HomeMy WebLinkAbout18085 (17) CITY OF DIAMOND DAR �
�� DEPAR'I'Iv�Nf OF COMMUNI'I'Y&DEVELOPMENT SERVICES
E- ��` 21825 E.Copley Drive
(909)860.3195 Fa�c(909)861-3117 R ESS
�`%��� BUILDINGPERMITAPPLICATION FIR LY
o� JOBSITE 3 y.�l �sr�� �a� � APPLICATIOf�•r� .�O�UMBER ` li�
ADDRESS DATE J
� ISSUE �.�1 TYPE OCC
APN LOT TRACT DATE �/lr CONST. GROUP
p OWNER 1�'
p ADDRESS f ZONING SETBACKS
gCITY B,�.ZIP I TEL. — / REART RW �❑
APPLICANT_ Q6[7 �Y/Ale7'/N .FJ�EL. SIDE/SIDE STREE7 RW ❑
� CONTRACTOR S G SIDE ❑
o CDDRESS ZIP q,2.�s bTEL. ��.q-Fi$7S PROPOSED USE
o ARCH/EN
� DESIGNER NO.DWEL NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLAHATION SFR/ADDlREM
O �
p 1 NEREBY AFFlRM UNDER GENAL7Y OF iERNRY THAT I�E7fEMCT iROM iHE CONfMCTORS U• Gef9Q9/W IpOR
W CENSEUWFORTHEFOLLOWM(iREASON(SEC.70.71.58USWESSANOPROFESSIONSCODEANVCfTYOR (n
U COUN(YWHIqIREGUIRE5A7EM11T1000N51F1uCT,/�1TER��RWE.DEl10U3H.ONREPMRiWYSTRUG W patiolDeck
� NHE,PPoOR TO RS ISSl1ANCE.ALSO NEOUIRES THE AVVUCANT FOR SUCH PERMR 70 FIIE A SIGNED �
STATEMENT THAT HE OR S11E IS LICENSED PURSUANf TO THE PROYISIONS OF THE CONTMCTORS lF
� CENSE UW�CMAFTER i(COMMENCINO WITH SECTION 7000)OF DMSqN 7 OF THE BUSiNE55AN�PHO� u- PooVSpa
fESSIONS COOE)OR THAT NE OR SME IS E%EMPTTHEREFROM ANO TME BASIS fOF TME N1E6E0 E%EMP-
� 710N.�M/VqIATqNOFSEGTWN7W1.6B1'ANYAPPLIGANTFORAPERMITSU&lEGT3TMEAP%,IGANiTO Z Re-Rool
A dVIL OENALTV OF NOT MORE TW W FNE HUNDREO DOLURS(i5oo).��
O�ASOWqEROFTHEPROPERTY,ORMYEMP�0YEE5MATHWA0E5A5iHE1RSOLECOMPENSATqN, Q
Z Commerclal -
MALL DO THE WORK,M!D 7HE STRUCiURE lS NOT INTENOEO OR OFfEFEO FOH SALE(SEG 70/�,BUSb J
� NE55 AND�1iOFE55lON3 COOE THE CONTMCTORS LICENSE UW DOES NO7 APPLV TO AN OWNER OF ?
