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HomeMy WebLinkAbout11555 (5) � ---��---, CITY OF DIAh10ND BAR�.'�: '" ^.= � •. :: '�. ,x , � � CaMMUNITY DEVELOPMENT DEPARTME � „ . . � .;,,.�; . 21660 E.Coplcy Drive Suite 190' .. .';� PAESS (909)860-3195 Fax(909)861-3117 '' ` ' ' .. . ' '��� BUILDING PERMIT APPLICATION FI R M LY � JOBSITE" � " APPLICAT_ Ny' Q NUMB R I� �/C Q, , � :� � : , Q ADDRESS ' � - � DATE 1I ��/� �/ $ ISSUE��� TYPE OCC .. : � APN � T . - ACT . . . -- DATE _ _ . .. GROUP p OWNER � ZONING SETBACKS ... .. p ADDRESS ' ! ' '' , _ .. „ FRONT . .. . . -.. �l ❑ OCITY ZI TEL: - � REAR V J I U� • p o APPLICANT � " TEC. � _ SIDE/SIDE STREE7 RW ❑ �m¢, CONTRACTOR ' . CICI S � � . PRO' SIDE .... . __. .._ � � Q ADDRESS ._ . � � . �y. ,. . . . __.. ' � CIN �r�I L T�n� ZIP � TEL. _ '- -••- . POSED USE . � � n .. . . _ . ... . .._ w ARC NC� ' ' ' ' z DESIGNER `�,� - � �� ' UNI SWEL- S ORIES 8 DR _.__. aw. ADDRESS ' � ` : . � '' OOMS,:„ : . . � CITY ' ZIP �TEL. - 3G ' . - - - ! .. .__ . .... .. ., ._. . . . .. . . ESCRIPTION " , � , � D SQ�FT: FACTOR PSF ADJ.AREANALUATION � __...OWNER•BL'ILDER DECLARATION. .... .. . '�' '" SFRIADD/REM .__._ . . .. .. . _ ... . . . . _ ... . . . O . , .p 1 HEREBY AFFIRM UNDER PENALTY OF DERAIRV THAT�AA1 E%EMPT FROA1 THE COMRACTORS LI• GaPBge/C.3�p0A � �� � � � � � W CENSEUWFORiHEfOLLOWINCHEA50N(SEC,7o71.68U51NES5ANDPROFE55KKJ5C00E:ANYCITYOR. (n � , U COUNTYWHICHREOUIRESAVERMITTOCONSTHUCf,AITER�MPROVE.OEMOU5H,0i1REVAIRANVSTRUF� ' W 'PdSIOID@Ck.,.... "" � z NFE.PFIOR TO fT5 ISSUANCE,IL50 RCOUIRES TME APPLILANf FOR SUCH PERMIT TO FILE A SIGNED w - - - - . .. � ' S STATFMEM T}UT HE OR SHE IS LILENSED PURSUNfT TO T/1E iROVi510N3 OF THE CONiMCiOR9 L4�� "� � � �� . i CENSE lAW(CNAVTER i ICOMMENGNQ WITH SECTION 7000)OF DINSqN]OF THE BUSINE55 ANO Pfi?� �POOUSO� , - " � � � , . ... .., . .. . . . . 0 F[SSIONSCADE)ORTHATHEORSNEISE%EMPTTMEREFROMMIDTHEBASISFORTHEALLEGEDEMEMP-� . . V iqN.ANVVIOLATqNOFSECTION77J1.6BVANVAPPUCANTFORAVERMITSU&IECTSTHEAPP�IGNTTO ' Z pQ-Rpp� � A CML PENALTY OF NOT MORE iHAN FNE HUNORED DOLLARS(f5oo)d: � ' 7 . I , ` Z. OI,ASOv1NEROFTNLPROPERTY,ORMYEMPLOYEESWITHWAGESASTNEIRSOLECOMPENSA7K)N,! : 0 (`,pmmBfCi3I � � �• YALI DO THE WORK,M7D TME STRIICTUNE IS NOT INfENDEO OF OFFERED fOR SALE(SEC.7oN.BUSF � J NE55 AND VROFESSIONS LODE:hIE CONTRACTORS LIC[NSE UW OOES NOT�DPLY TO AN OWN[R OF � � N DROPfRTYW1108UILD50RIMPROVESTHEREON.ANDYh10DOE55UCHWORKHIlASELFORH[RSELFOF � C= THtiOUCHHI50RHGROwNEA�PLOYEES.VRONOEDTHA75UCHIMPROVEMENTSARENOiHTENDE00R m . . , , � W OFFER[DFORSALEIF,HOwEVE0.731EBUILDINOORIlAPROVEMEMISSOLDWR/pNONEYEAROFCdAPLE• ' ' 0 TION,TNE OWNER�BURDER VALL MI1YE T1E BUfiDEN OF PROVINO T1AT ME OR SME DID NOT BUILD OR� � Z M7fiOVE FOR THE CURPQSE OF SALE). � � =' ' � = C4ASOVJNEROFTHEPROPERiY,AMEXCLUSNELYCONTMGTIN6WRHlICENSEDCONTRACTOR3 � � Q TO CONS7RUCT THE PROIECT(SEC.70N,BUSINESS IWO PROFESSIONS CODE:TME CONTMCTOfi3 U• , Vatuetion ADJ.AHEA W CENSELAWDOESNOiAPPLYTOANOYMEROFAVROPERiVN'FIOBUItD50RMPROVESTHEREON,AND WNOCOMRACTSFOHSUCHPRO.IECTSNA7HACDHTRACTOR(S)IICENSEDFURSUANTTOTHECONiMC•., . QUAHTITY � �ESCRIPTICN� � � � � � �-� �FEE � � iOR50ll AM E%EMPT UNDER SE4 ��... � . '. .. B.i P.Q fOR , � �' . : . / O ' . . . . .... . _ . _ THISREASON Q ' '1 ,� ... .... ._ . . ._ . .. :......_ _ _ ........_. .. .. ..� ... V . . -. . ........ . .. . ..__ . , .. . . ..._.. . . .. . ' � . . .. ,' . V" DATE OWNEF . ��I . V . . . . . .,.. . ..... _........ . .. ... ... .. ..__ ' _' ' ' ' W � LICENSED CONTRACTORS DECLARATION .; " ' -' ' � ., . W . ... . .. . , . . I HEFlEBY�FFIRM UNDEFl PENALTY OF iERtt1RY TFUT I MI IICENSEO UNDER PROVISIONS OFCVNPTER= • � ' ' d Y�COMMENCINGWITHSECfION7000)OFDMSION70F7HEBUSMESS�N�PROFESSIONSCODE,MlD'-' " Z "" "-' ""� '� "' '-' "" ' ' A1Y LICENSE LS IN FULL FORCE M1D EFFEC7. i m . _ _ :_ .. ... ....... . ... ' / . . �. � � ' . . ., �', ', � UCENSE CUS � LtC.NO. � ��SN�`'� J � V DATE � CONTRACTOR � 0- , . . . , ' W .. .... . ..._ . .• ._..__. . .._ . . �. �. � . .� � � � WORKERS'COMPENSATION DECLARATION a � N INEREDY/�FFIRMUNDERPENAL7VOFiERNRYONEOFTHEFOLLOWWGDECUMTIONS: ' U �� � � Z . , � � ,. ... � _INAVEAN�MnLL1.WNT�INACERTIFIGTEOFCONSENTTOSELFdNSUREFORN'ORI(ERS' � 2 � ��� :, � COMPENSATION,ASPROVIDEDBYSECTION77ooOFTHEUeORC00E,FORiHEPEFFOqA1ANCE W ' _ OF TME WORK FORNh1ICH THIS PERMIT 4S ISSUED. , � _ _ Q .,. _. ...,. .. .. . ... .. ... . .. ._. . . ..,..... _ _.. . , .. .... .. .. .. .. , . �I HAVE ANo WILL►UIMAIN WOflKERS'ODMPENSATION INSURANCE,AS RE�UIRED BY SECTION l Q �700 0F THE UBOR COOE,FOR THE PERFOfUAANCE OF THE WORK FOR WHICH 7HI5 GERIAITIS L . _ ISSUED.MVWOR(K�$�SCOM ENSAT101y1NSURANCECARRIERANDPOLICVNUMBERAR[: ��� �� �� ' �CONSTRUCTION " � � � �" '" � ' ' "' " ���� ' l• O } CARRIER V rJL�p I�lri � P . E4V .