HomeMy WebLinkAbout16960 (17) J� CITY OF DIAMOAID IIAP. r'
I
DEPARTh�tENT OF COM:vtUNTTY 8 DEVELOPMENT SERVICES (�
t� ,�T` � 21825 E.Copley Dcive
(909)860-3195 Fax(909)86t•3117 PRESS
BUILDING PER1�11T APPLICATION FIRMLY
� JOEiSITE 3��� C h err Q (Q APPLICATION 4.'C��rl( PERMIT � (�p/�
o ADDRESS DATE O J v� NUMBER Up
� APN LOT TRACT �SSUE TYPE OCC
p OWNE�Rr.ti E S�� DATE CONST. GROUP
p ADDRESS 41 2 ( C�L...� /�w � ZONING SETE3ACKS
� C�TY - n i w�.�.r.� .- ZIP g r)C5'TEL. q N- i 2 FRONT RW ❑
g APPLICANT en,,.c ~ C,1o,;�, ���97-5�� REAR �
� SIDElSIDESTREET RLV ❑
� CONTRACTOR SIDE �
ADDRESS /��
� C�TY ZIP TEL. PROPOSED USE�_'rV..V G Q
o ARCH/ENG/
z DESIGNER
� ADDRESS UOi SWEL. NO. NO.
� C�TY ZIP TEL. STORIES E3EDROOMS
� DESCRIPTION S�.Ff. FACTOR PSF ADJ.AFEANALUATION
¢ OWNER-BUILDER DECLARATION
p SFRlADO/REM
1 MEREBV ACFIRIA UNDER PENALiV OF PE0.AJRv THAT I M1 EXEMPi FROM TH[CONiM�TORS L4 GaragelCarport
W CENSEUWFORTHEFOLIOWINCPEASON(SEG7a]1.5BVSINESSANDPROFESSqN5LO0E:MIYCITTOR (n
V COUNTYWHICHREOUIR[SAVERMITTOCONSTRUCT,ALTERiNPROVE,OENOLISH,ORREP�IRAYYSTAUG F+y�i�eCk
W 7URE.PRiOR TO RS ISSUANGE,/�L50 REOUIRES TME APPLICUJ7 FOR SUCH PERMIT TO FIIE�SIGNED w
S STA7EMENT MAT ME OR SH[IS UCENSEO W RSUANT TO TME PRONSIOhS OF TME CONTMCTORS tb
� CENSE UW(p1AVTEN 9(OO�IMLNCINO WITH SECTqN 7000)OF DIVISION�OF THE BL15!NE55 AND PRO- LL' POOI/Sp1
0 iES5iON5CODE)ORTHATHEORSMEISEXEAIOTTHEREFqOMAN�7ME8A5I5FORTNEAILECEDExE�IP� (�
V TIOH.AM'VIOLATIONOFSECTqN7071.5BYANYAP7�ICANTiOR�PERAIR5UB1FCT5THCAPP�ICANTTO Z Fle•Raot SOO S
A CML 7ENALTY OF NOT 1AORE TWW FNE HUNDRED DOIURS(lSaC��.
0 ❑4�+0'NNEROFTMEPROPEflN,ORMYEMaLOYEESYATHWAGESASTHEIR50LECOMPENSATqN, 0 COmmerCi3�
Z WILl00 iHE WORK,AND TME STRUCTURE IS NOT INTENCFD OR OFFERED FOH 511LE(SEC.70�1,BU51� J
� NESSIWOGROFESSiONSCl�DE:THECOHTqACTOfISLICENSEUW�OESNOTAV7LYTOA40WNEROF
VROPEFTlwM06U4DSORIAIPROVESTMEREON,ANDWMO00E55UCHWONNHIMSCLFORHERSELFOf� �
wTHHOVGHMISORFIEROWNEMPIOYEES.VROV10EDTHATSUCNMPROVEAIENTSARE�OTNTENOEDOR m
� OFFEREDFORSFLEIF,410WEVEi�THEBUIOMGORI4PROVEMCMI550lDK9THINONEYEAROFC0IAP�E�
Z TION,THE OWNER�BUILDER 1MLL HAVE TME BURDEN OF PROVIN�THAT HE OR SHE DI�NOT BUIID OR
� IIJPROVE FOR THE PURPOSE OF SA:E�
UJ ❑LASOWNEROFTHEPROPERIY,AMEXCLUSNELVCONTMLTIhGWITHLICENSEDCONTRACTORS
[[ TO CONSTRUCT 7HE PRQIECT(SEC.70��.BUSINE55 AN7 PROFESSIONS CODE:THE CONTMCTOfiS U� VaIl12IiOf1 ADJ.AREA
W CENSEUWDOESNOTAPPL�TOM10w1:EflOFAPROPEn7YwF10BU1LDSOf1MPROVESTNEREON,/�ND '
T�- YMOCON�MCTSFORSUCHVFWECTSNnTHACONTMCTORIS)IICE�SEDPURSUANiTOTN[CON7MU QUANTITY DESCRIPTION
Y TORS LIC/ENSE UW). FEE
� MAIAE%E4PTUND[RSEC. B,LVC.FORTNiSRE�50N Q
?r, U
ZDATE g- I�� O�OW�:ER a �%5 � U
� LIGENSED CONTRACTORS DECLARATION W
� IMEREBYAGFWNUNOERGENALTYOFGE0.AIHYTIATIANLICENSEDI'N�ERPROVISIONSOFCHAPiER V.
