HomeMy WebLinkAbout17102 (42) �� CITY OF DIAMOPID BAR
� DEPARTMENT OF COMMUI�IITY 8c DEVELOPMENT SERVICES �
„� . 21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 PR ESS
����^ BUII.DING PERMIT APPLICATION FIRMLY
� JOBSfTE APPLICATI PERMfT p/C
o ADDRESS �-►V V"L DATE C NUM6ER�A
g ISSUE • TYPE OCC
APN LOT TRACT DATE CONST. GROUP
°C OWNER �a w
O
p ADDRESS t ✓-L 20NING SETESACKS
w FRONT qW ❑
CITY a ZIP af 17�9 TEL 5�l •- 2
� APPUCANT • TEL 9��J��.7�7� REAR ❑
� SIDE/SIDE STREET RW O
CONTRACTOR �� a. t �u- o SIDE ❑
� ADDRESS OI n 5 .. � ..-
CIT1CSRti a ZIP�� TE�.'7[NS9�9�- ^� PROPOSEDUSE �a u. �{ G
� S �
ARCFUENG/
DESIGNER NO.�WEI. NO. NO.
N ADDRESS UP�ITS STORIES ' �L. BEDROOMS
� CITY ZIP TEL.
�
rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWN[R-BUILDER DECLARATION SFiUADD/REM
O
p 1 HEREBV�GFlRM UNDER OENALTY OF PE0.IURV THAT 1 NA EXEMPT�ROA1 TNE ODHTMCTORS l4 GaregdCerport
W CENSEUWFORiHEFOLLGWWGREA50H($EGTW1.68VSWESSANDYFOFE5510NSCODE:ANYCITYOR (/�
� COIMT'/WMpIRE0U1HE5AVEfiMRTOCONSTAUCT,ALiER�CROYE,DEMOUSM,ORREPIIIRANYSTHUC- W P0Ii0/DBCk
TURE,PRIDH TO RS ISSUANCE�L30 FiEWIRES TNE 11G7LICANT FOq SUL71 VEfiMiT TO FILE 115ICHED w
STATEMEM 7HAT NE OR SNE 5 LICENSEO VURSUANT 10 THE PROVISIOY.S OF TME OOH7MCTORS LF
� fFNSE UW(CHAP7ER 0(COMMENCINO WRH SECTION 7000)OF ONISbN]OF T1E BUSME55 ANO PRO� � POOUS09
FESS�ONSOODE)ORTHATHEOiiSHE1SEXE6IPTTMEREFROMAt.'�THCB+l5I5FORTNEALLEGEDE%E/AP• (�
T10N.NIYVIOLATiDNDFSECT10H7Wt.6BYMrvMPtICANTFORAPERMITSUBJEtt57H[APPlIGW7ip Z Re-Rool �
� ACMLPENAL7YOFNOTMOfiETTW7FNEMINDREDDOLURS�1500�.�:
O Ol/50NMEROPT7EPROPERTY,ORMYEMPLOYEEsmTHWAGE30.5THEiRSOIECOMPEHSATqN, O CORIrt101C121 -
Z YVM11 DO TiE YVOFiK ANO TME S7FqlC7URE i5 NOT ItfTEHDED OR OFFERED FOfi SALE(SEC.7oN,BU54 ,,.1
N NESS AND iROFE5510NS OOOE:THE COHiMCTONS UCENSE UW DO[5 NOTAPPLY TO AN OWNER OF j
VAO�ERTY MAiO BURDS OH MPROVES THEREON,M1D WHO DOES SUp1 WORN HIMSELF OR XERSELF Oq
� TNqOUGHX190qNEROWNEYPLOYECS.DROVIOEOTXAT5UUIMPPOYEMENTSARENOTIMENDC00i1 C�
� OFFEAEDFORSALEIF,110WEVER7HCBULDINGORIYVROVEYENTISSqDWRMNONEVEAROFCdIPIE-
z TIOH,7ME OWN[R�BUM1DER WILL IIAVE TME BUROEN OF PROVINO iNAT HE OR S��E O�D NOT BUIID Oq
� W VFqYE FOH T1E PURPoSE OF SALE).
