HomeMy WebLinkAbout17210 (10) � CITYOFDIAMONDBAR �};pIRED
DEPARTMENT OF CONIIvIUNITY&DEVELOPMENT SERVICES
� 21825 E.Copley Drive
' �'w PRESS
(909)860-3195 Fax(909)861-3117 �U� �� �""�'
�`'%:�'� BUILDINGPERMITAPPLICATION FIRMLY
� JOBSITE +� ,r APPLICATION PEFiMfT I"'��J I ��/C
o ADDRESS ✓ I ' Cl�ST�IF_IM DATE ��s a� NUMBER � ��
� APN�— LOT TRACT DA EE O S O� NPE OCC
p OWNER 7�/+�-� (i'W�l�' CONST. GROUP
" ADDRESS - l Vl/ ZONING SETBACKS
gCITY ZIP9I�TEL ' • � R�R RW ❑
APPLICANT �� TEL���,;�� SIDE/SIDE STREET RW ❑
� CONTRACTOR�N SIDE O
Q ADDRESS �' � _
� CITY � � ZIP TEL PROPOSED USE
o ARCH/ENG/
z� DESIGNER NO.DWEL. NO. N0.
a ADDRESS UNITS STORIES BEDROOMS
� CIN ZIP TEL.
N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD�AEM
O
Q I MEREBY AFFlRM UNOER PENILLiY OF iEFWRY TlNT I AM E%EMPT FROM THE COfITMCTORS LM Garage/Carport
W CENSEUWFORTHEFOLLOWIN�REl150N(SEC.70.71.SBUSINESSANOPNOFESSIONSDODEANYCITlOR (n
U COUNT`fMMICHpEOUIHESAVERMITTOCONSTRUCT.hLTE0.11APROVE,DEAlOL1SH.OHREPAIHANYSTRUG W patiolDeck
TUHE.PRIOH TO ITS�SSUANCE.IL50 REWIFES THE APPIICANT FOR SUCM PEMIIT TO FRE A SIGNED
w STATEAIEHT T/UT HE OR SHE IS 110ENSED DURSUANT TO ME PROVISIONS OF 7HE CONTRACTORS LI- w
� CENSE UW(CHAMEH 9(COAIMENCMO VA7H SECTION 7000)OF DMSION 70F THE BUSMESS AND CR0. � PooVSpa
FESSIONSCOOE)ORTHATHEORSHEISEXEMPTTMEREFHOMANDMEBASISFORiHEALIEGEDEXEMP- C7
TION.ANYVIOUTIONOFSECTION7W1.58YANVAPPLIC�NTFORAVERMITSUBJEGiSTHEMPLIGANTTO Z Re-Root
A pVil PENALN OF NOT MORE 7HAN FNE hUNDRED DOLURS(f soo).1:
Z04�OWNEROFiNEPROPERTY.ORMVEMPIOYEESWITMWAGE5A5TMEIRSOLECOMDENSATqN, O COmmB�Cial �
WILL DO THE WORK,AND TNE STRUCfURE IS NO7 IMENOEO OR OFFEREO FOR SALE ISEC.70l1,eU51• J
� NESS AND GROFESSIONS COOE:TME WN7MCTORS LILENSE UW DOES NOi APPLV TO AN OWNER OF ?
