The URL can be used to link to this page

Home My WebLink About17528 �,`_ crrY oF n�orm B�x EXPIRED DEPARTMENT OF COIvII�1UNTI'Y&.DEVELOPMENT SERVICES 21825 E.Copley Drive MAY 0 9 2003 PRESS "'`" (909)860-3195 Faac(909)861-3117 "':»x' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE .7^^� QQ� ��,Qn,, �D�A_� APPLICATION 1�, ` PERMIT P/C oADDRESS�l1dtJ k�`�-��-' 7 v'� DATE � •O� ��1 NUMBER �� # ��r � ISSUE TYPE OCC APN L T TRACT DATE CONST. GROUP � � p OWNER � n ZONING SETBACKS o ADDR SS FRONT RW ❑ Z CITY i7 Z1P TEI. REAR � o APPLICANT TEL. SIDE/SIDE STREET RW O � CONTRACTOR �9tJL� � SIDE � � ADDRESS 4 '� '\ � � CITY SAJ F�Z�Li�-��^��ZIP �I�IUTEL. �' - PROPOSED USE ST/�L�L- �I S N S w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O . p I HEREBV AFFlRM UNDER PENALTY OF PERJURV THAT 1 M1 EXEMPT FROM THE GONTfUCTORS LI- G8f8Q0/C8lpOfl W CENSEUWFORTHEFOLLOWIN�REASON(SEC.70.71.59USINESSANOPROFESSIONSOODE:ANYCITYOR (n U COUNTVWHICMRE�UIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE.DEMOLJSH,ORREPAIRANVSTRUC� W patio/Deck WTURE,PRIOR TO ITS ISSUANCE.AL50 RE�UIRES THE A7PLICANT FOR SUCH PERMIT TO FILE A SIdNED w g STATEMENi THAT HE OF SHE IS LICENSED PUflSUNJT TO T1E PROVIS10N5 OF THE COfITRACTORS LI� � POOUSPB � CENSE UW(CiiAPTER e(COMMENCINO WITH SECTION 1000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � O FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� V TION.ANV VIOLATION OF SECTION 7031.5 BY ANY APPUCANT FOR A PERMIT SU&lECT57HE APPLICANT TO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOlLARS(5600).): 0 ❑I,ASOMMEROFTHEPROPERTY,ORMYEMPLOYEESWITNWAGESASTHEIRSOLECOMPENSATION, � COfTifl8fC�81 Z WILL DO THE WORIC AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70u,BU51- J � NE55 AND PROFESSIONS CODE:THE C-0NTRACTORS LICENSE UW OOES NOT APPLV TO AN OWNER OF � VROPERTVWHOBUILDSORIMPROVESTMEREON,ANDVMODOESSUCHWORKHIMSELFORHERSELFOR m � THROUGHHISORHEHOWNEAI7LOVEES,PROVIDEDTHATSUG}11MPROVEMENTSARENOTINTENDEDOR W pFFEREDFORSALEIF,HOWEVEiL7HEBUILOINOORIMPROVEMENTI550LDM�TM�NONEVEAROFCOMPLE- � TION,THE OWNER�BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOF TNE PURPOSE OF SALEI. � Ol�SOWNEROFTHEPROPERTV.AME%ClU51VELYCqMMCTINGWITHUCENSEDCONTMCTORS ¢ 70 CANSTRUCT THE PRQIECT(SEC.)oN,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ll- V81U9210f1 ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPqOVESTHEREON.MID Z WHOCONTRACTSFORSUCNPHQIECTSWITNACONTMCTOA(S)LICENSEDPURSUANTTOTHECANTRAF QUANTITV DESCRIPTION FEE � TORS UCENSE LAW.). J' � O 1 AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON � � Q LL DATE �wNER (_~j Z W � LICENSED CONTRACTORS DECLARATION J � w I HEREBYAFFIRM UNDER PENALTV OF PERIURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTEF � d o(COMMENCINO WRH SECTION 7000)OF DIVISION 30F THE BUSINESSAND PROFESSIONS CODE.AND Z X MY LICENSE IS IN FULL FOACE M1D EFFECT, m u� � � UCENSE CIASS ��/� UC.NO. � � V DATE `�' � �O� GONTFACTOR d W � WORKERS'COMPENSATION DECLARATION -� Q � U � I HEREBY AFFlRM UNDER PEN/LLTV OF PER1UflV ONE OF THE FOLLOWINO DECLARATqNS: Z Q � I HAVE AND WILL MlJNTA1N A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOHKERS' 