HomeMy WebLinkAbout16981 �� CITl'OF DIAMOND IIAR f
DEPARTMENT OF COMMLINITY 8c DEVELOPMENT SERVICES �
ZN� 21825 E.Copley Drive
(909)860-3195 Fax(909)86I•3117 PRESS
�`��� BUILDING PERMIT APPLICATION FIRMLY
yN,�, JOBSITE APPLICATI PERMIT P/C
o ADDRESS i �}�-� � r DATE �� O NUMBER/�9�/ p
� � ISSUE TYPE " OCC
-- APN LOT TRACT DATE CONST. GROUP
¢ OWNER F '
0
o ADDR SS �- S�_{�� ZONING SETBACKS
z CITY � "7 *''ZIP��_�TEL FRONT RW ' ❑
� APPLI ANT TEL. R�p p
0
SIDE/SI�E STREET RW p
� CONTRACTOR G -� ' � .�kC SIDE ❑
ADDRESS ► � • �
o CITY ZIPl��� TEL�'�U���l•'��tr PROPOSEDUSE�` � �-� '�L. I- i t (..
L�, ,t
wo ARC G/ 'SL�•v L ��v+o-✓ t rfrr+,�
DESIGNER ---r � - � -G---,—
.izi NO.DWEL. N0. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 NEREBV AFFIRM UNDER PENALiY OF PE0.AIRY TMAT I AM E%EM7T G{iOAI THE COtfTMCTOflS LF Garage/CarpoR
W CENSEUWFORiHEFOLLOWINGREASON(SEC.70.'f1.58U5MF55iVlDVROFESilON4CODE:ANYCITVOR (J�
U CpUNTyWHICHREOUIRESAPERMITTOCONSTRUCLALTER�MPROVE,DEMOl15H2ORREPA1qANYSTRUG W PatiolDeck
� NRE,PRIOR TO RS ISSUANCE./�150 REQUIRES THE APPLICANT FOR SUCH FERMIT TO FILE A SIGNED w
STATEMENT THAT HE OR SHE i5 LICENSED VURSUAN7 TO THE VR01nSiONS OF THE CONTRACTORS L4
O� CENSE UW�pUMER G(COMAIENCIN6 WiTH SECTION i000)OF DIVISION]OF TME BUSINESS M!D Pq6 � PooUSpa
iE5510N5C00E�ORTHATHEORSHEISE%EMPTTIIEREFROMANDiMEBASISFOFTHEALIECEDEXEMP- (ry
V TION.ANYVIOLATIONOFSECTION70�1.SBY/W`/APP�ICAMFORAPERMITSU&)ECTSTHEAP7�ICAMTO Z pe-Roo}
A GNL VEN�L7Y OF NOT MORE THAN iNE MINDHED DOlURS(f500)�:
� ❑4ASOWNEROF7NEVflOPERTY.ORMYEM�LOYEESNATHWAGESASTH['�RSOLECOMPENSATqN, � COrtIm0ICi31
,Z WILL DD THE WORK,ANO THE STRUCTURE IS NOT INTENOFD OR OFFERCD FOR SALE ISEC.)ON.BU51• J
N NESS AND PROFESSIONS COOE.THE COMMCTORS IICENSE LAW DOES NOT APVIV TO AN OWNER OF ?
VROPERTY VMO BUILDS OR IMCROVES THEREDN.ANO WMO DOES Sll[H WORK HIMSCLF OR HERSEIG OR
Q THROUGHNiSORHEROWNE4PLOYEES,VRWIDEOTHATSUCHW�ROVEAIENTSAFENOTINTEN�EDOH m
O OFFEREOLORSALEIF,HOWEVE{�T}IEBUIIDINCORIIAPROVFMENTISSOtDWiTMNONEYEAROFCOMPLE�
Z i7dJ,THE OWNER�U0.DER WILL HAVE TNE BUf70EN OF PROVINO THAT HE Ofl SH�Di0 NOT BUILD OR
= pAPROVE FOR TME W RPOSE OF SALE). �
�I,AS O WNER OF TME 7ROPERTY,IlM E%CLUSIVEIV CONTMCTINO WRM LICCN�EO CONTRAGTpRS
Q TO CONS7RUCT iHE PR0.IECT(SEG 7M1,BUSINE55 AND FROFESSiONS COD[.THE C011TRACTORS Lb Veluat1011 di°" QDJ.AREA
W CENSEUWDOESNOTAPVLVTOANONTJEROFAVqCPERTYWMOBUILDSORIAIFROVESTHEREON,A�D
� WFiOCOHTRACT5FOR5UCHPR0.1ECfSWITHACONTMCTORI5ILICENSEDGUFSU/Uf7T0THECON7MG OUANTITY DESCRIPT�ON FEE
Y TOitSLICENSELAWJ.
