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HomeMy WebLinkAbout13849 (17) �� CITY OF DIAMOND BAA �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE3 21660 E.Copley Drive Suite 190 (909)860-3]95 Fax(909)861-3117 PRE`S$ " ' �� �?9�° � BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ±= APPLICATION PERMIT r � � " P1C � ADDRESS���., t�rrC��('' DATE_ � NUMBER"'��' # c� ISSUE TYPE OCC APN_^_ LOT � TRACT_ _� . DATE CONST. GROUP � OWNER �-�FS�F. �--;7� `� ADDRESS S'/,6me� Qe .�G�.�-t.�.��� � ZONING SETBACKS w aTv DI,�tA`N�§ Yl�'n- ZIP__ TEL._ FRONT __ RW f] _ �_ APPLICANT __ TEL._ REAR u SIDEISIDE STREET_, RW I I______ �. CONTRACTOR� 'O' ��DC1FllV&J_^_ ___ SIDE _ _ fl Q ADDRE55 — PROPOSED USE�kL�VL'���1:r�y �I�R�C�e�iU��'�'f.[� I]LY`LV��� � CITY.J���.,_ IP j,��lt. TEL. �+ r y �x-�o�J _��� �. ARCHlI / �V y — � �ESIGNER ` —— -- -- -- NO.DWEL. NO. NO. ADDRESS UNITS_ S'fORIES _� BEDROOMS � CITY ZIP__! 'fEL. ^ y : y - — ; �ESCRIP7iON SQ.FT, FACTOR PSF ADJ.ARErWALUATION ¢'. OWNER-6UILDER DECLARA7IUN SFR/ADDlREM O �' i HEREBV AFFlfql UNOEfl PENALTV OF PFRNRY THA7 1 NA EX(MAT FROM THE CDNTfl0.CTOR5 LI� � Garage/Carport W� CENSELAWFOFi7HEFO:LOWINGREAuON(SFC.7031.58U'SiNESSMIDPROFE39lONSCODE:ANVCITYOfl .U;, COl1NT1'WHICHREWIflESAPFRMRTOCONSTRUC7,ALTEfl.IMPROVE,OEMOIJSH,DRNEPFIRANYSTHUC- �W patiolDeck W j 7URE,PRIOR TO ITS ISSUANCE,ALSO RE�U:RES'ME APRIICANT FOR SUCH PERMIY TO FlLE A SIQNED .W �, STATEAIENT THAT HE OR SHE IS LICEkSED PURSUANT i0 THE pqpy�SIONS OF Tf1E COMFACTOHS LI. CENSE LANJ(CHAPTER 9(COMMENCING W17H SEf.T10N�000)OF DIVISIUN 3 OF THE BUSINE55 RND PHP 'LL' P�ol/Spa � FESSiON5CO0E)ORT4ATHEOR3HEISE%EMPTiHEflEFflOMANOh{EBASISFOHTHEALLf:dEOE%EMP� (} "— � TION.ANYVIOU170NOFSEC71INJ7IX31.5BYANYAPPLICANTFORAPERMITSU0.IF:CTSTHEAPPUCANi'YO Z Re-Foof � ACML PENALTV OF NOT MORE TSiAN FIVE HU40RED DOLLAHS(5100).