� 0(COI.�uCNCINdVlITHSECiqN7000)OFONISION70FTH[BVSINESSANDPROFESSqN5CO0E,AV� Z
�� IAY LICENSE IS W FUIL FORCE A40 EFFECT. m
� LICENSE CUSS �IC.NO. �
V DATE CONTqAC70R d
W
� WORKERS'COMPENSATION DECLARATION a
� I MEREBY AFFIRM UNDER PEN.LL7Y OF 7ERIURY pJE OF iHE FOLLOW'NG DECUMTIONS: Z
� _IIUVEANDWILL4AMTAINACER71FICATEOFCONSENTTOSELF-INSUREFOqWORKERS' ¢
S
COMPENSATqN,ASPFlOViDED8Y5ECTION»o00FTMELADOflCODE,FORTHEOEPFpM1ANCE U
Q OF TNE WORK FOR NMiCH THIS VEFMIT IS ISSUED. �
W _IHAVEANDWiIYAINTAINWORKFRS'CdAOENSATpNMSURANGE.ASREWIRE08YSECTION `
� J7000FTHELABORCOpE.FORTNEOERFpfLIAHCEOFTHEWORKfORWHICHM15VERMITIS Q ��Il
J ISSUED.MY WORNERS'CAMPENS�TqN INSURAM10E LARRICF/�tiD POLICY NUM�ENARE: CONSTRUCTION ��-'1�`)
j CARR:ER PLAN REVIEW y-�—
Z va�cVNUMeER ELECTRIC
¢
0 �n+�ssEcna+r2mwi¢[ca.nErEooFncrEar.rtswnarh�ua¢o0a1MSR+xiat�Fss�. PLUMOING
w
Z 1 CERTIFY THAT IN TME PERFOHIAANLE OF TII[WORK FOR WHICH iH15 PE W.�iT IS ISSUED,1 MECHANICAL
U' SHALINOTEYPLOYANYDER50NNM1VMANr:ERSOASTOBLCAM�5U6JCCTTOTHE
(n N"ORKERS'CAAlPENSATIONUN50FCALIFORN:AAN'J�GFEETHATIFISHOULDBEGOME IPISPEC710NFEE
S Sll[iJECTTOIHEWORKEHS't041�[NSATIONVROVISiON50FSECTqN77000FTHElABOR —'�------ .
CAOE,ISM�IIFORTIAVITHCOMP�VY/ITHhtOSEPROVi$qNS. ISSUANCE �?� �''�,� ��� � :�`"�\
O �f... �i
�Z
p DATE: APPLICANT. SMIP � �O
� WAfiNINQ�FAIWRETOSECUREWDI7NER5'COMPENS�TIONCOVERACEISUNUWFUI,ANDSMALLBE ENERGYPlC ./y�G���R'�
SU[iJECTANEMPLOYERTOCR.MINALPENALTIESMIDCNILFWCSUPTOONEHUNORE0TFKK15AY� r� �� "
� DOlUR51f100.000),INN'DITqNTOTMECOSTOFCpAPENSATpN,OIUAACESISPROY-0EDFORM ENEHGYPERMI I
J SECTqN7�0eOFTN[LA[fOACOOE.WTEHEST,ANJAT70fWET'SFEES.
ct RETENTION FE •
� CONSTRUCTION LENDING AGENCY PRC-ALT FEE: �•��•---- . ........_._..�
� INEREBYAFFIMIUNOERiEN�LTYOFFERIURYTHATTXER[ISACONSTRULTIONlENOINGAGENCY
FOR TME FERFORMANCE OF iHE W ORK FOR WHiCM TM�S PENAIT IS ISSVED(SEC.]091,G�V.CJ.
