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___�� CITY OF DIAMOND BAIi (��:-,' DEPARTMENT OF COIVIMUNITY&DEVELOPMENT SERVICES v� w , 21660 E.Copley Drive Suite 190 (909)860-3195 Faac(909)861-3117 pRE`SS 'y�'� � BUILDING:PERMYT APPLICATION FIRMLY � J�BSITE �• f- APPLICATIO�J / PERMIT P!C o ADDRESS ��+�� �%I C��°� C_C�'� 'C..- DATE__✓"�O�A"���� ' NUMBER ��' #_ � APN LOT O TFtACT �� t�C� �SSUE / TYPE OCC C DATE "�"'-I 2T� � CONST. GROUP p OWNER _ � ADDRESS � Y"' ✓ ZQNING SETBACKS $ CITY�.y�`L �J��_�3— ZIP�s"ZT�' TEL. �.'��BC.� FRONT RW q APPCICANT TEL. REAR ❑ � SIDE/SIDE SYREET RW � ' � ' < ,�, , ,.J"�-�l�� SIDE ❑ CQNTRACTOR �`! ADDRESS � -� E PROPOSED USE " �- I p CIT°( �i�'�i f �U`. ZiP��ZS� 7EL:�/.� 2'" w ARCH/ENGI a DESIGNER �� NO.DWEL. NO. NO. 'a ADDRES5 UNIYS STORIES BEDROOMS � 'CITY 21P tEL. y � DESCRI?710N SQ.FT. FACTOR PSF ADJ.AREA/VALIJATION' Q OINNER-BUILDES2 DECLARATEON SFR/ADD/REM O ;p . I HEREBY AfFlRM UNDER PENAITY OF PEFUURY THAT I AM cXEMPT FAOM THc Wh7RACTOP,S LI- 'G8f8JB,�CdfPOff � . � CBISELAWfORTHEFOLLOW�NG�q6ASON(SEC.7031.5BUSINESSANDPFOFESSIONSCADE:ANYCfIVOR� (/y _ C.) COUN7V,WhICMREOUiH'eSAPER ITTOCOYSTRUCT,ALTER,IMPAOVE.DEMOLISH,ORREPAIRANYSTRUC• � p�tio/peck � � �TUpE;PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOfl SUCH PEHMIT 70 FILE A SIGNE� 'V'�' �STATEMENT THAT HE OR SHE IS LICENSEO PUASUANT TO THE AFiOVISIONS OF THE CONTPACTORS LI. 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