HomeMy WebLinkAbout16997 (40) CITY OF DIAMOND IIAR
�� DEPARTMENT OF COMMUNITY R DEVELOPMENT SERVICES �'
�xy � 2(825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
} JOEiSITE ^� ' t APPLICATION � PERMIT P/C
o ADDRESS����� �o'E-'rd�G�Oc7� Ln./ DATE NUMBE ��1
� APN LOT�— TRACT ISSUE TYPE OCC
p OWNE��. �,�t "�-ti ,���O r� DATE CONST. GROUP
o ADDRESS ZOPJING SETBACKS
gCITY ZIP��� 7� S ^ ,2 FRONT RW ❑
APPLIC T _T A-�n TEL. REAR p
� SIDE/SIDE STREET RW ❑
� CONTRACTOR� � �t�f' SIDE ❑
Q ADDRES PROPOSED USE
o CITY ' ZIP�j�f TEL,7L,�1•,�n��4
o ARCH/ENG/ cA�l �r�:Gt �< <"'
DESIGNER
fia N0.DWEL. NO. NO.
n. ADDRESS �CQnCf� 2 � �
� CIN ZIP TEL. �'� UNITS STORIES BEDROOMS
�
cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OYJNER-BUILDER DECLARATION SFR/ADD/REM
O
� 1 NEREBY AFFIRM UNDEN VENALTY OF VERAIRY TYUT I AM EXEMPi FRpA THE CONTMCTORS L4 GaragelCarport
W CENSEUwFORTMEFOILOWINGREA:ON(SEC.7071.SBUSIfrE551W�7ROFE5510N5CODE:ANYCIiYOR (n
U COUNryNMICHRE0U1RE5APERMITTOCONSTRUCT,ALTERIMPROVE,DEMOLISH.ORREPNRANYSTRUG W Pd1iO/Deck
� NRE.PHiOR TO RS ISSUANCE.I1L50 REWIqES TNE APPLICANT FOR SUCH PEN4IT 70 FILE A SIGN[D W
STATEAI[NT THAi HE OR SME IS LICENSED DURSUANT TO TN[PROV!SIONS OF tH[CONTiUCTORS Lb
� CENSE UW�CYU7TER Y(COAOAENCING WITH SECTION 7000)OF D�VISION 1 OF TNE BUSMCSS AND PFla � PooUSpa
FESSIONSCODE�OFTHATHEORSHEISEKE�PTTHEREFROMANDTN[BASISFORTHEILLEOEDEXEMP• C3
g TION.ANYYqLATqNOFSECTION70]I.68YI1NYAPVLICANTFORAVERMiTSU&1EC75TMEAGPLICANTTO Z Re•Roof
� A CML VENIWTY pF NpT MORE TW W FNE HUN�RED DOLUAS(f500).�'
ZOI.ASOWNEROFTHEPROPERTY,ORMVEA�PLOYEESWITHWAGESASTMEIRSOLECOMFENSATqN, ❑ COmm0rCi31
1NLL DO THE WORK�ND THE STNUCTURL IS NOT INTENDED OR OFFERED FOR SAIE(S[G 7W1.BUSb _1
� NE55 AfJD VROFESSIONS COOE:7ME CONTMCTORS L�CENSE UW DOES NOT AGPIV TO A4 OwN[R OF j
VROPERTV V11q BUttDS OR II.APROVES 1MGREON,I W�Vnq DOES SVCH WORK Hi1.15ELF OR HERSELF OR
WTHROUCHNISOi1HFRONMEIAPIOVEES,PROVIDEDTHATSUCHIMPRDVEAlENTSARENOTINTENDEDOR m
� OFFEREDiORS�LEIF,FIDYYEVERTMEBUILDINOORMPflOVEM[NTISSOLDWITFIINONEYEAROfWNVLE�
Z TqN,TME OWNER�BUILDER WILL MAVE TME BUADEN OF GROV W6 TMAT ME OR SHE OiD NOT BUILD Ofi
� MVROVEfORTHEPURaOSEOFSALEI.
LLl ❑lN^�N'NEROFTMEPROPEH7Y.AME7(CLUSIVEIYCON7MCTINGWITMIICENSEDCONTMCTORS
Ct TO CDNSTRUCTTHE GROJECT(SEC.7oN.BUSINCSSAND VROfE5510NS CODE:THE COMMCTOf15 LI� Valu3t�On ADJ.AREA
W CENSEUWDOESNOTA7PLYTOMIONMEROFAPROPEflTYWHOBURO50RBAPROVESTXER[ON.AN�
� W11000MRACTSFORSUd1PRQ1ECTSWITHACONTMCTOR�S�UCENSEDVURSVANTTOTNECONTMG QUANTITY DESCRIPTION FEE
tORS LICENSE Uw.�.
