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HomeMy WebLinkAbout11225 i— • -.-- . ____ - . . .. . . ... _ _.... . - -.. .. . _.....—•--- -_.—_.._---- -------�------. ..-- -_...--•---- - � . � -�-��` ---• C1TY OF DIAb40[VD BAR : , �� � COhfMUNITY DEVELOPMENT DEPARTh1ENT� � �:.•C 21660 E.Coplcy Drivc Suite 190 � , (909)860-3195 Fax(909)861-3117 ' ; � PRESS �'"' BUILDING PERD4ITAPPLICATION FIRMLY } DDRESS ��/ APPLICATION PERMIT / y !C o _ DATE NUMBER__(_� � • ISSUE �� TYPE OCC APN LOT TRA T �� �DATE CONST. GROUP °C OWNER �,Q OO ADDRES�I ZONING SETBACKS RW O z CITY ' ZIP TEL. FRONT o APPLICANT T , REAR p � SIDE/SIDESTREET RW ❑ � CONTRACTOR_Q 1.� /L � SIDE ❑ o CDDRES� � C�=IP EL ' Q PROPOSED USE � o ARCH/ENG/ - z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. • • UNITS • STORIES BEDROOMS � cn DESCRIPTION SQ.Ff. 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B 8 P.C.FOR THIS REASON Q ��-i� � � V - - LL' OATE OWNEF � . . . O W � __ LICENSED CONTRACTORS DECLARATION W . • , � I HERGBY AFFIRN UNO[R PENQTY OF PE0.AIRY THAT IAM LICENSED UNOER PROVISIDNS OF CNACTER V. . . � , • . �\ � Y(COAIMENCINGWR}ISECTION7000)OFDNISION]OFTMEBUSINESSANDVROFESSIONSCOOE,AYD _ Z X YY�ICENSEISRlFUILFORCE/W�EFFECT. � LL1 � LICENSE CLASS IIC.NO. � . . � V OATE CONTRACTOA d W � � - . WOHKERS'COMPENSATION DECLARATION ¢ y1 HEHEBY AFFIfiM UNDER PENILLTY OF VERIURY ONE OF iHE FOLLOW.NG DECLAMTIONS: Z � _IHAVEANDWILLMNNTAINACERTIFICATEOFCONSEMTOSELFaNSUREFORVpRKERS' ¢ S GOMPENSATqN,AS FROYIDED BY SECTION 7IOOOF 7NE LAl30R CODE,FOR iME PERFORMANCE U Q OF THE WORK FOR WHILH iMIS VEHMIT I5155UED. _ � . 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