The URL can be used to link to this page

Home My WebLink About18251 cr��nI�AIvt�o B R �x�-, re-c� , ---�` — DEPARTMENT OF COMMUNITY&,DEVELOPMENT SERVICES � \ 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 . PRE$$ �"%�� BUILDING PERNIIT APPLICATION , ,. �� FIRMLY � JOBSITE APPLICATI N � PERMIT -� p/C ¢ ADDRESS�33 h p DATE NUMBER # � APN LOT TRACT ISSUE TYPE OCC DATE CONST. " GROUP V.�P. � Ip OWNER �F- o ADDRESS ZONING SETBACKS Z CITY`��q ZIP�(p.� - FRONT RW ❑ g APPLICANT Q��' �r S/1(1(�Ltp2 - REAR p zd SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ ADDR SS � CITY ZIP TE PROPOSED USE oCH/ENG/ �z D I ER NO.DWEL. NO. NO. � ADD SS � C ZIP TEL. UNITS STORIES BEDROOMS cr� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM p 1 HEFiEBV AFFIRM UNDEfi PENALTV OF PERRIRV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f890/CBfPOh W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.fi8USINESSANDPROFES510N5CODE:ANVGTVOR (n U COUNTVWHIC}IREOUIRESAPERAIITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w w TURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIoNED w Patio/Deck � STATEMENT h1AT HE OR SHE IS LICENSEO PURSUANT TO iHE PROVISIONS OF THE CONTMCTORS LI- � CENSE LAW(CHMTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPe FESSqNSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFOFiTHEALlEOEDE%EMP- (� � TqN.ANY VIOLATqN OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPIICANT TO Z Re-Roaf A CML PENN.TY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtIrtl0fCi81 Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7061,BUSI� J � � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY NAfO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR wTHFiOUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDFORS�LEIF,FIOWEVER,7HEBUILDINQORIMPROVEMENTISSOLDWfTHINONEVEAROFCOMPLE- Z TION,7HE OWNER�BUILDER WILL HAVE TFIE BURDEN OF PROVINQ THAT HE OR SHE DID NOT BUILD OR . � IMPROVE FOR THE PURPOSE OF SALE). �yJ OI,ASOWNEROFTHEPROPERTV,AME%CIUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- ValU8�10l1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWhqBUILDSORIMPROVESTHEREON,AND � NMOCONTRACTSFORSUCFiPRQIECTSWI7HACONTMCTOR(5)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.�. Q ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q ?j U � DATE OWNER F- Z U � LICENSED CONTRACTORS DECLAAATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJURV hIAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � I � e(COMAIENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS M!D PROFESSIONS CADE,AND Z �� MV LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLA S LIC.NO. � � r J V DATE CONTRACTOR a. - W � WORKERS'COMPENSATION EC ATION Q - � U N I HEREBY AFFIRM UNDER PENALTY OF PERJURV ONE OF THE F-0LLOWING DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSl1RE FOR WORNERS' _ � COMPENSATION,AS PROVIDED BY SECTION 37ao OF THE UBOR CODE,FOR THE PERFORMANCE U OF THE WOFK FOR WHICH THIS PEFiM1T IS ISSUED. W � � w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS J ISSUED.MV�WOR`KE^FS'lCO_MPEN/S�ATION INSURANCE CARRIER AND POLTICY NUMBEfiARE: CONSTRUCTION j CARRIER �fTC.L�SE�_ l"1�(�'lld. �. t �✓1/1 pLANREVIEW � PoLICV NUMBER��i]__'r_�_� �"r� � � ELECTR�C ¢ � frwssEcnadrh�rio7eE�ErmoFnfrEw.vrSwaat+Etairor�ooa�usltioo)oa�ss} PLUMBING w Z I CERTIFY THAT IN 7HE PERFORMANCE OF THE K'ORK FOF WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE (/� WORICERS'COMPENSATION LAWS OF CALIFORNI^AND AOREE THAT IF I SHOULD BECAME INSPECTION FEE SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700OF THE LABOR '` � ,I SH FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE _ �y � - p DA .- .APPLICANT: � SMIP w ENERGY P/C 'J WAANINO:F ILURE T SECURE WORKERS'COMPENSATqN COVERAOE IS UNUWFUL,AND SHALL BE J �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(f 100,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVI�ED FOR IN J SECTION 37oB OF THE UBOR CODE.WTEREST,AND ATTORNEV'S FEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIqM UNDER PENALTV OF PERIURV THAT THERE IS A CANSTRUCTION LENDINd AGENCV FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB],CIV.C.). Z W � LENDEF'S NAME H LENDER'SADORESS w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TNAT 7HE ABOVE INFORMATION IS CARRECT. TOTAL FE ES � �� I AGREE TO COMPLV N7TH ALL GTV!WD COUNTV ORDINANCES AND STATE LAWS RELATINO TO BUIIDING �,� . � CONSTRUCTION,AND HEREBY AUTHOFIZE REPRESENTATNES OF THIS COUN7V TO ENTER UPON THE Z � EMIONED PROPERTY FOR INSPECTqN PURPOSES. COMMENTS � 0 J � m PE EE NAME(eRl � Q � � URE OF I DAT — RECPT.NO. PAID BY VAIIDATION WHITE—Depart Copy,YELLOW--Finence Copy,PINK—Assassor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . . . .— .- . .. ..-�� .�. ... _;}•,:... �.-✓�'4,v: :r�� . � -,�4l1.� „ . _ . _,w., i �r. � . . ._ . . . . 6�'�� ..i� ��ihi Atl1�YV� �/1'U� ' �!�'J�If�IGK��U�6tl IrO��.a�LY�� U o �GJ`�' -�s�itUG�i D�� o � o '�� ,_ ' � ' ` I o� SET BACK FLOOR JOIST , FTGS/FORMS/STEEL FHA REQM7S � � ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBWG UNDER FLOOR CUMDUIT SLAB GRADE FIREPLACE FdUNDATION TEMP POWER FIREPLACE BOND BEAM � WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 Ff. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING . ROUGH HEATING SENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUIvIBING FINISH uRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING � WAIL INSULATION POOL FINA� CEILIGJG INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEP71C TANK LANDSCAPE/IRRIG. SEEP PITlL.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID F1NAL PLUMBING ENERGY CC�Gfi�O(� o � o COMfViEf�TS SEPTIC TANK SIZE SEEP PIT/U SIZE � � � � °