iR07EHTY MA10 BUILDS OR IIAPROVES TNEREON,AND VMO DOES SUd/VlORK HIIASELF OR HERSELF OR
� THiLOUCNNISORHEPOWNEMPLOYEES.GROVIDEDIHATSUCHIMDROYEMEMS�RENOTINTENDEDOR m
� OiFEREDFORSIIEIF,HOWEVE0.TMEeUItDINGORIYPROVE/AEN!ISSOLDWITMNONEYEAROFLOMOLE-
� T10N,THE OWNfH-BUItDER WILL IUVE THE BUR06N OF GROVIN6 TMAT HE OR SHE DIO NOT BUItD pR
MPROV[FOR THE PURPOS[OF SALE}
W OLASO'HNEROFTHEiROPEfliV,AMEXCLUSNELYGONTMCTINaVATHt�CENSEUCONTMCTORS
[= TO CONSTRUCT THE iROUEGT(SEC.70��,BUSiNE55 AND PROFESSIONS COOE:THE CONTRAC70R5 LI- V01U311Df1 ADJ.ARE1l
W CENSEUWDOESNOTAPPLYTOANOWNEflOFAPROPEflTYWMOBUIlD50R0.1VRDVE57NERE0N,Ml0
Z N110CANTMCiSFOqSUCHVHOJEC75WITMACON7MCTOR�S�IICENSEDPUHSUANTTOTMECONTMP QUANTITY DESCRIPTION FEE
� TORS LICENSE UW.I. .
� O I MA EXEYPT UNDER SEC. B-1 P.Q FOR THIS REASON U
� �
� DATE OWNER V
Z W
� UCENSED CONTRACTORS DECLARATION w
� IHEREBYAFFIRMUNOERPENALTYOFPE0.IURYTHATIAMUCENSEDUNDERPROVISIONSOFCNMTER Vr • .0 G/}�-► �-T .
� 91COMMENCWO WITH SELTION 7000)OF OMSION 70F THE BUSINESS AND PROFES510N5 CODE,AND Z J �+�Li./
��� MV IICENSE IS N Fl1LL fORCE AND EFFECi / m
� UCENSE CUSS�J� LIC.NO. `�" ����l j
V DATEJO-�('�� corir�ucro�Uti/i��,� -��.5 0�'..
w
� WORKERS'COMPENSATION OECIARATION 4
� IHEREBYAFFIqMUNDERVENALTYOF0E0.1URYONEOFTNEFOLLOVANCDECURFTIONS: Z
� �IMAVEANDWI�MAMTNNAGEHTIFICATEOFCONSENTTOSELF�INSUFEFORNURKERS' $
COMPENSATqN,ASPROVIDEDBYSEC710N�7000FTHElABOHCODE,FORTHEVERFORM�IVCE U
�� OF 1HE WORN fOR NMICH TMS VERMIT IS�SSUED. �
�
1 HAVE AND NALL MAINTAIN WORKERS COMPENSATION INSMANCE.AS REWIRED BV SECTION
4Q �7000FiHELABORCOOE,FORTHEPERFORMANCEOFh1EWORKFORWHICHTH15FERM1T13
ISSUED.MY WOcRKERS'COMPENSATION INSURANCE CARfiIEH AND POLICY NUMBEfl ME: CONSTRUCTION
� CARRIER yT T�'�F�IN✓� PLAN REVIEW
� PoIICVNUMBER a yti�i U j� (� ELECTRIC
� �nuus�cna+r�mr�oreEoa.++�ooFnfrean+rsFoaorvE�ooau�sn+a�a��ss7 PLUMBING
- Z I CERTIf'/THAT IN THE PERFORMMlCE OF THE WORK FOR WHiCH 7HI5 PERMIT IS�SSUED,1 MECHANICAL
U' SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SU&IE�TTO TNE
y 1MDRKERS'COMPENSA710NUWSOFG�LIFORN10.µDAGREETHATIFIS1i0ULDBECAME INSPEGTIONFEE
S SUBJECTTOTHEWORNERS'COAIPENSATIONV IONSOF ECilON77000FTHElABOR
cooE,�s�uu�oarHvnn+cor.ra�v Hnnr t E ONSI N . ISSUANCE -
� r��U� APPLIGANT: - SMIP
p DA7E
� ENERGY P/C
WARNINQFAILURETOSECUPEWORKERS'QDM SATIONCOVEMGESUNLAWFULANDSHALLBE
�y SU6IECTANEAIPLOYERTOCRIMW�LFENALTIESANOpVIIFINESUPTOONEHUNDREDTHOU5M1� ENERGYPERMIT
DOlURS(f 100,000).IN ADOITION TO THE COST OF COIAPENSA110N,OAAIAGES AS PROVI�ED FOR IN
� 6ECTION 71oe OFTHE LABOR CODE,NTEREST,AND ATfORNEYS FEES. RETENTION FEE: �
d CONSTFUCTION LENDING AGENCY pRE•ALT FEE:
O
� INEREBVAFFIPIJUNDERCENALTYOFPERNRYTHATiHERE15AfAN5TflUCTIONLENDINCACENCV
FOR ME PERFORMANCE OF TME WORK FORNMICH THIS PERMI715155UED(SEC.7097.CIV.CJ.