¢ OI/JAE%EMPTUNDERSEC. BiO.C.F08TNI5REA50N Q
� U
� Q
OATE ONMER F�
� W
�Q LICENSED CONTRACTORS�ECLARATION W
Lt I HEREBV AFFIRIA UNDER OENAL�`/OF PE0.IURY TNAT I AM LICENSED UNOCR PRONSIONS OF CHAPTER �
p„ i(COMMENCINC WITH SECTION 7000)OF DNiS�ON]OF TH[BUSINESS AN7 PROFESSIDHS CODE,AND Z
LL� MY LICENSE IS IN NLL FORCEAND EFFECT. m
�7J/ � �
� IICENSE CLASS ' � LIC.NO. 3�.7 7' ' �
V OATE �,'' IC����CONTRACTO� .--✓� �� 6J.
W
� WORKERS'COMPENSATION DECLAAATION Q
� IHEREBYAFFIRMUNDERDENALTYOFGERJUMONEOFTHEiOLIOW'�NGDECLAMTIONS z
� _IHAVEMIDWILLMAMTAINACEf{TIFICATEOFCONSEMTOSFLF-INSUREFORWORKERS' _
COMPENSATION,ASPRONDEDBYSELTIONJ7ooOFTMEUBORCOOE,FOFtTHEPERFORMANCE U
O OFTMEWORKFORWHIp7TM15PERMIT15155'JEO. �i �
�W _IHAVEANDWILL►IAWTAINWORNERS'COAIPENSATIONINSURANCE,�SREOUIREDBVSECTION
J7ooOFTHEUBORCOD[,FORTHEPERFORMANCEOFTHEWORKFORWHipITr115PERMITIS �J ��
J ISSUED.MY WORKER5 CAMPENSATION INSUMYCE GARRIER AND 70LiCY NUM�ERME: CONSTRUCTION /G
j CARPoER '� � L�'V�I-lZ� �� PIAN HEVIEW
� POLIC7NUMBER„� �w.�'���3�/ ' ELECTRIC
� (fH1SSECf10NNEmNOTBE0..�.S'LETEDOFhEPEPMTI5FORONEHl�1X7ED0OlAF5(ftOD)Of1LESS} PLUM8ING
Z ICENTIFYTHATINTHEPERFORMANCEOFTHEWORKFOflWHI�FITH�,SVERAlITt5155UED,l MECHANICAL — — '
(�} SHALLNOTEMPLOYANY7ERSONWANYMM7YERSOASTOBECOM'e5U&1ECTTOTHE ".//°R�, I�. I �
� WORKERS'COMPENSATIDNUWSOFCALIFOPNiAANDAGREEiHATIFISMOULDDECOME INSPECTIONFEE -
S SUF3JECTTOTHEWORKERS'COAIPENSATqNPROVISIONSOFSECTION]]�00%THEU80R
fADE,I SHALLFOiiTHWITM CAMPLV WITHTHOSE PROVISIONS. �SSUANCE
0 `
p DATE: APPLICANT. SMIP � � * JD
J WARNIN6:FAILURETOSEWREWORKERS'C0IAPENSATqNCOVERACE15UNUWFl4.AND5HAL�BE ENERGYP/C
�y SUBJECTMIEMPLOYEHTOCRIMINALPENALT;ESAIJDCVILFMESUPTOONCMVND9EDTMOUSANO ENERGYPERMIT
DOLLAiiS(f100,000�.INADDIiIONiOTMECOSTOFCOMPENSATqN,DAMAGE5A57ROV�DE�FORM •_ _ . /
� SECTION 37oe OF TNE LABOfl COOE.INTEREST,ANDATTORN[YS iEES. � RETENTION FEE: • /•r�
oCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IMEREBYAFFIRMUNDERFEN�ITYOFPERNi1VTHATTHEREI5�CO45TRUCTIONLENDIN6�GENCY
fOR THE PERFORMANCE OF THE WORK FOR WHip/THIS PERMIT IS ISSUED(SEC.7DBi,CIY.C.).
