HomeMy WebLinkAbout12572 CITY OF DIAMOND BAI,L
- ' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�� 21660 E.Copley Drive Suite 190 PRESS
�., (909)860-3195 Paa(909)561-3117
BLTIL.DING PERMIT APPLICATI�N FIRMLY
� DDRIESS U�� �\`�^-S � � DATE�ATION 6 O NUMB R 2���
1.
� 15SUE TYPE OCC
APN LOT TRACT DATE CaNST. GROUP
LL OWNER �c9kN ,��"�
o ADDRESS ZONING SETBACKS
W CITY ZIP TEL. PRONT RW f-1
� APPLICANT T , REAR ❑
� SIDFJSIDE STREET RW ❑
CONTRACTOR A SIDE ❑
� s ADD SS � PROPOSED US� � / � � �
� CITY ZIP�;�"�OTEL.
� ARC NG/ (�' �
DESIGNER `c—�--- NO.DWEL. NO. r NO.
ADORESS UNIT3 STORIES BEDFtOOMS
� CITY ZIP TEI..
� DESCRIPTION SQ.FT. fACTOR PSF ADJ.AREANALUATIOM
cn
� OWNEF-BUIIDER DECLARATION �q/qpD1AEM
O
� (] 1 HEREBY AFFIHM IAJDER PENPLTY OF PERJURV THAT I M1 E%EMPT FRO/A THE CONTMCTOFS LI� (�ry�p/C8IPOIS
� W CENSEUWFOfliHEFOIL�N'�NGRE450N(SEC.7W1.58USINESSMIDPROFESS�ONSCODE:ANYCITVOR (n
CJ COUNiYMR{K*1PEWWESAPERNdTiOCONSTAUCT.AITERINPROVE,DEA10LI5N.ORPEPRIRRNYSiRUC- W� Pdii0ID6CK
� lUqF,PqpR i0 ITS 198WIYCE,ILSO REIX11RE5 THE APOLH:ANT FOR SUCH PERYIT TO Fl�E A SIGNEO
.� ST�7EMENT iMRT HE OR SHE 45 LICEN5EU PL1FSUANT TO THE PROVISIIXJS OF THE CONTRACTOH9 lb
� CEN8EtA1V(R7AV7ER9(ODMMENCINGWI7MSECTION7000)OFDIVISpN30FTHE8U31NE55ANOPRO- � P�VSP3
� fE55pN5CODE�ORhUTMEOR5XEI5E%EMPT7HEPEFROMAND7HEBASISFORiHEMLEGEDEXENP- s�
T1011,AMYVIOLATIONOFSECTION7031.SBVANVMPLICANTFORAPERMITSU61ECT5'�NEAPPlIC0.HTT0 Ap-{�qpr ``
� A qNL PENAITY OF NOT MORE TMAN FNE HUNpREO DOIURS({5ao).):
� ❑4��EROFTHEPROPEHTY,ORMVEMPLOVEFSVnTNWlGESAS7MEIflSOLECOMPENSATION, (�'pmR�gfCI81
W0.1U0 TME WOPI(,/iN0 SME STAUCT1fRE IS NOT INTENDED OR OFFFAED FOR SALE igEC.7oN,BUSI� J
� ME68 NID PHOFESSlON9 COOE:7NE CONTRACTORS LICENSE UW DOES NOT APPLY TO M!OWNFH OF =
� OqOiEq7YNh108U11D50RIMVAOVESTHERCON.ANOWHODOESSUp1Y/OHKNIMSELFORHENSELF6q
Q 1NPOVGHMSORHEROMMEAIPLOVEES,PR9VDEphIAT5UCH8APPOVEA�ENTSARENOTINTEN�E00R m
L�1 OLF(qEp WqSALE li.NpWEVE0.7MEBUI.DING OR IAIVNOVEMENT IS SqD WITHIN ONE VEAR OFCONOLE
Z T1O11,TXE OWlIEfi-BUILOfiR WiLL W4YE THE BUROEN OF PROYING TMAT ME OR SFIE OfD NO�BUND OR
� � YPliOVEFOATNEWPPOSEOFSALE).
