HomeMy WebLinkAbout11024 .
--�''`�---- CITY OF DIAMOIVD BAR �� � ��p��
� COMMUNITY DEVELOPMENT DEPARTMENT � T �O
_;,,w 21660 E.Copley Drive Suite 190 0�/ PRESS
(909)860-3195 Fax(909)861-3117 O
'�"� BUILDING PERMIT APPLICATION `��D�D FIRMLY
o� JOBSITE �7 �f' , p DATE CATIO NUMB R/��� #!C
ADORESS '��� 1 °Z'� � �-11� +'Y t' �N`' Z' �
o ISSUE T(PE OCC
r° APN LOT TRACT DATE CONST. GROUP
°C OWNER
O
ADDRESS ZONING SETBACKS
� CITY ZIP TEL. REART RW ❑❑
o APPLICANT TEL.
SIDE/SIDE STREET RW ❑
Q C�NTRACTOR L�- A S ��C 'J�j� SIDE ❑
� ADDRESS�� fl 'Q� � • PROPOSED USE �r � ����"t"�!E
a CITY ZIP�_ TEL. 6
w ARCH/ENG/
w DESIGNER NO.DWEL. NO. NO.
0. ADDRESS UNITS STORIES BEDFIQQMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BI:ILDER DECIARATION SFR/ EM �Z/�/
� O
� �HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gdl09B,�C3tPOft
W CENSELAWFORhIEFOLLOWINGREASON(SEC.7031.58USINESSAN�PROFESSIONSCODE:IWYCITYOP (/)
U COUNTYWHICHREWIftESAPERMI7TOCONSTRUGT,ALTER,IMPROVE,DEMOlISH,ORPEPAIRANVSTfiUF W P0ft0/OBCI(
w TUiiE,PRIOR TO 1T3 ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PEflMR TO FlLE A SIGNE�
� S7ATENEIl�THA7 HE OR SHE IS LIC[NSE�PURSUANT TO THE PpOVIS10N5 OF THE CONTRACTORS ll�
� CENSE UW[CHAPTER B(COMMENCING WITN SECTION 7000)OF DNISION 3 OF THE 9USME55 AND PRO� � �DOUSPe
Q PESSIDNSCODE)OflTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALIEGEDE%EMP- (�
U TION.ANYVIOLATbNOFSECT10N�o31.58VANYA7PLICAN7FORAPERMITSU&IECTSTHEAPPLICANTTO z Re-Roof
� qCIY1L PENALTY OP NOT MOFiE THAN PIVE HUNDRE�DOLLARS(f5oo).�:
� ❑I,ASOWNEROFTHEPHOPERTY,ORMYEMPI�YFESWITHWAGESA5TNE1RS�lEWMPENSATION, C� Commerciat
Z YliLL DO TME WORN,PND THE STRVCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70M,BUSI� J
NESS ANO PROFESSIONS�DE:THE COMRACTORS LICENSF LAW DOES NOT APP�Y TD AN OWNER OF
� PR07EflTYYMOBUILO50fl�MPROVESh1EREON,ANDYhiODOESSUCHWOPKHIMSELFORHERSELFOR �
� TNROUGHHISORNEROWNEMPIOVEES,PflOVIDEDTHATSUCHIMPiiOVEMENTSARENOTINTENDE00R m
W OffEFiE�FORSALE.IF,HOWEVER71'1EBUIL�INGORIMPROVEMENTISSOLOWITHINONLYEAROfCOYP�E-
� TION,THE OWNER-BUILDER W�LL HAVE THE OUROEN DF PROVING THAT HE OR SHE�IO NOT BUILD OH
Z R,APROVEFORTHEPURPOSEOPSAIE).
= t]1,ASOVAJEROFTIFPROPEHTV,AAAEXCIUSIVELYCAhiTPACTIMGINITHLICENS£UCONTAACTOFS �/
Q TO WNSTFUGT TME PROJEGT(SEG.70M,BUSINE55 ANO PppFE5510N5 CODE THE CONTRACTOR9 LI- i(18I10l1 V e ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPEfliYWHOBU�IDSOFIAIPROVESTNEFEON,AN�
� HMOCANTRAGTSFORSUCMFROJECTSWITMACON'RACTOR(5)LICENSEDPURSUANTTOTHECONTRAC QUANTITY DESCRIPT�ON FEE
TOAS UCENSE UW.). /��j�/
� ❑I AM EXEMPT UNDEfl SEC. 8.6 P.C.FORTH�S HEASON Q / '`"'" , /L''�
� � 8 i�lS�f
LL onrE OWNER U
W
� LICENSED CONTRACTORS DECLARATION W
a
� I HEFEBY AFFlRM UNDER VENAIN OF PERJURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER � ��/�� �
d 91��uENCINC WfT}i 5ECT10N 700010F DIVISION 30F THE BUSINESS AND PROFES510NS�DE,AN� Z
X MY UCENSE IS IN FULL FORCE ANO EFFECT. s� m � /7i S/ ��� ' 'r•
� LICENSE CLQ ' LIC.NO. / ��2 �(� j /',^/ �� .