W 04�OMNENOFTMEFROPERTY,NAE%CIUSNFLYCOMMCTIIJOWfTH�ICENSEDCOHTMCTOft3
¢ TO CONSTPAJCT 7HE VRQIECT(SEC.70N.BVS�NESS AND ViqFE5SqN5 COOE:T7�E CONTR�CTORS ll• ��81U8IIOf1 �J A0.1.AREA
l�� �NSFUWOOESNOTAYPLYTOIWONT�EROFAPNOPCRT7YRq0URD5DHM7ROYE5TMEflLON.Ah9
� NRqCONTRACf9fOH5UCHVR0.1ECi5WIT/AWflTRACTOR(SILICENSEDVURSUANTTOTMECONfMG pUAN717Y DESCPoPTION FEE
� roas uccNSE uw.�.
O 111�fXEUPi UNDER SEG B.t O.C.iOR TMIS NEASON Q
3 � .
u. ¢
OATE ONNER V
�4 LICENSED CONTRACTORS DECLARATION W
CC 1 NERLBYAFFIHM UNOER PENA:TY OF PE0.RIRY TMAT IAA1 LICENSED UNDER 7ROVIS�ONS Of CHAPTFR �
� 0(COMFIENCNOWITNSECT�OH70o0�OFDN�SION]OFTMCBVSINESSANOPROFESSIONSCOCE,/WD Z
X MY LICENSE IS N ML fORCE AND EFFEC7. m
11J �
� UCENSE ttASS LIC.NO. J
�j DATE CONTMCTOR a
W
� WORKERS'COMPENSATION DECLARATION a
� IHEREBYAFfIPA1LNCERPElULTYOFPERIURYONEOFTHEFOLLOH'NODECLNiAT10N5: �
Q
C _1 HAVE/V!U WRl1.1AN7MM�CERTIFICATE OF CONSENT TO SELF�INSURE FOR N4RKER5' _
Z Cd17ETI5ATION,AS FROVIDED BY SECTION�10a OF THE UBOFi COOE.Fdi TNE VEFFORMANCE V
Q OFTHE WORK FOR WHICH THIS VEq��i IS ISSUED. �
0
� ,�IHAVEANDWILLWp+TA�WORKERS'COuvEN5A710NIN5UMNCE,ASREW�REDBVSECTION /O
Q ]70D OF TME UEOR COOE,FOR 7HE PEHFORMrNCE OF iHE WORN FOR WNICN TMIS OERMIT I$ {r
RSUEO.4YWORKEP5COYPCyNS�ATIONINS MHC[ RIERANOGOLIGYNUM�ERME: CONSTRUCTION , �!.
� c�wwER S /"� �� PLAN REVIEW
� POLICYMIMBER� }��� '�CJOC� E�C7f�lC �..�.. _
� fn�scc�rxmralecoa.�rEnoonEocaMrsrana�Huu�[ooa�nss,xlaa�sst PLUMD�NG f-�i_� .:.� �1� 't -
Z ICERTIFYMATNTNEPERFORAUNLEOFTHEWORKFORNMiCH7H15PERUIT1565UE0,1 M.ECHANICAL _�
C7 57ULLNOTEA1PlOYAN'IPERSONWANYYANNCRSOASTOBEC0IAESUB.'ECTiOTHC
� WORKE�75'CO4�ENSATiONUw50FC/�UFORNiAN+DAGHEE7Fu7IF15110UL�0[COAIE INSPECTIONFEE
SVBJECTTOTME WORKFRS'CO�AOEN5AT10N vROV15qN50F SECTION 7700 F THEtABOR " •
cooe.i swui Foan+vnn�toraa�r win� rrav`ia�. ISSUANCE
� u � SMIP T I ��
`p DATE: !�II��CJ i APPLICANT: � _ � .
� ENERGY P!C - --
WARNINQ:FAILU0.E TO SCCURE YJORKERS'COMPENSATpN COVEMCE IS UNUWFUL.AND SHALlOE
� SU&IEC7/WEMPLOYERTOCRIMINµ,iENILLTIESANDCNILFWESUPTOOH[MUNDREOTHOVSAW ENERGYPERMIT
DOlLARS(f 100.OW).W ADDITION TO THE CAST OF CpAGENSATqN.D�AGES AS PPOVIDEO FOR IN
� SECTIDN770lOFTMELABOHCOOE.NTEPEST,ANDIITTORNLYSFEES. RETENTIONFEE: . ����
pW.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� IHEREB'/AFFIRAIUNDERF[NALTYOFPEiLM1IAYTUTTHFREIS�CONSTRIKTONLENDWOAGCNCY
�Z- FOR iME GERFOFWINGE OF T11E Y/ORK FON WHICH TMIS VERMIT IS ISSVED(SEC.7oY7,CIV.G�.