��� ... . . _ - , • ... .. ...... . . � .. ... .. .. . .... ._.. . . . . � � � POIiCYM1M0ER ��� ELECTRI _... . _ .._. . _ � �ussEcm+wEIDnorseoa.t�E'rEooFnfPcrx+rsr�a+E�nocuu�sg�ao�on�.ss�. PLUM6ING _ T� � Z ICERTIFYTHATNTHEPERFORMMICEOFTHEWORI(FORMrtnO1THi5PENMITISISSUED,I MECHANICAL .(J -- SMALLNOTEAAPLDYANYPERSONW�NYMANNERSOASTOBECOMESU&IECTTOTNE . . . .. _ . _.,._... . � WORNERS'C0IAPENSATION UWS OF CALIFORN10.�NO AGREE THAT IF I S eEcoM[� �INSPECTION FEE �"� ��� � SUBJECTTOTHEWORKERS'CWdPENSATqNGRON510N50F iONJ7 FTHELABOR �. ' COOE,ISHALLFORTIWIIHCOMOlYW1iHiH0 PR NSI . � ISSUANCE • O . . . .... . _. . ...... ....... .. .. ... . .. . .. .. _.. ... . . ... . . ... . . p OATE:'� AFPLICANT: � SMIP � ENEFGY P/C_..-. . WARNING:FAILURETO SECUFE WORKERS'COMPENS COVERAGE IS UNUWFUL.ANO SHALLBE��� � SVElJECTAN EMPLOYER TO CRiMINAL VENALTIES AND qVIL FINES UP 700NE HUNDRED T10USAND ENERGY PERMIT � DOLLMS(5100.00D1.M ADDITION TO THE WST OF COMPENSATION,DPMAGES AS PRWIDEO FOR IN ' J� SECTION]70!OF THE LA90R CODE,INTEREST,AND ATTOPNEYS FEE3.�' " ' ' "' '�" '� � RETENTIONFEEi- -.. .... ....... . _. .. .., _.,` � oCONSTRUCTION LENDING AGENCY ! PRE-ALT FEE � � � �� - � CL INCREBVAFFIAMUNOERVENALTYOFPERIURYTHATTHEREISACONSTRUCTIONIFN�WGACENCY lA �� � 3`{ ,�� � �- FOq TNE PERFOPMANCE OF THE WORK FOR WHICH THIS PEPMIT IS ISSUED(SEC.]OY7,CIV.C.1. --�—� . . , Z . ... ..... .. ....__ .._...... ........ ._.......... .. ._ .. . _... . ._... . . ._ . ..., .. LLI .. . . . . . . ' � LENOER'S NAME S�j , D�i : � � , � . ... _. ...... _... ... ...._.. ._... .. ....._..._. . .... .. . .._ ... , LENDERSADDflE55 � ¢ ICERTIFYIHATIHAVERE/�DTMISAPPLICA710NM1D5TATEiHATTHEA80VEINFOR/AA710NISGORRECT. TOTAL FEES, , � , , � I�GR[ETOfAMPLYYATiIALLCT'ANDCOUNTYOROWAIJCESMIDSTATEUWSRELATWGiOBU1L01NG� � � ����� �� � , CONSTRUCTION.AND HEHEBY AUTHORI2E REPRESEMATIVES OF THiS COUNTY TO ENTER UPON TNE Z ABOVE��[NTIONED�ROPERT7 FOR INSVEGTqN PURPOSES. , . COMMENTS �� i. Q . _. . ..�,_.._ .. ...'__ . .. . _ .. ... , , . _ ' : . � m PERAIITTEENAME 7 7J . . .._ . .. . ..... . ....._ . . ...._.. . .. .__ . . . . , a �� y�5� � �. SIGNAT �O VE I � � DATE � RECPT.NO. PAID BY VALIDATIO � � � � �� �� � � - -�� � �-��-WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy.GOLDENHOD—File Copy,GREEN—Applicant's Copy- - � . � ' . ' . . •,} . f , . . .. . ... ..t. ... . Y r . . . � . ' a. � ,� . . . . . ._ . ,.. "i•. . ... . � .. . . , . ,. .. � .���� ... ., ..v, , c "5.•. . - ..� � �`� I �I�iiOF,DIAMONO B�4R ;':' ' . , ',' :'; . � �. . � . �� .. . . - INSPECTION RECORD ' ; .;: . ; ' . . ,. . ;._;;�.. . ,� ,. , . ..