HomeMy WebLinkAbout13374 (153) ��_ CITY OF DIAMOND BAx F
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
w 21660 E.Copley Drive Suite 190 I
(909)860-3195 Fax(909)861-3117 PRESS
��`'�'�. BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE /1 Q O�/ t/��,/�A�rst w� �� � DATE CATION p r /�_G)'p NUMBER� 3 3 7 y #�� ��
o ADDRESS f�l 1 ( N'`4►�`� O / L O
ISSUE TYPE OCC
� APN LOT TRACT DATE �" � "K�{ CONST. GROUP
°C OWNER '�7
O
o ADDRESS O • ZONING SEBACKS
w CITY ZIP�� TEL. FRONT RW ❑
� APPLICANT.�.M.IJOU4N TE REAR ❑
SIDE/SIDE STREEf RW ❑
� CONTRACTOR SIDE ❑
Q ADDRESS PROPOSED USE �� K. (!V��i W IIVI�WA�G
o CITY ZIP TEL. ���_ � �
wo A�(ENG/ n Y�. �' A-' �
� �6ESIGNER �� HT�� NO.DWEL. /� NO. 2 NO.
ADDRESS UNITS J STORIES BEDROOMS
y CITY ZIP��.TE
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
¢ OWNER-BUILDER DF_CLARATION SFR/ADD/REM
O
p I HEREBY AFFlRM UNDER PEN/�LN OF PERJURY THAT I AM EXEMPT FROM THE CONTMCTORS LI- G8f99B/CB�OR
W CENSEUWFOHTHEFOLLOWINOREASON(SEC.70.71.58USINESSANDPROFESSIONSCODE:ANVCITVOR (n
U COUNTYWHICHRC-0UIRESAPERMRTOCONSTRUCf,ALTERIMPROVE,DEMOl1SH,ORREPAIRANVSTRUC- W P8110/DBCk
�Z TURE,PRIOR TO RS ISSUANCE,ALSO REOUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-.
� CENSE UW(CHAFTER i(COMMENCINa WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. �- PooUSpa
FESSIONS CODE)OH THAT HE OR SHE IS EJ(EMPT THEREFROM AND THE BtiSIS FOR 7HE ALLEOED EXEMP-
TION.ANYVIOLATIONOFSECTION7W1.6BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAN770 Z Re-Roof
� A CML PENALT/OF NOT MORE THAN FNE HUNDRED DOLURS(i500).):
� ❑I,ASOMfNEROFTHEPROPERTY,ORMVEMPLOYEESWI7HWAOESASTHEIRSOLECOMPENSATION, 0 COrt1rtIBfClel �
WILL DO THE WOFiK.AND hiE STRUCTURE IS NOT INTENDED OR OFFERED FOR SQE(SECJa�,BU51� J
NESS AND PROFESSIONS CODE:TNE COHfMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF-
� PROPEHTYMM1108URDSORIYPROVESTHERC-0N,ANDWHODOESSUCHWORKNIMSEIFORHERSELFOR m
Q THHOUGHNISORHERONMEMPLOYEES,PROVIDED7HATSUqiIMPROVEMENTSARENOTINTENDEDOR
W OFFERmPDRSALEIF,HONlEVER711EBUILDINOORIMPHOVEMINTISSOLDWfTHINONEYEAROFCOMPLE-
0 �`TION,THE OWNERSUILDER WILL HAVE THE BURDEN OF PpOVINO THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOH THE PURPOSE OF SALE). � I
_ ❑I,ASON?IEROFTHEPFiOPEHTY,AMEXCLUSNELYCONTMCTINOWITHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7W/,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VeIUeNOfI ADJ.AREA �
W CEHSEUWDOESNOTAPPLYTOANOWNEROFAPROPEflTYWHOBUILDSORIMPROVESTHEREON,AND
� NM1qCOMRACTSFORSUCHPRQIECTSWI7HACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE �
� TORS LICENSE UW.�.
J
� O I AM IXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
3 �
Q
� DATE ONMER V
F LICENSED CONTRACTORS DECLARATION �
� w .