7ROPEHiYYn10BU0.DSORIMVROVESTHEREON.ANDWHODOE55Up1WOqNHIMSELFOqHERSEIFOR
� THROUfiHHI50RHEROWNEA�PLOYEES.PRONDEDiHA75UCHpAPROVEMENTSARENOTINTENDEDOR m
. QOFFERWFORSALE�F,HOWEYEF�TNEBUILDIN�OflIMVROVEMENTI550lDWf1T11NONEYEAqOFCOMPIE�
z TqN,TNE OWNERAUILOER WILL HAYE TNE BURDEN OF VpOVINO THAT HE OR SHE DiD NOT BUILD OR
= WPROVEFORTMEPURPOSEOFEALE�
w OIASONMEROFTIIEVROPEHTV,AIAEXCLt151VELVCONTqACTINOWR5ILICENSEDCOHTMCTOFS
Q TO CONSTRUCT TME PAQIECT(SEG 1014,BUSINESS M!D PROFESSIONS COOE:THE CONTMCTOflS U• V8IU81IIX1 ADJ.AREA
W LENSEIAWDOESNOTMPLYTOMIOWNEROfAPFOPENTYWH09URD50RMPROVESTHEHEON.AND
F N7qCONTMCTSFORSUp/PROJECTSWITMACONTMCTOR(5)LICENSEDPUPSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE
� TORSLICENSEUW.�
� OIAMEXEMPTUNDERSEC. B.�V.GFOHTHISREASW! Q
� U �
� �
O OATE OWNER U ,
� UCENSED CONTRACTORS DECLARATION W
J
� I HEREBYAFFIRIA UNDFR PENALTV OF PERJURV THAT IM1 UCENSED UNOER PROV1S10NS O�CIUVTER V.
d �(COMMENCiNUWITHSEGT10N7000�OFDIVISION�OFTHE8U51NES5ANOPROFE5S10NSCODE,AND Z
X YY LICENSE IS N Fl1LL FOHCE AND EFFECT. �
� IICENSE CIA53 C�I� LIC.NO.� r 7 J
V DATE c�.��'V'��_ CONTM a
W
� WORKERS'COMPENSATIONDE ATION � - - .
N1 HEREBYAFFIRM UNDER PENAITV OF PERJUfiY ONE OF?HE FOLIOYNNa OECUIUTIONS: Z . �
� _IHAVEANDWILLMAINTAINACERTIFICA7EOFOONSENTTOSELFaNSUREFORWOHNERS' _
CpAPENSATI0N,A4PHOVIDED8Y5EC710N77ooOFiHELABOHC00E.iONTHEDERFOHIAANCE W
OFT1E YYOHK FOR WHICH THI9 PERMI715155UED. �
'� �IHAVEANDWILLMNNfAINWORI(ERSLOMPENSATqNINSURANCE,ASREWIRE08Y5ECTION
Q07000FTHEVBORCODE,FORiHEOERFORIAANCEOFi EWORNFORWMId/THISPENAITIS
� ISSUED.MY WOPJ(ERS'OOAIPENSATqN MSUHANCE IER ANO POL�CY NUMBERARE: CONSTRUCTION
� CARRIER �'�A� �� PLAN REVIEW
� DOLICYNUTABER � ,�.� �.�.� l.E1S ELECTRIC •
o pwssEcnonr�mnoTeeoon�noFnevEaMrsroaa�wraaGnoau�sR,m�ar��ss� PLUMBING
Z ICEHT6YTW�TINiHEPERFORMANCEOF E FORWHICMTHISPERMITISISSUED,I MECHANICAL
C7 SMALLNOTEUPLOVANY0ER50NWAN ANNE S 4TOBECAMESl1BJECTTOTNE
� WOFL(ERS'COMGENSATqNlAW90FC _IFORNI A AGREETNATIFISHOULDBECOME INSPECTIONFEE
� SU81ECfTOTHEWORKERS'COMPEN TIONiR VI i Y - BOfl
rj CODE,ISFW1F01iTINA7MCOMPIV W�H �SSUANCE _ _
' O
. O DATE:T ��2.. APPLICANT. SMIP
� ENEflGY P/C
WMNINO:FNLURETO SECVRE WORKERS'COAAVENSATION CAVEM�E IS UNUWFUI.AND SHALL BE
�y SU&IECTMIEMPLOYERTOfAl1AINALPENALTIESANDCMLFWESUPTOONEMINOREDTHWSIWD ENERGYPERMIT
DOlLM3(f 100.000�,IN ADDITION TO THE GOST OF COMPENSATION,DAMACES AS VROVIOEO FOR IN
� SECTION77000FTHEUBORCODE,INTEREST,ANOATfORNEYSFEE3_ {jE7E(�JTIONFEE:
a CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O
� I HEREBV AFFIRN UNDEfl PENALTYOF PERIUNV THATTHERE IS A CONSTqUCT10N LENDIN6 AGENCY
Z FOR THE PENFONdANCE OF TME WORK iOR WMiCM THIS PERM�T IS ISSUED(SEC.iDv7,GIV.G).
