HomeMy WebLinkAbout16725 (37) J _. . . . . .. . . . . . . ....... . . .
�` CtIY OF DIAMOND DAR �
� DEPARTMENT OF COMMLlNi'TY&DEVELOPMENT SERVICES r-
��� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��%��� BUILDING PERMITAPPLICATION FIRMLY
� JOBSITE ^�,, ,l � � )
¢ ADDRESS���7I (�fJf�N LC'D�D 4.�J � APPLICATION � � �� PEflMIT I 2F�P/C
o DATE NUMBER 1 O' /
� APN LOT TRACT ISSUE TYPE OCC
DATE 0 CONST. GROUP
p OWNER D f..�LK�
o ADDRESS L3 D ZONING SETE3ACKS
z CITY � ZIP TEL O FRONT RW p
g APPLICANT TEL. — REAR p
� ` SIDE/SIDESTREET RW ❑
� CONTRACTOR 'y O i` SIDE ❑
� ADDRESS
p / PROPOSED USE
CITY C r N ZIP 9�oY TEL �.�j'�[.�3
o ARCH/ENG/ �
iz DESIGNER NO.DWEL. NO. NO.
N AD�RESS UNITS STORIES DEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER�BUILDER DECLARATION SFR/ADD/REM
O
1 HEREBY AFFIRM UN�ER PENILLTY OF PERM1IRY THA71 AM E%EMP7 FROM TNE CONTMCTORS Lb G213g0/C3fPOfI
W CENSEUWFORTHEFOLLOWINGREASON(SEC.70.7LSBUSINESSANDVROfE55qNSCODE:ANYCITYOR (n
U CpUNTYYMILHREWIfiESACEfU11iTOCANSTRUCT,ALTERMPROVEOEMOLISH.OFIREP�:RANVSTRUC• w
w TURE.PRqR TO RS ISSUANCE.ALSO REOUIRES iHE APVLICANf FOR SUCH OERAIIT TO FILE 1151CNE0 W Patio/Deck
STATEIIENT TMAT HE OR SHE IS UCENSED PVRSUMlT TO TNE OROV1510N5 OF TNE CONTMCiORS U-
� CENSEUW(QMPTEfl9(COMMENCWOWITHSECTqN7ooL)OFDIVISqN�OFiHEBU51NE5S�NOPRO• LL' POOVSpa
� FE5510NSCADE)ORTNATMEORSH[ISEXEMPTTHEREFROM/,NDTHEBASiSfORTHEALLEGEDE%[MP• (�
TION.l1NYVIOLATIONOFSEGTION70]1.58YAN7APPLICANTFORIIPERMITSUBIECTSTMEAPPLiCANTTO Z F�0-R00�
A GVIL VENA{,TY pF NpT MORE THAN FNE NUNORED DOlURS(5500)�:
� OIASVNNEROFTHEOROVERTY,ORA1VEMVLOVEESWITMWAGESASTHEIRSOLFCOMPENSATqN. ❑ COmTerCi01 -
WILL DO THE WORN,AND THE STRUCTURE IS NOT INTENDED ON OFFERED fOFi SALE(SEC 70��,AUSI. J
� NE55 ANO PROFESSiONS C17DE:TNE COflTRACTORS LICENSE L�W DOES NOTA�PLY 70 AH OWNER OF �
7ROPERTY MA/O BUILDS OR IAIPROVES THCRCON,Ml�MMO DOES SVG1 WORN HIMSELF OR MERSELF Oft
2 TMROUCi1HISORMEROWNEYPLOYEES,PROVWEDTHAT5VC11MPROVEGENTSARENOTMTENO[DOH m '
� OFFENCDFORSNEIF,IIOWEVERTMEBttiLOINGORIMPROVEMENTISSOlDW1TMINONEYEAROFCqAV�E-
Z TION.TNE OWNER�BUILDER WILL MAVE TNE BVRCEN OF PROViNG TMAT ME OR SHE Oi0 NOT BNLD OR
= IMPROYE FOR TME PUflPOSE OF SALE}
w OI,ASONMEROFTMEPRODEHiY,AMEI(CLUSIVELYCON7MCTWGWITHI�LENSEDCOMMCTORS
[C TO CONSTRUCT THE VRO.IECT(SEG 70�1.BUSINESS AND 7ROFESSIONS CAOE:TNE CONTRAC70N5 LI• ValU2ti0n ADJ.AREA
� CEHSEUWDOESNOTAPPLYTOANOWNEROFADROFERTVW1qBUILO50R11APRWESTHEREON.AND
YV1qCONTRACTSFORSUCilORQ7ECTSWITHACONTRACTOR(S�LICENSEOPVPSUANTTOTHECONTMG QUANTIN DESCRIPTION FEE
� TORSUCENSEUW.).