W
� lENOER'S NAME
S
� LENDER'SADDRE55
¢ ICERTIFYTMATIH�YERE/�THIS�FPLIGTpNANDSTATEiH�TTHEABOVEWiOMUTqNISCORRECL TOTAL FEES J ���
W IAGRCETOCdAiIYVATNALLCITYANOCOUNTYORDINANCE5AND5TATEUwSREUTwGTOBULDINC
� CONSTRULTION.ANDMEREBVAUfHORIZEREPRESENTATIVESOF7H15COUNT'TOEMERUPON7NE �
ZI80VE.YENTIONED VHOPERTY FORINSPECTION GURPOSES. COMMENTS
0
J
�
¢ PERMiT7EE NAME(PR�tff)
N
(/� SN3NANREOFFE�iTTEE D�TE
� RECPT.NO.� PAID BY C VALIDATION
WHITE—Oepartment Capy.YELLOW�nence Copy,PINK—Assessor Gopy,GOID[ ROD--Fi1e Copy.GREEN—ApplicanCs Copy
CITY OF DIAMOf�D BAR
� - . • � ��dSPECTIO�J RECORD �
; . . .
.�_ _... _. . _
_ .
�
1111l►`F-�:�ac�E�l��►�! E���.—�'._ fi��-�.:������.:��� ��-i��:l:�_:�c:C't�1►�.. �r��i� ��_ I.►�E•7�=�''�c,�;z.
. . .._..._ . . _
i r• ,..
.��_........ .,._.....�..._..._....._..._...�.._..,__,....--�---�—;---� ,. _..__..._. .....__. _.,.- --..,._. . -.:..,._ ..............__ ,_....._._.._
...r_�._..----...__....._. .
iSET BACY. • i , ' FLO�R JOIST • '
� —
:FTGS/f=ORP�"S/STEEL ' - � ,`', �•• FHA P,�Q'V1TS —� � _.._
ELECTRIC GROUND UNDER FLOOR DUCT � � ;
GROUND PLU�•�1BING I � UhJDER FLOOR CUf•IDUIT "
- — ---------. . -- -
'SLAB GRADE- - •�' FIREPLACE FOUi�.'DATIO^J �
:TEF�1P POLNER FIREPLA�E BON�C�EAh1 '
�VATER SERVIGE ��41D HT. E30ND BEAD�1
iROOF SHEATHING •• -lL(-t�T _�. I E FT. BOPJD BEA�:9 � -
'FRAh11NG.NENTfLIATiON �—�_ �"' � FINAL EiOND BEAP:1 �
`ROUF COVF_R . �1�1I0J I��„_ - i PRE-GRADING '
!ROt7GH HEATING � B�PJCHING
;ROUGH ELECTFIIC ROUGH GRADING
'ROUGH PLU'�1BIP�G — FINISH GRADING
;SH��VFR�'�UB TEST PCOL ELECTRIC
;EXT. L�,TH/SlDING PCOL FENCING ;
�IJVALL iNSUL.ATiON - - POOL FINAL i
�CLILIN3 IidSULATION- �- ' OFF SITE Ih1PS. I I �
DRY1"JALL NF;ILING �EDICATIOi�S •
SEl•"JcR FINAL EWa. :
SEPTIG TANK LF,NDSCAPE/IRRIG. �
'SEEP PiT/L.L. � �� ON SITE ID�1PS.
�G�,S f,IR TEST � FINF,L ZONIPJG �
iF.l'•��•t_CONST. . _ FIRE DEPT. FIN/1L
�E-1;�:;�.�!-IEATING _ HEALTH DEF'T. FI�dAL
�[ ,:t•l_ELECTRIC DEV. FEcS PFJD.
;��-�:•�f_.L PLUP.IBING � ENERGY __ � _
: , --- — --
,---.---�-..,-.__,-.•:.------__��___.___.
, , � •.,_-�r e;l-.t_is.�.'.': I
.,,..
�_ ..::•:. ,.•�... .. _. _.___....:
' COiVIf�IENTS
_ � :
SEPTIC:fANK SfZE '
SEEP PIT/U SIZE ' — —
---�-------- _��� .�_—____--�
�
:.���� s — --- —
��--_.. ..�' ._.........__�: • ` . . - - -- —