� W ❑LAHOVd1EqOFTV�PiWGEHTY,AMEXCLUSNELVCONTRACTINOWfTFiLICENSEDCONTMCTpR9
� TD CCNLSTRUC(THE DAOJECT(SEC.70M,BUSINESS ANO PPOFES510NS CODE-THE CONTMCTORS L4 V81u2fip� �^_ADJ.AREA
C6N&E LAW DOES NOTAPPLYTO�NOViNER OFA PROPEflT'WHDBUM.DS OR IMPROVES hIEREON.AND
� � MNpOo�(TRACTSPDRSUCHP�IECTSWIThIACONTMCTORtS�LICEN5E0PURSUANT70THECONTPAG Q(jqp(T�Ty DESCRIPTION FEE
� roAs ucEnse uw.).
O ❑IAMIXEMpTUNDERSEC. 8.60.C.�OIi�Mt5REA50N �
� � �
LL D�.TE OWNER U
� W
L10ETISED CONTAACTORS DECLARATION —�
� � W
� � 1 liEAEBY AFFlPM UNDER PEN�LTV OF PERRIFY lFiAT 1 AM UCENSEO UDAEft PFiOYiSIONS OK CHAPTER �
� � Y(OOiWENCINOWITHSEC'f1ON70Do)OFDMS10N3OFTH�BUS�NESSANDPROFESSIONSCDOE,MiD Z
AIY LICENSE�M FULL f-0RCEµ�EFFECT, �
� tiJ _C__3.� �c`� r� r �
4i 0 LICEµSE CLp55 LIC.NO. �
� pq7E _�CONTRACTOR _ _
� ��~��+�� -
� ldlORKERS'COAlPE ATI(JN CUIRATION
cn `��.,
� i HEKEeY 11FFiF4 UNDER PENAL7V OF�ERIURY ONE OF THE FOLLOWMG DECIAMT� . Z
Q
O __INAVEMAWILLNAINTAINAGEH?tflCATEOFWNSEMTQSELF-INSURE('ORWORKERS' S
�� COMPENSATION,ASPROVIDE�BYSECTION3NOOFTHEUBOHlbDE,FORTHEPEiiWRMANCE W
OF THE WOflK FOR WNILH TMIS PERMIT 515SUEU. c2
�
� � �IHAYEANOWILLMAIMARIWORKERS'COMPENSATIONINSUMNCE,ASREWIREOBYSECTION �
� Q� 37000F iNE 1A90R E.W TME PERF�RM/�NCE OF TNE WORK WP VM1IICNTHIS 9ENM1T IS
I.%UED.MYWORKEHS SATIONINSU ECAPRIERMmPOL�CVNUMBERARE: CONSTRUCTION �
jcnRR;ER � ._ PLAN REVIEVJ
� POLICYNUMBEH r�_j — � EIECTRIC
/
Q ��ry��QEpp,p�ppF7FE�iAfsp7paNEHruREDpcuavs�s+ oaltss} PLUMBING
w MECHANICA�
Z I CERTIFY TH�T M THE PERFOPMMICE OF THE WONK FOR WHICH THIS VERMIT IS ISSUE�,I
(!} SNALLNOTEMPLOYANYVERSONMANYMANNERSOASTOBECOMESU&IECTTOTHE INSPECTIONFEE - .r
� WOfiKERS'COM7EN511TIONUWSOFCq�IFORNIAM'�AGREE7MATIFISHOuIDBECOME
� Sl&IECT TOTNE WORKERS'CDMPENSATION PFONSIONS OF SECTION 37000F THE U90N �SSUANCE �
GOOE.1 SXRII iORSNWITH 00�.1VLY W1SH THOSE PROVISIONS.
� ��I��� � �/ SMIP
p DAiF:IL_!'��`��PLICANT: 6C��.—�7^�—
� �`� ENERGV P/C
W�pNINO:FAILURE TO SECURE WORKERS'COMPENSATKK.i COVERAGE IS UNUWFUL.AND SMILLL BE
� SU6JEC�fNEMPLOYERTOCR�M�NAL�ENALTfESANDCMLFINESUV�ooNEHUNDAEDTHOU5MID ENERGYPERMIT � ���N
' ppLLAqS(5100,000�,Ml ADOITIOq TOTHE COSTOF COMPEN511TIIXY.DMMGESAS PROV��EO FOR IN
J SECTqN370DOF7HEU�'�ORCO�E,MITEREST.ANDATTORNEYSFEES. RETENTI
` DI
p� CONSTRUCTION LENDING AGENCY PRE-ALT
� D G ANt�ga ,
1 HEREBV AFFiNM UNOEN 7ENALTY OF PEflJ�RY iHAT7HEPE IS ACONSTRt1CTION LENDING ACENCY
WqiHE PEflfORMANCE OF THE WOflK FOP WHICHTHIS FERMRIS ISSUEO(SEC,a0ffl,CIV.G).