1 NEREBV AFFIiW UNDER PENPLTY OF PEfUUiiY THAT I AM LICENSED UNDER PHOVISIONS OF CHAPTER �n
d Y(COMMENCINO WfTH SECTION 7000)OF DMSION 3 OF THE BUSINESS AND VROFESSIONS CODE,AND Z I�''.�-.�'1 5�
X IAY IICEHSE IS IN FULL FORCE AND EFGECT. m �
lJJ �
� UCENSE CLASS LIC.NO. J
V DATE COHTRACTOR �- ^� �yU
W
Y{�'4 I� V � �J J
� WORKERS'COMPENSATION DECLARATION U ^11 Q'��JA I�+a�� I7 x2 d TA I
� I HEREBV AFFIRM UNDER PENQTY OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Q �v�L,�JG lSltl AJ�A '�F.'II��Y
� � I HAVE AND WILL MAINTNN A CERTIFICATE OF CONSENTTO SELF-INSURE POR WOfiKERS' 2 � �
� COMPENSATpN,AS PROVIDED BV SECTON 970o OF THE LABOR CADE,FOR THE PERFORMANCE W i
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
W _I HAVE AND WILL MAIMNN WORKERS'COAIPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 37000F THE UBOR CODE,FOR THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS l 8 71�D
ISSUED.MY WORKERS'COMPENSATION INSUHANCE CARRIER AN�POLICV NUMBER ARE: CONSTRUCTION �j
j �pq�Ep PLAN REVIEW C/
� POLICY NUMBER ELECTRIC i,
� �Ss�crar��r�orgEap,p�r�ppFn�pEw,�iswporiEMxot�moalnas(sim�oqtFss� PlUM81NG
w MECHANICAL
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
(J SHALL NOT EMPLOV AHY PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
� WORKEHS'COMPENSATION UWS OF CAIIFORNl0.�ND AGREE THAT IF I SHOU�D BECOME INSPECTION FEE
S SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR ���S Q
COOE,I SHALL FOHTHW17H COMPLY WITH THOSE PROVISIONS. ISSUANCE (
p DATE: APRICANT: SMIP • ` �I �
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNLAWFUL.AND SHALL BE
� SU&IECT AN EMPLOYER TO CRIMINAL PENAL7IES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT �,
DOLURS(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN `c
J SECTION 37oB OF THE UBOR CODE,INTEREST,AND ATTORNEPS FEES. � RETENTION FEE: � �+� O� '
Q I
OCONSTRUCTION LENDING AGENCY PR�,►r�/{,�}'(�T FEE:
� I HEREBY AFFIRM UNUER PENALTY OF PERIURY 7HAT THERE IS ACONSTRUCTION LENDING AGENCV l f�j
FOR THE PERFORMANCE OF THE WORK FOR WHICN 7HIS PERMIT IS ISSUED(SEC.30v7,CIV.C.�.
Z
W
� LENDER'S NAME � '
F- LENDER'SAUDRESS
w ICERTiFYTHATIHAVEREADTHISAPPLICA710NANDSTATETHAT7HEABOVEINFORMATIONISCORRECT. TOTAL FEES
� 1 AGREE TO COMPLY N7TH ALL CfTV ANO COUHTY ORDINANCESANO S7ATE UWS REU71N0 TO BUILDING
CONSTRUCTION,AND HEREBY AUfHORIZE REPRESEMATIVES OF THIS COUNTV TO EHTEH UPON 7HE
ZABOVE-MENTIONED PROPERTV f-0R INSPECTION PUR sEs. COMMENTS �
� �n� U �
_
¢ PERMITTEE N (P ' ��
N �
N SKiNANRE P OAT
� RECPT.NO. � PAID BY VALIDATION
WHITE�epeAment Copy,YELLOW�inence Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—Applicant's Capy
.::. , . , . ,. , .
C��'Y OF Dll�fillOtVD��AR� .
II�ISPECI'BOdV FiECO�d�
�J.��`3��:.6t,f,4�.�,�` � _� ��1� �� - .:o .�� e • �. � � � s A �
A �' a
_ -. .. . .. ... , �.,. , b. .., �. ��
SETBACK � . .. _ :' FLOORJOIST '�� "f '���:;��' ;; '�' �. �"' . � ;
-� � .;
�, � ;
FTGS/FORMS/STEEL , . FHA REQMTS '
ELECTRIC GROUND ' � UNDER FLOOR DU�T�. .� ,� , � , _,-, ;y:�,;, '
GROUND PLUMBING UNDER FLOOR CUNLIUI�Tj � ' ��=i;a1'�'.,�, _ j !t<`.'•
SLAB GRADE FIRE LAGE OUNDA ION ��,� � �� •�'+�'��'� �`� '''"'°''��
TEMP POWER FIREP�� G��{O1V[��'��EAM - � � � ~�
WATER SERVICE MID HT. BOND BEAM
ROO��HEATJ°{II�G.,�'•`� .. . r�' . ,.., , .
8 FT. BOND BEAM
FRAMINGNENTILIATION � � � FINAL 80, D�EAM ,� - ..;., �L� , ,�..;� :,T.,r.J f.�'•� -- --
„-
ROOF C�VER � `=-` PRE-GRAGIIN �..;';1� ,L tti' :ti�4 pi.l;'f r• ..t�• _
ROUGH HEATING BEN''�II�N��)-`. ,.. _1.:i � _:t ,'y`t��/1`!'e�;'�-'�
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUiVIBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING P�OL FENCING
WALL INSULATION POOL FINA�
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILWG DEDICATIONS
SEWER FINAL ENG: �
SEPTIC TANK . _ � ;_ .,� LANDSGAPE/IRRIG.
SEEP PIT/L.L: _ - � � ' � � •.� �' ON SITE IMPS. � ,
GAS AIR TEST FINAL ZONING
FINAL CONST. o FIRE QEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID �
FINAL PLUMBING ENERGY
o s 0 .`� r �.id'
COiViMEiVTS
. .. � . . ,
, � • . t
�
�
I
�.
SEP.TIC TANK SIZE ,
SEEP PIT/U SIZE
��
���! �,�
� +
r . .
.� ��(5 :
t
. , � � � - .
� � . - . `;4..' . ' � ;'�
��e�� � • '� � � . . ��� �V��\ -�`..-� •�- ��; � �-�� : .
.a�... � _.��