Z
w
� IENDER'S NAUE
F— LENDER'SADDRfSS
� TOTAL FEES %OZ• Gv
� I CERTIFY THAT I MAVE READ TMIS APGLILATqN AND SiATE 71UT THE ABOYE WFORAIA'qN IS CARPECT.
w IAGREETOCOMPLYN7TMALLCITYANDCWI:TYOROINANGESANOSTATEUWSflE',ATINGTOBU0.DINa
� CONSTHUCiION,ANDHEFEBVAUT/10RREPEPRESENTATNE50FTHISCOVNTYTOENTEqUPONTHE
Z IONED71iOPERTYFORiNSCECTiONPURPOSES. �
� COMMENTS
o . L ��L
J
� ...i S
m ITTE E(PRI
a " 2�_0.�
� IG EO PERMITTEE DATE �
'— � RECPT.NO. PAID BY�T/�— VAUDATION
WHI7E—Depanment Gopy.YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Capy,GREEN—AppUcam's Copy
C.�i..�_.�r � 'r" ._,11,.7'•.i��'l��f� � .-.!".
��'Fi... ...:'�� � .li�� i .'�...W^1.;. �.,t
_____�Mpr w_( _ e. , - - _ti,y._ . .. .'�.I_ _. ..._VA;j.. ..... 'f._...... . . ---- - -'.,�- -.... _.___. _. - -----------�
Is`._._._ _r_t.'.,.. ._-- ..._3_.. !:: . _ - �, . ' 1a'; � _.r'� I��w=''v.c �i'�)��
_ - -
SET 6ACN: ; � � I F LCOF3 JC�1ST r � --
J. --- -- - - -- - ---- - ---�-�--- ---�-- --------;- -i--- ----
FTGS'FOR�.^��STEEL � I r�����F�����'"�� � i
-- - - -- -- -- - --�-------- ---
- ------ ---- ----• �------ -
GROJfJD PL.0'BIND--- ----� --- -------- j ; Ui!D��_FLGOR C"r "i�i ----�--- � --- -
^ � -------- �J"�
---
� -- - OR C�=JIT---�- �--- -
}-- ---�- -- ---- ------
CLAE3 GRADE I I I i FIREP�I�,i�E FO'��'!D�',I10[� • I
i ------- ---- •----
--
TF�.4P PO`�"dER -�— - ----' �IREP�F,CE EOt�� B�i,G�i �
-- •---- - ---- �------ -- , _.___ ---�_------------
L^1FsTER SERVICE I I I �"'� F;T. �'��'� E=-f�'" !
-- n ��/Z�V��-�-��----__ � � FiiJ1LJf��iJ:� 6�l,',+, --- -------- -----
R00=SH�P�.Ti-iIT!G -_ / _ _& r;�ti:� B�F� --------� _ --
FR!'�h,^I��.G�'EPJTILIF,TIO�J __ �-- ---� --- - - - -_
ROOF COVER I�y�o��/r._/r""- ' I I_PRc-GR?'�D�f_<G _I_ i
ROUvH H�l�i ING ;�( � � I E�E��7��H'�t�JG I I
ROUGH ELECTPJC ; --- i' Fi�U�afi GR�;DIi�G ! I -
--��-- ----------- --- — -- --
--- ; - -- ---- ---
ROU�H PLU;�"�IN3� __ - ' � FIi�;Stl uHF�.D;�JG � i
_ --- � ----.---- - ---';_I-F'OCL ELECTRIC - i ----�-- ----- --
SH�I'JCR,TU6 T�ST ! i i �
�---- -
E}:T. U'1TH/SIDING I � PO�L FE�•�CI'��u i
r-•----
�'lALL IivSULATlO��! � --- - ---- � � i'O�L F=IPJAL --- --_I__� ---
� ^ j OF`SITE I`,�PS.
CEILLd� 1��1SULATIOtd � -�-- _ I . --� _ - -----�- �
DRY1'lf,LL fvAILI;JG � � I i [�EDiCi,TIOidS � ---- --
SE�'JER ------ I I FI,J,AL�NG. - --�
--�----
SEPTIC TAt•,K } _ � __ _ • i I LF�.P1DSGt,P.E/IHril=,. '
SEEP PIT/L.L I � . ! ON S17E I�:^PS. j
--- �-------- -- --
Gl',S P.IR TEST � � __ • I ; �'I;JAL:C'J:i!G j ---
FIh1l1�CO,"JST. � � , � clr�i� D�PT. Fl�d�i�- I
FIfJAL HEF,TIPdG �_ �-`--- ---'�_f'•EF_LTH D�r T_FIf:.��L I �
FI�JAL ELECTF�IC � � j DEV. FE�S Pr1iD _ � � _
(- i---- I •--- �
FINAL PLU��131^d� I � --�� E�J=Rv`{
-- . _ .,..----....---- -..-_--� --. -
II �- �_ • I _ __- --
- - ' --�-- _ _ _ _._. __ ' � ' , �
� CC�PJi�U�ENTS --- -
�i 1
SEPTiC itir,�r: sizE
SEEP PITIU SIZE - --"- --- - --------- -- --
. . ._---- -- �
- --- - �,I -- --- --
4�r
0. , . .