HomeMy WebLinkAbout17036 (37) CITY OF DIAIv10ND BAR �
-�� � DEPARTMENT OF COyIIv1[JMTY&DEVELOPMENT SERVICES
Z�` 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRE$$
��%:�� BUILDINC PERMIT APPLICATION FIR LY
N JOBSITE ��- �\ APPLICATION v PERMIT f� r„P/C
o ADDRESS -r'7�• C-�"I��e{'�- � CAvY�N DATE � �� NUMBER� � ���x
� APN LOT TRACT �SSUE � TYPE OCC
DATE CONST. GFiOUP
p OWNE�lx��142 D
o ADDRESS ZONING SETBACKS
gCITY ZIP TEL. - � REART RW p❑
APPLICANT TEL. SIDE/SIDE STREET RW p
� CONTRACTORG(�( �,`( (� l�;Fjec►CTtJ�J SIDE ❑
p� ADDRESS�t�. - pROPOSED USE � -�/loV - � ,
O —
o CITY ZIP�� TEL 4 L ��� (� yp-t;� �� ► At r..
w ARCWENG/ ,_____�S_T �F-��� �l�
z DESIGNEfl ������� �L� � j°�
w N0.DWEL. NO. I NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
v> DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFR/AOD/REM
O
p 1 NERE6Y AFFIRM UNDER FEtU1TY Of PEfWqY TIUT i AM EXEMPT FROM THE CDNTqACTORS U• GBf3g0/C31pOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC70]1,6BUS:NESSANOGROFESSIONSCODE:ANYCITYOR (n
U LOUHiYYMICHREOUIRESAPERMITTOLONSTRUCLALTERII/PROVE.DEAIOlISH.ORREPA,RANYSTRUG W P0Ii0/DBdc
Z TURE.PRqR TO RS ISSUANCE,ALSO REOUIRES THE ADGLICANT FOR SUCM VERMIT TO FILE A SIGYED
W STATEMENT THAT HE OR SHG IS UCFNSFO OURSUANT TO THE VROVi510N5 OF TNE CONTMCTORS ll� W
� CFNSEUW�CNAP7ERY�WI�1MENpNUWITNSECTION70a0)OFDINSqN70FTHE8U5iNES5�NDPRO• �" POOVSPO
FESSqNSCODE)ORTHATXEORSNEISEXEMPTTMERCFROMANDT/1E8�SISFORTHEA1lEGEDEXEMP• �
V TIDN.IIM/VqLATION OF SECTION 7031.5 8V AYY APPLICAYT iOR�PERMIT 5U&lEGTS TME AVPLICANT T0 Z F{g-Rdp{
A CML VENALTY OF NOT MORE THN1 FIVE NUNDREO DOlURS(f500�.�'
� OlA50YJ"lEROFTHEPROPfRT/,ORMYEMPL0YEE55MMWAGC5A5THEIR50LECOMPENSATqN, ❑ COTRI0fCi31
1MLL DO THE WORK,ANO THE STRUCNRE IS NOT INTEND[D OR OFiERED FOR SALE(SEC.70��.BU51• _!
N NE55 AND DROFESSIONS COO[:THE CANTRACTORS LICENSE Uw DOES NOT�vFLv i0 AN OWYCR OF j
PROPERTY NM1IO BURDS OR 4APqOVES TMEfiEON,ANO WHO DOES SUCN WORK HIMSELF OR HERSELF OR
CL TH{qUCNNISORHEROVINEMPIOYEES.PROVIOEDTWITSUCHUAPROVEM[NT511RENOTINTENDEDOR m
� OFFEXCDFORSALE.IF,NOW[VERiNEBU0.DIliGOAWPROVEMCMI550lDWRMNONEYEAROFCO�diLE-
Z TIDN,TM[OWNER�BNLOLR NlILL MAVE T1+E BURDEN OF PROYWO TMAT NE Ofl SHE DIO NOT BURD OR
= MPROVE FOR TME PURPOSE OF S�LE).
W OL�OWNEROFTHEVROPERTY,AMEXCLUSNELYCON1MCTv:OWRHUCCNSEDCONTMCTORS
Q TO CONSTRUCT THE PRQIECT(SEC.)Ot1,BUSINCSS�ND PROFESSIONS CODL:THE CON7MCTORS LI� Velua�ion A0.1.AREJ1
W CENSEUWOOE3NOT�GVLYTOIWOWNEROFAiROFERTYWFqBUILD50RIlAPPOVESTNEREON.AND
� NMqCOMMMSFOHSUCHPROJ[MSVnTHACCNTRAttOR�S)LICENSEDPU0.SUANTTOTMECONTRAG QUANTITY DE-SCRIPTION FEE
� TORSLICENSEUW).