� O IAM EXEMP7 UNDER SEC. B.a V.C.fOR TNiS RLASON Q I
LL � �
DATE _ OWNER / � ,
Z
F LICENSED CONTRACTORS DECLARATION W
� IMERCBYAFFIRMUNDEHPENALTYOFPEM1RYiHATIAMLICEN4EDUNDERiROV15�ON50FCMAPTER �
p„ s�CpaMENCwON7THSEC710NtoaolOFDrvi5iON70FTHE8uS:NESSANDPflOFE5510N5CODE,IwO Z
X MY LICENSE IS M iLll FORCEAND EFFECT. �
LLI
� IICENSE CUSS IIC.NO. �
� J
oare corrrrucron a
w
� WORKERS'COMPENSATION DECLAHATION Q
� IMERCBYAFFIRMUNDER7EN4LTYOFOE0.NMONEOFiHEFOLLOWINGD[CUiUTIdJS: Z
� _IMAVEANDWILLMAINTNNACERTIflCATEOFLONSENTTDSEIF�INSUREFORWORKERS' _
COh�PENSATION.AS VROViDED BY SECTION 77oa 0F TME LABOH CODE.FOR TNE VERiONAANCE W
OF iHE wORK FOiI WHIp17H15 PERMIT IS ISSUED.
� 1
� �IMAVEMlDWILLMAIMAINWON(CFS'COMPENSATIONINSUR�NCE,ASflEOUIRE�BYSECTION
O77000FTHEU90HCADE,fOFiMEPERFOPM�IJCEOFTNEWORKFORYMIC7iTHI5YEqMIT15
= ISSUEO.MYWORKERS'COMPENSATIONINSURANCEURRIERANDPOIIC'INUM9ERARE: CONSTRUCTION
� GRR:fR PLAN REVIEW
Z POLICYNU/ABEii ELECTRIC
Q
� (fH155ECT70NNEmNOTBEWMLFTmOFT1EPER.7T6fi7R0�LMULN�CDWUAit51f:(CI�LESS} PLUMDING
Z 1 CERTiFV THAT INTH[OERFORu.WCE OF iHE WOaK FOH WHiCNTNiS PERuiT IS ISSUED,1 MECHANICAL � �
(} SMALLNOTFIAPLOVANYVERSONWANVMANNERSOASTOBLCAMGSU0.IECTTOTME
� WOqKERS'COMPENSATqN�AWSOFCALIFORN:AAN'JAGREETHATIFISFIOVLDBECOME INSPECTIONFEE ��'- --
SUOJECT TO THE MIOR%Efl5'COMPENSATION PROV1510NS OF SELTION l70o OF THE UBOR J�-^-��;.;�� �� 'I �,
�j CO�E,I SHALL FORTMMTM COMPLY WITH THOSE VROVISIONS. �SSUANCE y L
pDA7E: AVPLICANT: SMIP i
� WARNINO:FA0.URETOSECUREWORKERS'COMPENSATpNCAVERAGEISUNUWF�A,AND4NALlB[ ENERGYPIC I 1
� SlR1ECiANEMP�OYERTOCHIM9JALVENALTIE5IWOLMLFWESUPTOONEMUNORED7MOU5AN0 ENERGYPERMIT �
DOlURS(f I00,000),W ADDITON TO TME fAST OF COMPENSATqN,DM�AGES AS PROVIDED fOH IN
� SECTION]70eOFTHEU00RCODE,WlERESLANDATiORN[Y5FEE5. RETENTIONFEE: �},�\`r' �
L._._-.-—-----�-..
a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: --'" �
O
� IMEREBYAFFIHMUNOER7ENAl7YOFPEFWRVTHATTMERE15ACON5TRUCTIONIENDINaACENCY
FOR iHE PERiORMANCE OF iHE WORK FON WNICM THIS PEfiMiT IS ISSUCO(SEC.]oY7,CIV.41.