�: -'— �. LII,ASOWNEROFTHEPFlUP[RTY.OFMYEMf'LOVEESWITHWAGE5ASTHFIRSOLF_COMPtNSA710N, [' COfI1fI1BfC13I WILI 00 7HE WORK,AND THE GTRUGTURf IS NOT INTEN�ED OR OFf ERF�FOH SRL:(S�:G 7n�a,BU51- ,,.,I _. ( � NESSAN�PROFESSIONS COOE�.THE CON�HNCTOflS LICENSE LAW UOES fvOTAPPiY TO AN OWNER OF '_ � PfiDPERTY WFiO BUILD3 OR IMPHWES THEREON,AND NhiO DOES SUCH WONK NIMSE�F OR HEFSELF OA � THROUGHHISOFHEROWNEMPLOVEES,PROVIDEDTHA7$UC#yIN:VROVEMEtJTSpRENOTINIENJ[[10R m � OFFEREDFORSALEIF,F70WFVER,7NF9UILUINQOPIMPROYtMENTI55o:DWITHINONF.YF(IROtCCMPLE� _ _ Z TK7N.INE OWNEN-BUILDEft WILL HAYE TF1F.BUHDEN OF PROYNG TNAT HC:OR SHF DIO N0�BUILO OH = IMPFpVEFORTHEPURPO5EOF5ALE�. ii{ ❑I,/150MRlEflOFTHF.PROFERiY,AMEXCLU5IVELYCO7�TRAC71NGW17}�LI.^.ENS[DCO4THMCTOR� " — —" — Q TQ CANSTHUCT iHE PfQIEC7(SEC.70U.Bl1�iPJESS AN�J PflOiE55!Orv5(:()DE:1 H�CONTNACTORS 1 I- 1/r^,�U2�1011 ___ �_._..._._A��.Af�EQ__,________..,__ _ W CENSELAWOOESNOTpPPLYTOAIsOWNEROFAPflOPEFiT'WNODUiLO50FlIMPROVE5IMENC:CN.AND — — � MMOCJNTRACTSFORSUCHYRD3ECTSWITHACONTRAC'OR(S�LICE45f.�PUR3UANT70THF.CONTRAG � QUAN?I'fV DESCRIPTION FEE Y TOi15LICENSEIAW.). __ —" —"� a• J o O IAM EXE�dPT UNDER SEC. ___. __.�.R P G FON LNIS REASON U __,_ � '___' __"__'_—___""__—'_'_ _"""'__ CL . � DATE D4VNER F' ' (1J .__—__� •. .� Od LICENSED CONTRHCTORS U[CLARAI"ION —� W, LL I HEREBY AFFIRM UNDER PENW.TY OF PERJUP,V THAT I AM LICENS[D U4UER PROViSIOIiS C��(:I IAATER � � 9(LUAIMENCINCWITNSECTICYJ7000jOFDIVI510N:iDFI1;EClI51NE5SAN�v'NOF[SSIGNSCObE,FND � __.____. __ X W LICENSE IS IN FULL WflCEAND EFFEG,; m LLt ry �_LIC.NO....— ' a � _"_' '_ � —__ '__ ' 0 UCENSE C SS� 5� / _t � � . w �ATE_Z __ S�P CGNTRACTOR.�'�'aA(iL.-fi`C N��. !x. —_ � ._—_—.—' _.-- __ ,_/_.._.._ _ � K� WOflKEfiS'CQMPENSAI"IONUEq.ARATION � Q � v -- - � IHEREBYAFFIqMUNDEfiP[NALTVOFPSRJUNYONEO':'iHE'OLLUN/INGDkt:L�NnfIONS� CA ¢ ; � I HAL'E AND WILL MAINYAI4 A GEH71fICATE CF GGNSENI'TO S[LF-M5l1HF�OR WOqKEftS' � � y— — �C0IAFENSAiICN,AS f+ROViJFD BY SECiIOM1 a'/0o Or TME LAEOR CO�E,fOH T}IE PERFORh9FIVCE C% _�—_ � OF ll{E WOAK FUR WHICH 7FI15 VFRA91l IS I.SSUE�- � Q I �_�___ "_ _I HAVE AND WILL AIAIMO.IN WCIFlKE�15'COMPENJATION I�SUPANCf,AS RF.UUTAEO BY SECTiON �� '} d 371100FTME1�1130RL"CYJ[,FORTIIFPEHFOHMA�CECFiHF.'lJONKFOR1VNi(71:HI5PEf1�M�T15 — ---- - -- / ISst,'E�.MVMlOHKFRS'COMPEN5ATIONIkSUqANCECARRIERANDr'OLIc:YNUMCERAR'c: CONSTRUCTION t:.�'�_,�5�1 ! ? 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