O I AM E%EMPT UNDER SEC. B.6 P.C.FOR TNIS HEASON Q
� U
LL �
DATE OWNER V
Z W
� LICENSED CONTRACTORS DECLARATION W
IMEREBYAFFIRMUNOERVENALTVOFFERJURYTH�TI�MLICENSEDUNDERVROVISiON50FCHAPTEH �
� Y�COMMENLINCWITHSEGf10N7000)OFDIVISION70FTHEBUSM[SSMI�PROFE55iON5CO0E,AND Z
L1J r.n'UGENSE IS W FULL fOHCE AhD EFiEGT. �
� UCENSEClAS�� LIG.NO. ���� j
V DATE 8—���L)I CONTRAGTOR ��IeJ �.. I M a
W
� WORKERS'COMPENSATION DECLAFtATION Q
y U
N I HEREBYAFFIq1A UNDER OENAL7Y OF VERIURY ON[OF iNE FOILOW'NC DECLAMTIONS: Z
G �I HAVE M9 WILL MAINTAIN 11 CERTIFlCATE OF CONS[NT TO SElFaNSURE FOR WURKERS' _
� COMPENSATqN,�5 VROYIpED BV SECTION 710oOF TNE U[30R LO�E,FOR T11E PERFORMANCE W
OF iHE WORK iOR WMICH TMIS DEiiMIT IS ISSUED. �
�
� �IMAVEANDIM�LLNAINTAMWOAKEHS'COAIPENSATIONINSViW�CE.ASPE�VIFEDBYSECTION (�. ^
Q �1000FTHELA00HC00E.FORTHEiERGOHMRNCEOFTHEWORI(FORWHICHiMISVERMiT15 ]��� / .D
ISSl1E0.YVWORICERS'COAIPENSAi1ONIN5URJWCELAFRIERANDGOLICYNUM�EHME: CONSTRUCTION � 1 ��
� ��L�T�_�
] CARRiER IJD_ PLANREVIEW
� voucrniuuoEa ,'�'1�1�,Q�nf1 -ri ELECTRIC
0 (IFIlS5CCf1(XJNCmNOT6LC0.6'LEfmOFTlf7'cPMi6WftOnEIU�CH[DOOLLui51f'oolONlEss) PLUM6ING
Z ICfRTIFYTWITINTHfPERFOAMANCEOFTNEN'ORKiORYMICMTMSVEM�Ii15155UED,1 MECHANICAL
('} SMAL�NOTEVPLOYANYPENSONWIINYMANNCRSOASTOBEfAA1ESUBJFCTiOTNE
N VNRKERS'COMPENSATqNU'NSOGCALIFORNI�AN7AGREETHATIFIS/IOULDBCCOME INSPECTIONFEE
S SUO.;ECTTOTHEWORKERS'COMPENSATqNYROVI510N50F5ELT10N7T000fTH[UBOR
COOE.1 SHALL iORTMMiN COMPLr w�rH 7HOSE vROV�sqMs. ISSUANCE
� -, SMIP �
p OATE:���.—�� APPLICANT:
J WARNING:FA0.URETOSECUREWORI(ERS'COMPENSATqNCOVERAGEISVNUwFk,µpSHALLBE ENERGYP/C
� SUBJECTANEM.PLOVERTOGRIMINALPENALTIESINOCMLiWESUPTOONEHUN�REDTMOUSAND ENERGYPERMIT
DOLURS(f 100.000).N ADDil10N TO TME COSi OF CAMaENSATION,DAM�GES AS PROVI�ED FOR IN �
� SECT�ON]]0!OF iHE LABOR COOE.NTEREST,ANO ATTOPNEYS FEES. {�E7ENTION FEE:
d CONSTRUCTION LENOING AGENCY PRE-ALT FEE:
O
� IMEREBVAFFIqA1UNOEFPENAL7VOFPER1URviHATTMEHEISACONSTRUCTIONLEN0INGAGENCY
n- FOR iHE OEHFORMANGE OF 7MC WORK FORNTIICM TNIS FERMIT IS ISSUCD�SEC.�OG7.CIV.C.).