�� O 1 AM EKEAIPT UNDER SEC. B.a flC.fOR TH6 NE�SON Q
U
LL �
DATE OWNER U
Z W
� LICENSED CONTRACTORS OECLARATION W
OC IXERCBYIIFFIRMUNOERiENALTYOFPERRIRYTH�TIAMLICENSEDUNOERPROVI5:ON50FCMAPTER �
d Y(ODMMCNCWOWITHSECTION7000�OFOIVISION70FTH[BUSINESS/JrOPROFE5510N5CO0E,AY� Z
X YYLICENSEISNFULLFOfiCEANDEFFECT. m
LLI (�
� IICENSE�q(�y1�SS LIC.NO, • �`� � j
V DATE Mr'� CONTMCTOR a
W
� WOFKERS'COMPENSATION DECLAMTION —� � �
¢
= U
� 1 NEREBYAFFIFAI UNDER OENA�TV OF VE0.IUHY ONE OF TME FOLLOWINC DECLARATqNS. Z
� �I MAVE MA W:LL MAINTAIN A CERTifICATE OF LONSENT i0 SEIF�INSURE FO�i WORKERS' _
COMPENSA7qN,A5VROVIDED8V5[CTION77ooOFT11ELADORC00[,FOqiMEPERFORM�NCE �U
OF THE WORN FOR WHICH THiS PE WAIT IS ISSUED. �
�
� _I HAVE ANDYAIL NARITAIN WORKERS'COAIPENSATION INSURANCE,AS REOVIRED BY SECiION
Q J700 OF THE LADOR CODE,FOR TME PERFORMANCE DF THE WORK FOR YMICM 7HI5 PE�I715
ISSUEU.MYWORNERSCOMVENSATIONINSURANLELARRIERA4DVOLiCYNU4BERARE: CONSTRUCTION
J
� CARRIER PLAN REVIEW
Z PoLICVNW6ER ELECTRIC
Q
p (IH65ECf�GJNCmNOTBEWbf1.EfEDOFMPE�6FORONEM1�aREDDCtUfLS{f�o�IC(1LE55} PLUMBING
Z I CERTIFY MAT N TNf CERFOHAI�AIJCE OF THE WORN fOR WHlpl THIS PENu1T IS ISSUED.I MECHANICAL
('} SHALLNOTEMPLDYANVPERSONWANYuIU:NERSOASTOBECOMESL'OJECiTOTHE ,^
� WORKERS'LOMPENSATqNUM'SOFCAI�FORNIA,M011GREETNATIFI5/1WLDBECOME INSPECTIONFEE � //"� _
S SUBJECT TO iHE WORKERS'CpdPEN5A7qN PROVISIONS OF SECTION D7000F THE l/BOR
tooE,i sNnu voannwn�ca+ttr wmi rr+ose vaohswns. ISSUANCE
� SMIP
p DATE: AGPLICANT:
J WAfWING:fAILURETOSECUREY/ORKERS'LOMI'ENSATqNCOVERAGEISUNUWFUL.ANOSHALLBE ENEFGYP/C
� SUOJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CNIL iINES UP i00NE MUf:DRED T�qUSAN� ENEFGY PERMIT B��
OOLU�ii51f 100.0001.w�DOITION TO THE COST OF COMPENSATqN,O��GES�5 CROVIOED FOR IN
� SECTqN710lOFTMELABORCOOE.INTEREST,AN�ATTORNEYSFEES. RETENTIONFEE: ��-"'r '
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
Q IHEREBVAFFIRMUNDERGENILLTYOF7EiWRYTHATTMEREISACONSTPUCTIONLENDINGAGENCY
� FOH TME VERFORAIANCE OF iHE WOFK FOR WHiCH TNIS�ERMIT IS ISSVED(SEG]oD7,CN.C.�.