Z
W
� IENDER'SNM1E
1-- LENDEH'SiIDORLSS �
W ICERTiFYTNATINAYEREA0T115Ai�lICATION�YDSTATETHATTMEA[70VENFORMATqN15CARFECT. TOTAL FEES I J�. I V
� IAGR[ETOCOMPLYWITHIILLCRYANOCOUNTYOR'JIWWCESANJSTATEUNSREUTWCTOBUILDING
� CONS7qUCilON,M1�HEFEBYAUTHORIZEREPR[SENTATIVESOFTH:SfAUN7YT0ENTERU�ONTME
Z A90VE�MENTbNE�71iOPERTVFORINSPECTqNGURVO5E5. COMUENTS
O � -l._Y� `
� �� �
m GERum N '�PRINn
� ' • �/��O / 1 ��yy
(n SIGNFTUH VERMITTEL DATE '��I �
� RECPT.NO._ V ._PAID DY _ VALIDATION _
WHITE—Depanment CODK YELLOW—Finance Gopy,PINK—Assessor CaOY.GOLDENROD--File Copy.GREEN—ApphcanCs Copy
,. .., . . . ..,,,
l..,.. . ,:. ... �f�.,:..:-.�;; _ .. .. :I...-7 _ •n . . .,. ri. . -� �._. � . . _ i ... . . • ., . .. . .,. .
• ...
• � ..'•:..-: .�. :•.._. .:�.'... � ' t �. . . .. . .
. CI a 1' �O� DIl�sf:�G's �D F�f-�F�
� l�dSt-�C";��fd i=��CGi�D
:I►'�'�:a��'C(c]i'� T^ �j.�'F�.�I►�F�'i:�at;�p'c��t-__----__. (►`l�.:�._.c';Fif;�,��e.., - [i�'.I'- � (►'�'�-'-�c�t'.c).l
. _ _ _ . .. .. ..- - ---...._._.. . . ._ .._._._ ..._. ......- ----._...___.._....__... ...._.-.-=••-=-...------
..---------._...... .. ...._ .__..._.._._._....... ......... ...-.... ..__..--- -
SET BACY. � ___I ' � � � FLOOR JOIST
FTGS/FORPv1S/STEEL I --- ' , ----_I_i FH;REQ.":iTS '— ,�----� —
ELECTRIC GROUND � � � UPdQER FLO�R DUCT � !
I---
GROU;JD PLUTABING i UP;DER FLOOR CU11QUIT ,
SLAB GRADE I I FIRcPLl�CC FOUilDATIO�J ^ 1
TEh4P POWER I I_� FIF.EPLi�CE BO��D BEAP.1 I I
�^JATEFI SERVICE _ �_ I �.�ID HT. �OND B[nP.1 � � _
NOOF SHCATHING �g'��p�_��_�Q"` �—��_Fi FT. 6�i�:] E3t=A":1 __ � --
FFiAP�11NG.NEN7ILIATiON I / � I FINAL EO�JD 6EA�.1 � !
ROOF COVER o� �Z_�� I PRE-GRADRJG � I
f�—__ . __ ____
ROUGH HEATING S� � B:NCHING I
ROJGH ELECTRIC � � ROUGH GR�1DIt�G I �
R�UGH PLU�."E3R�G � � FI�11SH uRADI?JG I �
SHO`�"JER/TUB 7EST � � � � POOL ELECTRIC I f
EXT. LE1TH!SIDING � � i POOL FEI`dCltlG I I
VJALL I�JSULATIOfJ i POpL Fit�lAL I
CEILING RJSULATION � OFF 51TE IM?S. j
DRl'1�b��LL�JAILING � � DEDICATIONS �
SEb'VER FI"�/',L ENG. �
SEPTICTA��dK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. • O;�SITE IP,1PS. I I
GAS AIR TEST � � FINAL ZOPJIP�G �
FINAL CONST. FIRE DEFT. FIPJAL
FIPJAL HEATIPdG H�ALTH DEPT. FIPJAL
FI�dAL ELECTRIC � � DEV. FEES PAID � I
FIhAL PLUt�lBIUG I I I EWERGY I I
� --
t' ^.::.P^(��- -.j«- -�.
� �
. , ��
CUMMENTS
SEPTIC TANf<SIZE
SEEP PIT/U SIZE
. 1`I _ .�
I�r� ;;, :
: � i .