2�1_`rf►�I^4 REAR ❑ � SIDE/SIDE STREET RW O CONTRACTOR W 7 CWFi �o� ' . SIDE p ADDRESS�LATin Ma�i.�Sr. SurtY 5?,0 � � CRY ��v�r�E _GPr ZIP q2�14. TEL�4R-VZZ^(�ty0 PROPOSED USE Q�'--�ICP .T.�. o ARCHlENG! • � DESIGNER Z AODRESS_L47 39 �,�1n�� v , �4p N0.DWEL. NO. NO. }-+���— UNITS STORIES �1 BEDFi00MS y CITY �rv�,nr � ZIP12(�17- TELqY°�2'�•1y14 v� . DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFWADD/REM O ' p I NEREBY AFFif►.1 UNDER►ENAITY OF PEIWFiY 1HAT I MI ExEMFT FAOA1 iNE CONTRACTORS Lb ('i�f8g0/C81pOfi � GENSEUWFORTNEFOLLOWNOREASONISEG7W1.6BU51NESSANOVROFESSKKJSCOOE:INYCITYOq (n COUNTYWHId1REONqE511P£fiMrtTOCOH57RUCT.ILLTERMPi10VE,DEUOl15�LORRECURANVSTitUC- W pdtiplpOCk TURE,iRqR TO RS 65UANCE,KSO REWIRES THE APPLICANT fOR SUCH iERMI7 TO FI�E A SIGNED � lTATFMENT TFUT HE OR SHE IS UCLNSED PURSUANT i0 THE PROVISIONS OF TME CONTMCTORS U• CfMSE UW(LHAVTER i(C0IAMENCIIW WITH SECTION 1000)OF DINSqN!OF THE BUSINESS 11ND PRO- � PooUSpa FES9�ON5 COO�OR TFIAT ME OR SHE IS EXE4IPT 1HEREFROM ANp iHE B.�4i5 FOR THE KLEGED EXEAIP• TqN.ANYVIOLA710NOFSECTION70]1.6BYANYMPLIGNTFOqAPERMIT5U8JECT5TMEMVLICMITTO Z Re-Rool r � I1 CML VEWLTY OF NOT M�i7E TUN iNE MUN�RED DIX1AR5(t5o0�.} � OL�30WNEROPTFIEFROPER7Y,ORMYEMVLOYEESWI7HWAGESASiHEIR50LECOMPENSATqN, O CpmmBrCl01 Q YlRL DO THE WORIC AND 7HE STRUCNRE IS NOT INTENDED OR OFiERED FOR S�LE ISEG 701�.BU56 J N NESS MU VROFE5510NS COOE 7HE CONTRACTORS UCENSE UW DOES NOT A7C�V TO AN OWNE(I OF ? iAOFEATY VA10 BULDS Oii MGROVES MEREON.AND N?IO DOES Sl1CN WOHK HIMSEIf OR HERSELF OR [� T}fR0U0HHI50RHEROMMEN7lDYEES.DROVIDEDTHATSUQIIMDROVEA1ChTSMENOTMTENDEDOR m � OFFEAEDiOR4A1.E6F10VlEVERTNEBULpNf70RIMPROVEAI[Ni�$SClDWR1A4DNEYEAROiCdAOLE- � TIOH,THE ONRIER-BURDER YNLL NAVE THE BURDEN OF PROVw�THAT HE Oq SNE DD NOT BUILD Oq 0.1FROVE FOfI T71E PUf1P0.5E OF SALE7. . 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