Z
W
� LENDERS NAME
� LENOERSADDRE55
� ICERTIFYTHATINAVEREADTHISAPPLICA7qNANDSUTETHATiNEABOVEINFOW.��7�ONISCORRECi. TOTAL FEES � • O
W IAGREETOCOMVLVwrtHALLCRYANDCOUNT'/ORDININCESANDSTATEU`NSREUTWOTOBU0.DIN6
� CONSTRUCTION.ANOHEREBYAUTFIORREREPRESENTATIVESOFTHISCOIINNTOENTERUPONTHE
Z ABOVE�MENTIONED VROPERTV FOR INSPECTION VURPOSES. COMMENTS
� Cf '1��[!� C- /�t/►�
m PERMi E N E(PRI
N .� v� -�
� uIUTVRE ITTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Departmen[Copy,YELLOW—Finance Copy,PINK—AssassorCopy.GOLDENROD—file Copy,GREEN—ApplicanYs Copy
.. ' ' .. _�t. ;. s.�.` i�. . _��� ..� . '.�,.I. � .-- ; �; :Sr ��r .. .1��:{,". . �i��.�o "A�.q n . .tn�r.i. < � . ,. . r � . � .. . , . . .. . . _..
Cl�"d' O� D1�1J�Q��,'D F/al�
�r�sP�c�zo�� ��co�,�
._____ _ �.___.�_- --.
_.��.____.... .
1���-"�.�=i�:t1i�)�! ��1�'�e=' !►'k-`1•a.LL��.� �e�•� I►'�..��.a �¢:±CC��,I��l �)�E�'= 'I►��-'�.�a�c��+�:¢
.�__.----------,--._ _.._._ _.. _..___ _._ --_, __.._ .__...._.__._____ ..___.. . ...-----
_.._._____._______.___._.____
5ET BACK ; � FLOOR JOIST �
FTGS/FORP�ISlSTEEL � _ _ ' FHA REQMTS
ELECTRIC GROUND � ' ' U��l�ER FLOOR DU�T ,
�— �---- 1
GRQUND PWh�1BiNG U�JDER FLOOR CU�IDUIT ; ' �
SLAB GRADE FIREPLACE.FOUNDATION I �I
TEMP POWER � I FIREPLA�E E30ND BEAM
WATER SERVICE I MID HT. dOND BFA�.1
ROOF SHEATHING I £3 FT. BOND BEAM � -
FRAMING.NENTILIATIOiJ FINAL 80ND BEAP11 I
ROOF COVER PRE-GRADING
ROUGH HEATING BEPJCHING
ROUGH ELECTRIC I ROUGH GRADING
ROUGH PLUMBiNG _1_ FIN(SH GRADI�dG
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/51DING POOL FEPJCING I
WALL INSULATIOPJ POOL FIPJAL �
CEILING INSULATION OFF SITE IPAPS.
DRYWALL NAILING DEDICATIOiJS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS A!R TEST � FINAL ZONIfJG
FINAL CONST. � FIRE DEPT. FINAL
FINAL HEAT�NG j HEALTH DEPT. FIfJAL
FINAL ELECTRIC � � DEV. rEES PAID
FINAL PLUMBING � � ENERGY
�
i j�lrl'-+�','y�7�.{�;��,.-�;2 � --• " .
._...._,,._..____..�.._r.. �.....�. _'._'
CUMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�'y�
����
a� . .
J ,�-- , _ •