W
� LENDER5 NM1E -
� IENDERSRDOHE55
� �ICERTIFYiHATIHAVEqEADTHI4APP�IGITqNANDSTATETUTT1E11BOVEWFORMATIONISCORRECT. TOTAL FEES �('`� • SV
� IAaHEEiOCO�APLVWITHALLCfTYANDCOUNTYORDINIWCESANDSTATEUW^+NEUTWOTOBVIlDINO
� CONSTNUGTION.MIOHEREBYAUTHDRREREPRESENTAilYE50FTHI5CAUNTI/TOENTERUVONTME
Z ABOVE�IAEMIONEDPROPERTYFORINSPECTIONMIHPOSES.
o O �� �� COMMENTS
�
Qv e arrry ���'—
�
N SIGNATUR O ER 1 � DATE
� HECPL NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPa Copy
. . ..,.'1'-:I.�"!:+?.. .�✓�.1:':f.31+V:;,�v:i -�r�..t:... � .. ,.:�I..tT� �:�"f'sy-:-�.: �� '.'�1�.iL.1;,�."��"'. ls+:....-��-�.r i..T-•�w.• �.�,.....�..♦�.�,vr�p�-�vt1.l..sri�. ._ r • . ,..4t
.. `����. . , .
ClTI' C�F DIAP�10f!!D �t�R
IPdSPE��"�t�N RCCORD
_._ . .
. '���'.���p.I�l�l. . - ��,��� 1.1i��-���.��°�•� . .��.Iw�-������IU��u.� D���.�� 1►� �
_ I
_,
----____.�_..._... _...r a_�. _.......�... _.�...__._ �. ..�� ...._._.._ ..r_ ._��
.�.� ° "
SET BACK ��.~WFLOOR JOIST ' . '�
F7GS/FORMSlSTEEL � y ___�__Yy I FHA REQMTS
ELECTpIC GR�UND ' � UNDER FLOOR DUCT ��
GROUND PLUMBING I UNDER FLOOR CUI�IDU17 ! '
SLAB GRADE I � FIREPIAGE FOUNDATION
TEPJIP POWER I I I �IREPLACE BOND BEAM
WATER SERVICE ? MID HT. BOND BEAM
ROOF SHEATHING I 8 FT. BOND BEAM ' •
FRAMINGNENTILIATION I � � FINAL BOPJD BEAM
ROOF COVER I � � PRE-GRADING ;
ROUGH HEATING i - BENCHING �
ROUGH ELECTRIC � I ROUGH GRADING �
ROUGH PLUMBING � I FINISH GRADWG �
SHOWER�fU6 TEST POOL ELECTRIC
EXT. LATH/SIDING ; ' POOL FENCING
WALL INSULATION I POOL FINAL
CEILING INSULATION j � OFF SITE IMPS.
dRYWALL NAILING � DEDICATIONS '
SEWER . FINAL ENG.
SEPTIC TANK � LANDSCAPEIIRRIG.
SEEP PIT/L.L. � ON 51TE IMPS.
GAS AIR TEST FINAL ZONING
FWAL CONST. . FlRE DEPT. FINA!. 1
FINAL HEATING ' HEALTH DEPT, FINAL � �
FINAL ECECTRIC"� 2Sljj� ' bEV. FEES PAID i �
FINAL PLUMBING �I I ENERGY
� " � i
i T F'�[��;.,,0 0�. � �
`� _ , . ,_
, : .� COMMENTS~ ' ---,_ -- -------
SEPTIC TANK SIZE
SEEP PIT/U SIZE .
__ _ (�
1���� I�� .. _
;
�
i . ` . h� . . .,�W � : � . . .