Z
W
� LEKDER'SNMI[
F-- LENDER'SADDiiE55
w I CERTIFY TMAT I HAYE RE�D iH15 APPLICATION Ml�STATE TMAT T/E�BOVE INFORMATION IS CORqECi TOTAL FE ES /n�� �O
� I AGREE TO C0IAPLY WITM ALl CITY iVl�fAtMTY ORDINANCES ANO STATE UWS HELATWG TO 91lCDING t�
CONSTRIICTION,AN�MER[BY AUT110W 2E P[VRESENTATIVES OF THIS LOUNTV TO ENTER UPON THE
Z �BOYE-M NTIONEDPROPEflTVFOi1IN5PECT10NPVRPOS[S. COM�,ALNTS
O
� �-C� I TL-f �_�<,' e�1
m p¢wa NM1[�vwNTJ /'
Q � /�� � /
tn G�t e-�.:.Cw-� � � �
� s�cr+- �v�we t�[ DaiE RECPT.NO. " PAID '� VALIDATION
� WHITE—Deparlment Capy.YELLOW—Finance Copy,PINN—Assessor Copy,GOLDENROD—File Copy.GREEN—Appl�canl's Copy
. . �. . . �_.. ,� . .�. _�.:.--�•. . . , .. . . .. ,' " '.. . . 'Y':.. . ..�� � �.i..:•.,r;';' .n�y. �� . � .^ . •-',. .. . • ., . .' . ..,.... .
;�iT',` �3�= �•I�,i��C��!� ����;t?
_ ?i�.:�r='�-:EL?f�' ;=�:=C�'iti:�t `�►� `"'
_________--.•----- ----..-- - --__..__..._._-- - - -_..__..._________.__�.___.._... ___.___...-. _ ._..____..
_, ... ..., . �.: _ � �� ,� �i ,r� ;�
---._T. . .. _
le��-7.��c,.fC�Ji`G �►:�.f. ►`F ''_ :�'J:. I����i:}� c:'rlel� �r�.r� �►4�`1.i=;c`�rc):�i .
_ .. ....- --_ -..... .....___...__. _ . . . . _ ... _ .._ _. .... . ... . . _..-- . .. .......... ......... . ... .._._._--------
.. .
5ET�ACf:
' ' I � FLOOR J�:I�T . ; '
� ' ' -��----- - -
---�-- ---- ---•-- ------ ---•-----.....:-- - ---------
FTGS/F�R��IS;STEEL i � _._ __ ' � FHA R�Q':1TS-- -- � -----.-1 --
ELECTRIC GROUMD � I ' j Uiv��R FLOOR GUCT ; I _
GFiOU��D PLUi:1BiidG- -----_I-------- I U;•lDER FLOO�i CU`,•DUIT ' �
—�-�----- ----------�----------- ---• — — ----
SLAE3 GRADE I I � FI�EPL/\CC FOUidDl�TIO�� I
-- ----�._:--- --- ----
TEt.�P POVJER I __ __I_I �IREPLF.CE �OND 6EF,��S _ _�
4VATER S�RVICE �I, �� t:"ID f�7. �DfJD_E3E��'�1_ __ I � _
ROOF SH�ATi-IING j____ _,i I &F7. EOt�� 6EA��" _� _
FR�tAING!VENTILIATIOPJ I __ ( __ ___ I�FINF�L EOiJD E3EAP11 —� __
ROOF COVER � —I � FRe-Gfil;DltiG . I
ROUGH HEATING 1__ I �E3ENCHIidG I
ROUGH ELECTRIC I { ROUGf� G�i�.D;?JG �
_--�--- --�-----------
ROUGN PLUPv1E31��G � ; � � FIhJIS��I u�3r,UI�JG I � ___ _
SHO�VER/TUB TEST � � POO� ELL=CTHIC
–�- ---1 –�-�---- - � --�---
EXT. LF,TH!SIDING I � i 00�FEPdCIP.G _� ;
VJALL IPJSULI',TIO�J � ---- --- � j-POOL FINE;L ---..--- � --- —
CEILING If•�SULF,TIOtJ � _ I I O�F SiTE IP:"PS. _
DRY4":ALL NAILIf•1G � I �DEDIC11T10�4S I I
SE4"JER � i FIPJAL Ef�G. _� _
SEPTIC T/1NK � � } LF,�JDSCAPE/IRRIG. �
SEEP PIT/L.L. � � O'�1 51TE I'A�S.
GAS P.IR TEST I � ,; l FI�dAL-�ONI'JG I_ I __
FINAI_CO"yST. I —�� ! �!Rc D�FT. FIPJA,! ! I
FIPtiAL HEATI"dG �,!�� � ! FIEALTH GEFT..FINAL � I
V�"_v l' -�— --- —
FRJF,L ELECTRIC � 'i ; DEV. FEES Pf11D � �
FRJAL PLU�:1E31�JG � I I I F�dGRGY � _ �
. � ---�-----_—����.��'= . �;--_: .- T_.__.._�_I-- —�--
c�n��r,nEr�Ts _ _
SEPTIC TAtJf: SIZE
SEEP PIT/U SIZE — ------ –
—__._.__�`y j.__._.,..__....__. - — —
��r� - - - --
;, , .
�, � ,