Z
W
� LEN�ERS N�AIE
�F-� LENOERSA�DRE55 � I ^ ,��
ICERTIFYTIUTINAVERE0.'JTHISAPPLICAiIONAADSTAiEiHATTHEAI30VEWFOHA.IATIONISCOHRECT. TOTAL FEES �
W IAGREETOCAMv�yyy�7NALlCRYANDCOIMTYORDINMICE5M1DSiATEUWSRCLATINOiOBUILDING
n' CONSTRUCTION,MOMEREBYAUTHOAREREPRESENiATIVE50iTMISCIXINTVTOENTERUPONiHE
Z ABOVE�MENTIONED P(70PERTY FOR INSPECTION PVRPOSES. COMMLNTS
� �,u� �_ �1�"1
J
�
m CERMITTEE NAME(PqINT�
Q �y
N d ^.1� �'"�
y SICNATVREOFVEHMIT'fEE DATE
� RECPT.n0. _PAID BY VALIDATION
WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assnssor Copy.GOLOENROD—File Copy.GREEN—ApplicanCs C py
r � .w... .. .�. . . .�.., . �.� � , . •. . .. ..� � �... � ,. .. .� . � ..��� .. . . -.-.. i ... .. . .
• , , . '" . • .. ., .. . . �... �. � .. . ' . � . .. . �. . . . . . . . .. .. .
CiT'�.` C�;� �i��:�:�,Cri�'f� �E�€?
{I�:3����.> .V4i.3i'�� :i1_:t�t.f:":�
��.�.__----...------- -- -----•------ ---- ---- —____ ---'------- _..__..�_.,_.__-----•-'------- —
I���yi��C:s���;.�1�� �.�:.":� �" �L�E=�:�=1f [.l"aF! ��'�..`�:.� - �G <<-.�1'( C}���:f':� :�1���:•��e,��':e�'�
�
.. .. ...----_-:....._.:.._.. .. ._.... . ._ ... .. .. . . . _.........__- --__. ._.....�---...__._
5ET r3ACY. ! I ; rL00�J�ISl- .- . . . _� .
/ T__—�_ .-----�-�- --------�-•---------�----------- ---�-- —r--- -�-----
f-TGS;f�R1�9S;5 i EEL -------- � i I f=Hr,RE_Q.'.'TS ; I
ELECTRI�GFiOUfJD �------�.--- _ ---i-U'•JD•cR FLOOR DUCT ----�— --�— --
GROUN� PWi�.1EING ---.- ----- ----------� � U'JJE=R FLOOF;CU���nuir � !
SLAB GRADE i � _ ___ I F1=3�F'LP.C.r_FOU'JDl�TIU".__ i _ I
TEPAP POVJER � I I FIR��FL.�,CE �O�dD E3EF,��1 i
- - — -� ---------- -- - -
WATER SERVICE � � � i � P.'!�HT. BJ:"dD BC=A"" _ __ � __
ROO�SHEFiTHIf•:G �� �old(__�.�:_%�-__,---� '�._� Fi. E3�_JD Ei�r"�P.t �--- � --
FRAP."ING-'VEfJ71LIATION I � � � {� ' ' '.' �`r �" � �
i F-1PJl1�GO�.D ,.�A
ROOF COVER i-------�-----.— I j FRE-G�!',D!P.G I
ROUGH HEATIiJG ---l ----�� Et=f•:CHIiJG -----� --� ----
R�UGH ELECTRIC I �I __ ______��. ROUGH CRl�DIf•JG ____ I _ I __
ROUGF-I PLU����ING i I I FI�:IS,� Gr�ADL`JG �
I, f'O��ELECfRIC i
5H04"✓ERITUSTEST I -- i-- __ -- I-.--- � � � — -----_—
EXT. t1'iTH/SIDING ( —�— I PGnL FE�.Ci��;�, ; —
4"JALL I�JSULATION I { � f'O�L f=1idAL. i
CEILING I�•J�ULATIOfJ � _ �OFF SITE i?J!FS. ___ I
DRYI?JALL NAILIfJG ; __ I _ ___ ,_� DEDICA,TIO�JS __� _
SE4•JER � ; ----. 1� FI`•JAL EPJG. ----1 —
SEPTICTANK � ; � � L�',PJDSCt,P�=/IRRIG. �
SEEP PIT/L.L_ � � � � OP:S17E li"P:. � 1
G.�,S AIR TEST I � __ � ; FI;J�,L 7_O��ING _ I
FINAL CONST. ; � . � F!RE DEP�T. FItJF.'- I
FIt�AL HEl,TIPJG � I ; j HEAI_Tl i D�P C FINF,L � �
1=1PdAL ELECTRIC I I I DFV. FE�S PAID � r
FIWAL PLUhABING j I EtdcRGY �
� �—_ � . _ �__ �,._ _ ---I —
I --•--•F-�--„- ---
.� _._.
I � �-E�.. +� � � . � r
. I
CUhr��JIENTS
SEPTIC TAPdK SIZE
SEEP PITlU SIZE -- --�- --
____.1�`__..—____._. ------ ------------
,y�i�«
� ' � . • — —