�
� LENDEWSNAME
1— LEH�ER'SADDRESS
� 1 CERnFY TNRT I HAVE READ THIS APPLICATION AND ST�TE TFIAT THE ABOVE INFOflMATpN IS CORRECT. TOTA L FE ES - `
4 1 AGFEE TO COMPLY N7TH�LL CITY AND CIXINTY OROINANCES AND STAif tAWS REU�TING TO BU4AING
CONSTRUCTION,ANDHEREBYAUTHORRENEPPESENTATIVESOFTHI GOUNTVTOENTERUPONTF7E
�, ABOVE�MEMIONEDPROVERiYFORIN5PECTbNPl1RPOSES. COMMENTS
� 2 n.j �,
_
4 PERYfTTEE N�NE(PR�lIn _
� -Z- l. 1 r) /f � � _
� ��N �ATE
RECp7.NQ. PAiD BV Yq�1WTI0N �
� WH�TE—Department Copy,YELLOW�inarwe Copy.PINK—Assessor Copy.GOIDENROD�ile Copy,GREEN—Applicent's Cnpy
i
Ci'TY OF �1,�1�90�iD BAR (
lhISP'EC"f14� R���►f��3 �
� � , . � , � . �
S�T�AGK ' ! " , Fl.QC3R Jt715T ;
�f"GS/Ft7�iP�StSTEEL j i FHA REQMTS (
EL�CTRfC GROIlN� UNDER FLOOR DUCT �
�
Gi�OUiVD PLUcv�F31NG ' UNDER FLQOR CORIDUIT ;
SI�A��RADE F(REPLACE FOUNDATION �
T'EtvtP POWE� FIREPLACE BOND BEAMI j
4'�al�TEI=�S�t�Vl�c MiD HT. BONC�BEAM I
F?�S=S't#'Er�TWif�'Ci D � � 8 FT.BC7l�iD�iEAM
FF4�"�r91NC/VE3�ITILIAT(C�i�l _ F1NAL B�hlD BEAM I
R�JJ4F GC}VER � !�_3-'j� PRE-GRADWG i
�iUUGN H��TINC"a BENCHING '
RtJU(:i}-9�LECTRlC ( ROUGH GRAI�ING �
--,
RQUCaH PLUMBiNG i FICVISN GRADING
SH�WE�iTTU�TEST Pt7QL ELECTRIG j
�XT.LA�'HlSIDING POOL FENClNG t
1NALL INSULI�TIC3N POOL F(NAL - _
CEILiP�'ta INSULATiOPJ � (3F�S1TE IMPS. ,
Dr�YV`JRLI.NAILI�IG C3EDICATIONS �
SE'k�`Er� {I— F1NAL�NC�. i ,
S�PTlCT�a�iK ! LANDSGt�PE(IRR1G. ;
��cP PiTlL.1., - C�N SITE IiviPS. �v j -- �
C��S�9�i TEST FiNf�L ZC}C�IING
F!tdt�LCC7iVST. ijl-3-gl� � ��� FIi�EDEr'"3'. F1hJAL ! -__.._ _. _____
�1d'att;'�.E-i�Al"ING f I HE�L.T!-i C�EPT. �iNAL
_._.__.. __�`__.__...�
FiNF��.ELECTFiIC _____��_____ _ ______ DEV. FE�S PAI� �
F3r�iA�PLt,.iB+��F�i�it'.a i � � EN�FfiGY ; � I
__. �_--____ __ 1 � k
f� : .. , ' � /1 f _.,.__.�._�� i
��������T� Ed-�8� ��� ,�e, ; f� .�.�c�.� �� .a����o,Q� � i
_ ' _ �
` =`��f.�. � �- i �
r .5.,.` i
`'3��'T�C TA[�dl4 SI�E !'t.',, ;,, .' ; . .
�EEF� PIT1U �1�� ....��,�j�T_���— _
----�---�--�-�-�-'`o'�+ �'i:•-- ,. r,
� ,-t:,: '�.. �
�..:, . _.__ _..
I