2 � COMPENSATION,AS PROVIDED BY SECTION 3700 OF TME UBOR CODE,FOR THE PERFORMANCE w OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED. � � w I HAVEAND WILL MAINTAIN WORKERS'COMIPENSATION INSUHANCE.AS FiEWIRED BV SECTION l Q 3700 OF THE LABOF CODE,FOR THE PERFORMANCE OF 7HE WORI(FOR WHICH THIS PERMIT IS � ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLIGY NUMBER ARE: CONSTRUCTION r' �� CMRIER r PLAN REVIEW Z POLICV NUMBER �Q�� ELECTRIC ¢ � ([wssEcrioar�rroreEao�.u�ermoFn�aEtu.arswaa+er�a�000uNu�siaoloFl�Fss4 PLUMBING w MECHANICAL Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PEPMIT IS ISSUED,1 (} SHM.L NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TOTHE Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,AN�AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECTTO THE V10RKERS'CAMPENSATKKJ PFOVISIONS OF SECTION 37000F TME IABOR ISSUANCE ��D CODE.I SHN.L FORTHY/ITH COMPLV WITH TFIO E PROVISIONS. /�� Y�--� p DATE:�Z' O� APPLICANT: ��NA �I L�YJ SMIP ��'�� ' � l, � W _/ J WARNINQ:FAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNIAWFUL.AND SHALLBE ENERGY P/C J � SU&IECTANEMPLOYERTOCRIMWALPENALTIESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT i _ OOLURS(f100.000I.IN ADDITION TO THE COST OF CAMPENSATION,OAMA�ES AS PROVIDED FOR IN J SECTqN37oBOFTHELABORCODE,WTEREST,�NDATTORNEr'SFEES. RETENTIONFEE: �� w CONSTRUCT�ON LENDING AGENCY PRE-AlT FEE: �- BY:. 0 CL I HEREBV AFFIqM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LEND�NO AGENCV -- 0- fOR 7HE PERFORMANCE OF THf WORK FOR WHICH THIS PERAIIT IS ISSUED(SEC.308�,CIV.C.). Z W � LENDEA'S NAME F- LENDER'SADORESS wI CERTIFV TFIAT I HAVE READ THIS APPUCATION AN�STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES � � I AGREE TO COMPL�WITH ALl CITY AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTTIORIZE REP{iESENTATIVES OF THIS CWNTV TO EPRER UPON THE Z AflOVEyENTIONEO PPOP RTY fOF INSPECTION PURPOSES. COMMENTS o � �J 11i�6 J � m ITT E NAME(PRINT) �/� � � �2' Vw _O� � SIGNATUREOF ERMITfEE �pTE RECPT.NO. PAID BY VALIDATION � . WHITE—DeDartment Copy,YELLOW--Fi�ence Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , , . �8�� f� �9�QGlN��f� (�31�1L� - � �;� ��l�L�[�c��f'0�(�ll�f��ff�i� . �� '`DG� ' �� . ry �i�'p��'�tr n�GJ o '� e�C� 1r� SET BACK FLOOR JOIST FTGS/FORPvIS/STEEL FHA REC�MTS � � ELECTRIC GROUND UNDER FLOQR QUCT GROUND PLUMBWG UNDER FLOOR CUI�IDUIT SLAB GRADE ' FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHIiVG ' 8 FL BOND BEAM FRAMfNGNENTfLIAT(ON FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATIIVG BENCHING ROUGH ELEC7RlC ROUGH GRADING ROUGH PLUIVIBING FINISH GRADING SHOWEFi�TUB TES7 ^ � POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL ` �� CEILING INSULATION QFF SITE IMPS. DRYWALL�1AILING DEDICAT[ONS SE�IVER FINAL ENG. �� ' SEPTIC TANK LANDSCAPE/IRRIG. � SEEP PIT/L.L. � ' ' ON SITE IMPS. GAS AIR TEST F1NAL ZONlNG FINAL COAlST. GIRE DEPT. FiNAL F1NAL HEATING HEALTH DEPT. FINAL FiNAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY �OO� Q o o,� CONiMEfVl"S { . SEPTIC TANK SIZE SEEP PIT/U SIZE � i � �� a � �t [� � � , _ � � � . � ,