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Home My WebLink About18016% '?�.'�EN��L��. ��_i`�•_oj � ^ _��_ CTI'Y OF DIAMOND,BAR � DEPARTMENT OF COMMUNTI'Y&DEVELOPIv1ENT SERVICES � 21825 E.Copley Drive • . � � �� ' (909)860-3195 Fax(409)861-3117 PRESS ��"%�� BUILDING PERMIT APPLICATION , FIRMLY N JOBSITE � �O—L��,a�� S I�L' DATE � " G� NUMBER /�O�p g APPLICATION PERMIT P/C o ADDRESS � � ISSUE TYPE OCC APN L T TRACT DATE CONST. GROUP p OWNER Q. o ADDRESS rn ZONING SETBACKS Z CITY aMtl Y� ZIP TEL. U FRONT qyy p g APPLICANT TEL. REAR p ¢ SIDE/SIDE STREET RW ❑ � CONTRACTO Q � SIDE p ADDRESS +CL � CITY ZIP TEL: �.�a y PROPOSED USE Q, .�, . � oARCWENG/ z DESIGNER . w NO.DWEL. O. a ADDRESS • �r5� � CITY ZIP TEL. UNITS STORIES BEDROO u� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTV OF PEfiM1/RV THAT I AM E%EMPT FROM THE CONTRACTORS LI- Gfl1896/CBfPOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANOPROFESSIONSCODE:ANYCITYOR (n C-� COUNTVWHICHREWIRESAPERMITTOCONSTRUCT,AITERIMPROVE.DEMOUSH,ORFEPAIRANYSTRUC- w w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIpES THE APPLICANT FOq SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF hIE CONTRACTORS LI- � � CENSE LAW(C}IAPTER 0(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB ^ FESSIONS CODE)OR THAT HE OR SHE IS E%EMPTTHEREFROM AND THE BASIS FOR THE ALLEOED E7(EMP- C7 V TION.M1Y VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof A CML PENALTV OF NOT MORE hIM!FNE HUNDRED DOLLARS(f5o0).): 0 OI,ASON7JEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COrt1flIBlClel - Z WILL DO THE WOR1C,M1D THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI- J � � NESS AND PFOFESSIONS CADE:THE COMRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF � VROPERTY WFIO BUILDS OR IMPqOVE57HEREON,AND WHO DOES SUCH WORK HIMSELF OF HERSELF OR � THRWOH HIS OR MER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILDWGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- Z TION,THE OWNEREUILDER WILL HAVE h1E BURDEN OF PROVWO THAT HE OR SHE DfD NOT BUILD OR � IMPROVE FOR THE W RPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSIVELVCONTRACTINOWfTHLICENSEDCONTRACTORS � TO CANSTRUCT TME PR0.IECT(SEC.70U,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI- V81U8IIOf1 ADJ.AREA � W CENSE LAW DOES NOT MPLY TO AN OMMER OF A PROPERTV WHO BUILAS OR IMPROVES THEREON,AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG pUANTITY� � ��DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON �Q d , " ?� U . � DA7E OWNER � Z U �Q LICENSED CONTRACTORS DECLARATION w 2 I HEREBV AFFIRM UNDER PENALTV OF PEiLIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � o(COMMENCINO WITH SECTqN 7a0o)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MV LICENSE IS IN FULI FORCE AND EFFECT. m � LICENSE C SS . LIC.NO. �� I � U DATE `Q CONTRACTOR a. W — ' � WORKERS'COMPENSATION DECLARATION Q � U N I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF hIE FOLLOWING DECLARATIONS: Z � _1 HAVE M!D WILL MAINTPJN A CERTIFICATE OF CANSEM TO SELF-INSURE FOR WORNERS' ¢ ' Z 2 Q COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PEFFORMANCE U OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. W 0 � Qw _I HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEWIRED BV SECTION ,. /�� /i 3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICFI THIS PERMIT IS � ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POUCY NUMBER ARE: CONSTRUCTION � CARRIER PLAN REVIEW Z POLICV NUMBER ELECTRIC Q � (fl-OSSECIqNNE�NOTBENMPLETfDOFTI-IEPEPMTISFORONEF0.IPDREDDOLLAAS(5100)OqLESS} PLUMBING W Z I CERTIFV TM�T IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I$ISSUED,I MECHANICAL C'} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE (/) WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SFIOULD BECOME INSPECTION FEE � SUBJECT TO THE WORNERS'COM7ENSATION PROVISpNS OF SECTION 370o OF THE LABOR ^� CODE,ISHALLFORTHWITHCOMPLVWITNTHO OV151 NS. ISSUANCE � O 'p DATE:�-�(�-O�qPpLICANT: � SMIP � ENERGY P/C J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATIO fAVERAGE IS UNLAWFUL,AND SHALL BE � SUBJECT M!EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANO ENERGY PERMIT DOLURS(f1a0.o00),IN PDDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN � J SECTION 37oe OF THE LABOR CADE,INTEREST,AND ATTORNEVS FEES. i¢ RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENOINO AGENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS 7ERMIT IS ISSUED(SEC.3087,CIV.CJ. Z W � LENDER'S NAME F— LENDER'SADDHESS w I CEHTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARqECT. TOTAL FE ES ��y�� I AGREE TO COMPLV WITH ALL GTV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDINO � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MENTIONED PROPERTV FOR INSPECTqN PURPOSES. COMMENTS � he v►n� m PERMITTEE NAME(PRINn ' Q w � �� SIONATUREOFPERMITTEE DATE ' � ' RECPT.NO. L PAID BY VALIDATION / WHITE—Department Copy,YELLOW—Financa Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �6�"� �� 0�� f� . , . -o��r��u��c�¢�� ' , OIG��uDO►. � �.,� ' �� OG�° �� m o 1� �(�j o � :` SET B,4CK FLOOR JOIST hyfGS/FORMS/STEEL ' � FHA REC�MTS ELECTRIC GROUND � UNDER FLOOR DUCT GROUND PLUMBING ' UNDER FLOOR CUf�!DUIT � SLAB GRADE FIREPLACE FOUh1DATlON � TEMP POWER FIREPLACE BOND BEAM � WATER,SERVICE MID HT. BUND BEAh1 ROOF SHEATHING _/��Z,. i__ 8 FT. BOND BEAM FRAfvIiNGNENTILIATION I FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGF! HEATING � � BENCHING � ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNIBING FINISH iaRADING SHOWER/TUB TEST POOL ELECTRIC EXL LATH/SIDING , PO�L FENCING � WALL Ih1SULATiON POOL FI�dAL � CEILIfVG INSULATIOtU OFF SITE IMPS. � DRYWALL NAIUNG DEDICATIONS SEWER ` FINAL ENG. SEPTIC TANK LANDSCAPE/tRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST F1NAL ZQNING FINAL CO�lST. �lRE DEPT. FINA! FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FiNAL PLUMBING ENERGY __ __�.__ '`Y��l'�'JIT°'�'✓5�'�.:��.. .- . . _ _ CGMi�iEiVTS �, � � '�� _-�--fi:f..—....,.�—�� ' �� -- - �1 SEPTIC TANK SIZE ^ SEEP PIT/U SIZE I� . _ �l �. [� , �$ — � � � � --