U DATE � � CIXJTRACTOR ��•� a
W
� WORKERS'COMPENSATION DECLAR0.TION U �'i'�"
, ,�
� iHEflEBYAFFIRMUNDERPENALTVOFPEPJURVONEOFiHEWLLOWINGDECLARA710N5:
l� Q
� i MAVE AN�WILL MAINTAIN ACERTIFICATE OF COIJSENi TO SELHNSURE FOP WORKERS' _
COMPENSATION,AS PitOVI�ED BV SECTION 370o O'r THE LABOR CODE,FOR THE PERFOiUAANCE U
`x OF 7HE WOPK fOH WHICH THIS PERMIT IS ISSUED. �
�
W I HAVE ANO WIIL MAINTAIN WONKERS'COMPENSATION IN5URANCE,AS REQUIFED BV SECTION
Q �37000FTHELABORCODE,FORTHEPERWRMANCEDFTNEWORKFORWHIGHTMISGERMITIS
ISSUED.MY�`yq RKERS'COMPENS�A��T r+j MSURANCE RAftIER AND POLICY NU B[RARE: CONSTHU N ��G��
j cnAA��ER lT�� � "��� ��✓M�- I�� • PLANREV�EW
zPOIICYNL�!oEP���� ELECTRI 0•
Q �
� (M455ECitONNE�NOTBE00A�PLEfEDOF7FIEPEFB.[TISiDRONEHJI�DREDDOLLAR4R10D)ORIESS?
W CN 7��
Z 1 CERTIFV THAT MTHE PERFOPMANCE OFTHE WORK FOR WHICH THIS PERMIT�S ISSUED,I
(,'} SHALL NOT EMPLOY ANT PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE
� � WORKERS'COMPENSATIONLdWSOFCALIFOFltr1A�7DAGREETHATIF SHOU ME INSPECTIONFEE
� � SUBJECTTOTHEVIORKERS'COMPENSATIONPROVISIONSOFSECTIO �70o THELABOfl � y�
I ALLFOR(HWtTNCAM.PLYWITNTFIOSEPRO N�NS. �SSUANG
� ���p DATE: � � APPLICANT: � (i SMIP .______
w ENERGY P!C
J WARNMC:fRILUHETOSECUREWORKERS'WM7 S NCA RA ISlINU1WFUL,ANDSHALLBE
LL SU&IECTANEMPLOVERTOCFIMINALPENALTIES D VILFIN UPT ONENUNDPEDTHOUSAND ENERGYPERMIT
pOLLAP5�S100.000),INAOOITIONTDTHECOSTOF PENSATI D AGESASPROVIDEDFORIN
¢ SECTION 3�OB OF THE LABOR CODE,�NTEREST,ANDATfORNEY'S F . RETENTION FEE: � C +� �
Q CONSTRUCTION LENDWG AGENCY PRE-ALT FEE: '� �
O
� I HEREBV AFFlPM UNDER PENALTY OF PERJUiiV THATTHERE IS A CONSTRUCTION LEN�ING AGENCY
n- FOR THE VERWRMANCE OF THE WOPK WR WHICH THIS PEFMIT IS ISSUED(SEC.3aB�,CIV.CJ.
Z �
W
� LEN�ERS W1ME
F- �ENDER'SA��RE55
� 70TAL FEES �p��, �'v
� I CERTIFY THAT I HAVE HEAD THIS APPL�ATION AND 5TATETHAT THE ABOYE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALl CITV ANO COUNTY OROINANCES AND STA7E LAWS REUTING TO BUILDING
� CONSTPUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE
� ABOYE-MEtiT10NE�PROPERTY F INSPECTbN PUPPOSES.
Z COMMENTS
? � � �
� PE ITTEEt�U� RIM) ��'�� �� B �
♦�
� SI TUREOF IREE DATE -
= RECPT.NO. PAID BY VAU�ATION
~ WHITE—Oepartmenl Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicsnt's Copy
I
�' �z �� ��, '
�.��.��. �� a i��c�r�� ��►�
.�t �
t��= ,���;�;,,
_,.- �. .; INSPE�i'tC3� ���C3��
. I
� I R �' � - � i �
SET BACK ; ' FLOC7�i Jt?IST
FT'{aS;FORfv1S/STEEL � FNA REC2MTS ;
ELECTRIG tai�OUN_D.�,._.��..•� --�.�^__ ' UP�JDER FLOOE�DUCT - (
GRC}UVf�PLUt��9NG � � UtVDEFi�LC}C}A COJ�IDUIT I !
_ � I
SL�H GRADE , FIR�PLACE FOUNDfi�TION I
TE�9P P{�WER r FIREPLACE 80ND BEAtv1 j
'�d1�TER SE�tVICE M9D HT.80h1D SE;4f�! . ' I
F3007�SH�k`I'HiNG i_ H FT.B4hID BEAM
FRAC��IhiGl`J�NTILIATIOiV FlNAL 80ND BEAM
RCiOF COVEF� PRE-GRADING
f�QUGH t-fEATING BENCHINC;
RtaUGH ELECT€�1C ROUGH GRADING
RC7UGH PLUI��BINCa FIN(SN GRAD(NG ,
SHOu"d�Ri7�U8 TEST ^ � Pt?C7L EI.ECTRIC -- I
EXT.LATNISIDING � � PC?QL FEIVCING ! �
WALL 1(VSULATlOiV F'O�L FlNAL ,
CEILit�tG t�ISUL�TIt?N OFF S1TE 1MPS. ;
pRY'JVfiaLL NA9LI%!G DEDICATIONS
SE§r1tER �_ FINAL ENG. �
SEF'T6C T�aNK � LA14C?SCAPE/lRFilG. €
SE�P PITIL.L. I OIV SIT�IMPS.
�
GAS�4Ffi i"EST ; �INAL r'_QNING
i
�INr�L CONST. ? Fi€�E i7E�'T, FINAt �
�=iNAL N��TIt�3G j _� HEr1LTH DEPT. Flt�{AL �
Fi�«AL ELECTRIC i DEV. FEES PA1D � ;
F'INAL Fi.Ut�tBkt�((G i f ENERGY , ;
i i
� � I � �
• � ' . ,
�{����E�9TS �
�
.. ;
SEPTIG TANK SIZE
SEEP PITlU SIZE _