�� . � . • � � � • - • • � � � t�n�l�� .�r•.: SET BACK ; ; � �, ; . . . � FLOOR;JOIST •. - - -- , FTGS/FORMS/STEEL' '��"" �i`�,IP:` � � FHA REQMTS � - ' ELECTRIC GROUND UNDER FLOOR'DUCT - � • =� � � • , GROUND PLUMBING !�! �;-C� s� i<<I. - � ' UNDER�LOOR CO�IDUIT •.. � '��- SLAB GRADE - -- ' - FIREPLACE FOUNDATION._ ' '� '�' � ' '''• � �' '� " ' , _.. TEMP POWER ... . ..._ . ._: ._ : . -_ FIREPLACE�BbND'BEAM • .._J. ,, _.:. .._ ti� , ; � ' '', : WATER SERVICE �' � • • - --� -� • MID HT.'BOND BEAM �� '� ' '` � ' ";, . •, •� ROOF SHEATHING 8 Ff.BOND BEAM • . . - ' �" "� FRAMINGNENTILIATION � ' FINAL'BOND BEAM �; ,c :,�� ; �" - ""-" • , ' ROOFCOVER - -- - _ . -- . PRE-GRADING.�:..': �::.' ', -' _, ,, . � _ . .� ;�.•'_ . � � ROUGH HEATING-- ,--- � - ' BENCHING ROUGH ELECTRIC ' - - --- ROUGH GRADING ROUGH PLUMBING- - � FINISH GRADING . � ' > SHOWEH/'fU6TEST , �- --- - _ _ � -----� _ POOLELECTRIC " EXT.LATH/SIDING � � POOL'FENCING ', �: WALL INSULATION i �. PO�L FINAL ' , ;,, CEILING INSULATION ; OFF SITE IMPS. , DRYWALL NAILING � � DEDICATIONS SEWER ._.._. ... .. _ _ . . .�... . .. _ , FINAL'ENG, . SEPTICTANK : _ .-- _ _ � ._. _ - '. � ,,:., LANDSCAPE/IRRIG. : SEEP PIT/L.L. - - - ON SITE IMPS. GAS AIR TEST . - _ .-. - . . ' ,'._ •:,'- 1. . FINAL ZONING FINAL CONST. - - - - — -- -FIRE DEPT. FINAL , ; FINAL HEATING -- -- - --- � - - - -;--- - HEALTH DEPT. FINAL ; - FINAL ELECTRIC - ` DEV.FEES pAID ; FINAL PLUMBING � � ENERGY �,--:� t ' � i _ _. .----- • o �. ,. - _ . � . . +.. . ...-- ----. .__._.._ _._ _ . .__ .... . .. '-- - - .. � COMMENTS ------ . _. . , ; ; , . _ . .---- _. _. . ._ . . _ __ _. . _ . . � . ,\ _. .� i ._. .. . .. . . . .. . . . .. . _.. . I i ', . . . _ . _, ' _: _ `' �,';`;, , , , ; ; � . , . . - � • � • „ � . „ � � � . ,... � . , ` � -.... .. _ ' . .. . .. .,. .. 1,� W,j^p.� . . �... .. I ' .. .. . . . ' . ' .�. , _ _' � � . F .. .. ..__ .. .. _.. . ... . .. . . .. �. . .� ' � -. ., . , . , , , , , � _ ..; . ... .. . ��vv� �) ..3 :��� . ...... . , �., ' .'i' � ,. , � .. . . . . .,. � .� . _._...._ .. ... .._. ' ._.. � i ' . . . . � . � ' _' ' . . ' . �.� . _ 1, . � . .. 1'� . _... .. . .... . _. . ._... l� .�� �. � ', : . . , . . .. . . .. , , . t-_ , . _ . . .. SEPTIC TANK SIZE l I , ... . . . ... SEEP PIT/U SIZE -- . . � i . , , _. _ 1� :-; �� �.1' _ ' . . - • , _ . _. : j � � , ..._. ; i l . , � . :Y , f . . r-. i �--j`��-� '' . ',' . ` ; ' ; � .