HomeMy WebLinkAbout16323 — - ,
' � �� CITY OF DIAMOND BAbt
�, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
'} ' 21660 E.Copley Drive Suite 190
1 (909).860-3195 Fax(909)861-3117 PRESS
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c� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
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LL ADDRESS `'[c ZONING SETBACKS
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Q ADDRESS �,¢� J7/+�r''.y -7�-�iL L[ . � �� PROPOSED USE � (C . i � ` G �
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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U COUIRYNMIp1RE0U1FESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W patio/Deck
TURE,PRIOH TO ITS ISSUANCE,ALSO REOUIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 7HE PROVISIONS OF THE CONTRACTORS LI- w
� CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PRO- � PooVSpa
FESSKINS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEOED EXEMP-
TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PEiiM1T SU&IECTS THE APPLICANT TO Z Re-Roof ,iO
� A CML PENALTV Of NOT MORE THAN FNE HUNDREU DOUARS(S5ao).):
� ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COrtIfilBfCl81 '
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704l,BUSI- J
N NESS AND PROFESSIONS CODE:THE CAN7RAC70RS LICENSE LAW DOES NO7 APPLV TO AN OWNER OF �
PROPERTY WIIO BUILDS OR IMPROVES 7HEHEON,AND WHO DOES SUCH WORK HIMSELF OH HERSELF OR
[C iHROUOM HIS OR HER OWN EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS AHE NO7INTENDED OR m
QOFFERED�ORSALE�F,HOWEVER7HEBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCAMPLE-
Z �'TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO hiAT HE OR SHE DID NOT BUILD OR
� IMPFqVE FOR THE PURPOSE OF SALE).
W ❑I,ASOWNEHOF7HEPROPEflTY,MAE%CLUSIVELYCOMRACTINOWI7HLICENSEDCONTMCTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VelUOIlOf1 ADJ.AFlEA
� CENSE UW DOES NOTMPLV TOAN ONRJER OF A PROPERTY WNO BUILDS OR IMPROVES THEREON,AND i
NM1iOCONTRACTSFORSUqiPR0.1ECTSWITHACANTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG pUANTITY DESCRIPTION FEE -
Y TORS LICENSE UW.).
� ❑1 AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER U
Z W
� LICENSED CONTRACTORS DECLARATION W
I HEREBV AFFIRM UNDER PENALTY OF PERJURY 7MAT I AM IICENSED UNDER PROVISIONS OF CHAPTER �
I � Y(COMMENCINO WITH SEC710N 7000)OF DIViSION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�� MV LICENSE IS IN FULL FORCE AND EFFECT, m
� 0 LICENSE CUSS ��9 LIC.NO. � ��D / Z � �
WDATE �1� D I CONTRACTOR .���_ a
� WORKERS'COMPENSATION DECLARATION a
I � I HEREBV AFFIRM UNDER PENQTV OF PERIURV ONE OF 7HE FOILOWING DECUMTIONS: Z
I � _I HAVE AND WILL MAINiAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOHKERS' _
Q COMPENSATION,ASPROVIDEDBYSECTION37ooOFTHELABORCODE,FORTHEPERFORMANCE U
Q OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. �
W _IHAVEANDWILLMAIMAINWORNERS'COMPENSATIONINSUHANCE,ASREDUIREDBYSECTION
Q 370o Of THE LABOH CODE.FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
J ISSUED.MV WOHKERS'COMVENSATION INSURANCE CARRIER AND POUCV NUMBER ARE: CONSTRUCTION ���
j CARRIER � �� ` -PLAN REVIEW
� POLICYNUMBER �—.�� �]�� ELECTRIC
Z
Q
0 (iFASSECf10NNE�NOT8E00A1PLETmOFiHEPEPoXTISFORONEFRN�DREDDOLlA0.S(f100)OqLESS� PLUMBING
Z I CERTIFV THAT IN THE PERFOqMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
C�} SHP11 NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE +.
�/j WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGfiEE THAT IF I SHOULD BECOME INSPECTION FEE � I.. ��
= SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR _, r`O
CODE,I SHALL FORTHWI7H COMPLY WI7H TNOSE PPOVISIONS. ISSUANCE V
� 3�� .,,r/�� 1�_ l�� SMIP ,e ; �
p DATE: O APPUCANT.
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J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENEFiGY P/C
� SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT
DOIURS(f 7 00.000).IN AODITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF 7HE LABOR CODE.INTEREST,AND ATTORNEV'S FEES � RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEPEBV AFFIRM UNDER PENALiV OF PERJURV THAT7HERE IS A CONS7RUCTION LENDING AGENCV . �
FOR THE PERFOFMANCE OF THE WORK FOR wHICH TMIS PERMI715ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME , �
F— LENDER'SADDRESS
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA7qN IS CORRECT. TOTAL FE ES '� O�����
� I AG(7EE TO COMPLY WITH ALl CITY AND CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING V
� CANSTRUCTION,AND HEREBV AUTHORIZE REPFESENTATNES OF THIS COUNTV TO ENTER UPON THE � -
Z ABOVE-MEN710NED PROPERN FOR INSPECTION PURPOSES. . . .
�o COMMENTS
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m PERMITTEE NAME(PRINT) . � ' '
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� SIONATUFiEOFPERMI DATE
� RECPT.N0. � PAID BY VALIDATION
WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDEN O�File Copy,GREEN—Applicant's Copy
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GROUND PLUMBING UNDER FLOOR CUMDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM �
WATER SERVICE MID HT. BOND BEAM
ROOF SNEATHING , Z�J�CJC 8 FT. BOND BEAM
�RAMINGNENTILIATION FINAL BOND BEAM
RObF COVFR -��—d PRE-GRADING
R(�UGH NEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNiBING FINISH GRADING
SHUWER/TUB TEST POOL ELECTRIC `
E?CT. tATH/SIDING POOL FENCING
WALI.INSULATION POOL FINAL
GEILING INSULATION OFF SITE IMPS.
DRYWAI.L NAILING DEDICATIOIVS
SEWER FINAL ENG.
SEPTIC TANK LAIVDSCAPE/IRRIG.
SEEP PIT/L.L. OfV SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL C�NST. 3�2�' FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FiNAL ELECTRfC DEV. FEES PAID
E�1NAL PLUMSlNG ENERGY
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