Z
W
� LEN�ER'S1UME
S
F_— LENDER'S ADDRE55
� 1 CERTIFV TH4T I NAVE READ THIS APPLICATION IND STATE THATTHE ABOYE Y:FORA/ATqN IS CORRFC7. TOTAL FEES . � 5�
W IACREETOCOAI�LYWITNALLCRYANDCOUNTYORDINANCESANDST�TEUNSREIATWG708UIL01NG
� CONSTRVCTION,ANONEREBV�UTHOR12EREPii[SENTATNfSOFTMISCWNTYTOEMEHUCONTHE
ZABOVE�MEN710NED VROPERTY FOR INSVECT N PVRPQSES.
� �✓I oN� �W O/V COM.M[NTS
J
�
m VERMITTEENAME�VWM�
Q ��/��/+ �� �
(!j i�' / f �� '
y SIG �OF PENIIIT7EE -��� /DAiE 1
� RECPT.N2 PAIO BY � VAU�A710N
WHITE—Department Copy,YELLOW—Financa Copy.PINK—Assassor Copy.GOLDENROD—File Copy.GREEN—ApplicanYs Copy
, . � .. . .. '1.':A:v ... .. ,Y' ' • • ' '1'....�.1. � � . .. . . . ....�'?vv. . . �y .� , .... � . . . .. . . . .. � ..-. , _.. . _, ... . : �. � - �. �
CIT�� ��:. �{�;�:if�1'��f� u/';E3
lI'�,1cr=F�L S t'G't�,� i�=C..C�l=�L�
____---�_________---.-----.-.----------------------.--...__ __._---_._.____.___._.._--------
----- —,
_ . . _ . _
. _
li'�-`i:�=t�''[l�)�k �.i:.':r'= I►`F=1:��c:��'�1:� 1;+►��: ,�: � te�i ����:ti� I�+E=?a�c'pc�
.�' " .�
- -._.......------ --------......__.. ...._ . .. ._ .... . . ....-�- -�--.. . ...._...__ _..._....._.._...- -
_ ...
. ..
SET 6F,CK • ! � � j FLOO;JDIST - ; I
--' _ .—..:..----- —
FTGS!FOR!�9S/SiEEL --�-------�, ---------------�-� FH;,REO',"T5 I I _
ELECTRIC GROUND � j i I UN�rR FLO�R DUCT � I � _ _
GROUND PLUh�1EING ! _�_I U'JDER FLOOR CO�•�DUIT • •' ��___'_____
--+--
SLAB GRADE �-�- — �_� FIR�PLAC�. FOUFdDATI�^: i . � ' _
TEP�'P POWER I �_I FIF��FLA.CE E�O�dD E3EA"�•1 � _
WATER SERVICE 1--- - ! � P.".1�7 HT. E?�"�E'13EF,hA---� T I _.
ROOF SHEATHIfJG � � 8 �. E?J;"�D•B:A":'. � �
FRA��IING!VENTIUATIOPJ I ! � I FIPJAL Ei�Id� E�A�' � !
ROOF COVER I I —I I PR=-GRAD:t�G I I
ROUGH HEATING � � � EE�:CHIiJG �
ROJGH ELECTRIC I j_� ROUGH GR�'�DI'•Ju _�_ �
ROUGH PLUt�"E31NG � � i �i Fli•.ISH uR�',DI?•IG � �
SHO':"JER/TUE3 TEST I I I I �'��a�_FLECTRIC —� �
' � ' PO�L FENCiPJ i
EXT. LkTH/SIDI��G . __� �
VJF,LL IPdSULATI��d � � 'i POOL FINA� I _
CEILINu INSULATION � � OrF 51TE IPlPS. �
DRY4VALL PJAILIfJG � � DEDIC�',TIO�dS I i
SEVJER �_� I FIPJAL ENG. �
SEPTIC TANK � LAP� JDSCF PE/IRRIG. �
SEEP PIT/L.L _� � 1 OfJ SITE C:^P5. �
GAS AIR TEST I I I F=1NAL ZO��If•:G ��
FINAL CONST. � � FIRE DEPT. F1PJF,!
FINAL HFATIPdG (�-x.�1-0 � _� �_fiEAL.TH DEPT. FI�JAL �
FINAL ELECTRIC � " � � DEV. FEES P.�ID �
FINAL PLUPIBIPJG I I I Ft•l�RGY I
� - I_ f i.-�,-.,.�':�'j�-.x I ---
:
L--- , ._ .�.� ,,.__,, _.....__._.; -- - ----
cor�nr,�ENTs � � '
SEPTIC TAPJK SIZE
SFEP PIT/U SIZE
,'�.,..�^—._
►���
�� � �
.;