HomeMy WebLinkAbout17713 (17) crr�r oF D�orro s� . EXPIRED
�` DEPARTMENT OF COMMUNiTY&DEVELOPMENT SERVICES
21825 E.Copley Drive ,Jl1N 18 2002
"" (909)860.3195 Fax(909)861-3117 PRESS
"-�'� BUILDING PERMIT APPLICATION ��� FIRMLY
o DDRIES�Iof�� l/A i��N ��' DATE CATIOI Q�UMB R��/C
� ISSUE TYPE OCC
.- APN LO�T�� TRACT DATE CONST. GROUP
p OWNER . �!
o ADDRESS ZONING SETBACKS
Z CITY ZIP TELtJ FRONT RW ❑
g APPLICANT , /. TEL. , � REAR ❑ .
SIDE/SIDE STREET RW ❑
� CONTRAC • � • SIDE ❑
� ADDRES U
� CITY ZIP TE PROPOSED USE
o ARCH/ENG!
� DESIGNER NO.DWEL. NO. NO.
n. ADDRESS UNITS STORIES BEDROOMS
= CITY ZIP TEL.
�
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HENEBV AFFIRM UNDEH FENALTY OF iEfUURv THAT 1 AM E%EMPT fFiWA THE GOMMCTORS L4 Garage/CarpoR
W CENSEUWfORTHEFOLLOWINaRE11SON(SEC.7W1.68USMESSANDPROFESSiON5CO0E:MlYCITYOR (n
C� LOUHttNMid1RE0UIRE5APERMRTOCONS7RUCT.ALTERR.I7NOVE,DEA10L15M,ORREPAIRANYSTRUG W PefiO/DOCk
� NHE PRqR TO RS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FllE A SIGNEO W
STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO 7HE PROVISIONS OF TME CONTMCTORS LI•
� CENSE UW(��ER9(COA1uENCwd WITH 5ECT10N 7000)OF DIVLSION]OF TNE BUSINESS AND VP0. LL" POOVSpB
FESSqN5CO0E�ORTMATHEOR5HE15E%EMPTTHEREFRdAANOTMEBA515FORTHEALLEGEDEXfMP• (�
V TKKJ.ANYVpUT10NOFSECTION10.71.68YANVAPPUCANTFORAPERMITSUBJECTSTNEAVPUCANTiO Z qe-Roaf
A CIVIL GENALTY OF NOT MORE THAN FIYE FKINORED DOLURS(f5a0).�:
Z �LA30N'NEROFTHEVROPERTY,ORMYEMGLOYEESWITHWAGESASTHEIRSOLECOMPENSATqN, 0 CORItfIBfCI3I -
YALL DO TNE riORK�ND THE STRUCiURE IS NOT INTENDED OR OFFERED fOR S/�LE(SEG TW�.BU51� J
� HE55 ANO VROFESSIONS CODE:THE CONtMCTORS UCENSE UW DOES NOT APPLY TO Mi OWNER OF �
PROPERTY NT10 BUILDS OR IM�ROVES THEREON,AND MA10 DOES SUdi WORN HIA75ELF OR HERSELF OR
2 THFIOUGH HIS OR HEROWN EYPLOYEES,PPOVIDED THATSUCH IMPROYEMENTS ARE NOT MENDEO OR m
pOFFEREDFORS/�LEIF,HOWEVER7MEBUIIDINaORqAFROVEMENTISSOLDN7THINONEVEAROFCOMPIE•
Z 710N,7HE OWNER�BUILDER WILL HAVE iHE BUROEN OF VROVIN6 TNAT HE OR SHE DID NOT BUILD OR
= p.1PHOVEFORTHEVURPO5EOF5AIE}
W 04��WNEROFTHEPROPERTI;MIEJ(CLUSIVELYCONTRACTMOWIiHLICENSEDCON7MCiORS
� N WNSTRUCT THE PROJECT(SEG 7a�,BUSMESS M7D PROFESSIONS CODE:IHE CONTMCTOHS L4 VelUflfiOfl ADJ.AREA
W CENSELAWDOESNOTAPVLYTOANOWNEROFAPROPERTVWI/OBUILDSORWPROYESTHEREON,AND
� NTpCONTRACTSFONSUqIFR0.1ECT5YnTHACONTMCiOR(5)LICENSEDPURSUM7TTOTMEGONTMG pUANTITY DESCRIPTION FEE
Y TORSLICENSEUw.).
� ❑IMIEXEAIVTUNDERSEC. B.BP.GFORTHISREASON U
�
� �
DATE OWNER �
Z W
� IICENSED CONTR/1CTORS DECLARATION W
� IHEREBVAFFIRMUNDERPENALTYOFPEfWRYTHATIAMLICENSEDUNDERPROV15qN50FCHAPiEH Vr
� Y(CqAMENCIN(iW1iH5ECTION7000)OFDMSION70FTHEBUSINESSANDGROFESSIONSCODE,AND Z
��� MV LICENSE IS N FULL FOR AN EfFECL C m
� UCENSEC(//�55 UC.NO.V j
V DAiE / ' � CONTRACTOR . ♦ � d
W
� WOFiKERS'COMPENSATION DECU+RATION a
N U
� IHEREBVAFFlMIUNDERPENALTVOFPERIUMONEOFTHEfOLLOVJINGDECLAMTpNS: Z
Q
� _1/UVEANDW4LMAMTNNACERTIFICATEOFOONSENTTOSELF�INSUREFORWORNERS' S
'�r- COMPENSATqN,ASPROV�DEDBVSECTON�T000FTNEUBORGOOE.FORTHEVERiORMANCE W
OF TNE WORK FOR WHICH THIS VERMiT IS ISSUED. �
�
_I HAVE AND WILL MAINTAIN WORKfRS'COMPENSATION INSUMNCE,AS HEOUIRED BV SECTIDN
Q J7000FTHELABORLODE,FORTNEPERFORMANCEOFtHEWORKFORWHIpITHISVERMITIS
LSSUED.MY >@�K�E,RS'�COMPENSATION INSURANCE CARRIERANO FOLICY NUMBERARE: CONSTRUCTION
'_ _�� —E��GO�D / PUW REVIEW
7 CARRIER
� POLICYNUMBEH �Y/��i — ELECTRIC
0 (iHSSECfId�NEmNOTBEW�IETEDOFhEPERMTBFOR�NEMU�f��OL1A0.SK��)��ul PLUMBING ���O
z ICERTIFYiHATINTHEPERFOfiMANCEOFTNEWOPKFORWHIp/THISPERN1T44I55UED,l MECHANICAL
(.'} SMALLNOT EMPLOYANY VERSON IN ANY MAroJER SOAS TO BECOME SUBJECT i07HE
(n MIOFNER5COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHAiliISHOUL�BECOME INSPECTIONFEE
S SUBJELTTOTHEWORKERS'COMPENSATION R SqNSOFSECTION77o00FTHEUBOR
coae.isi!u_u.coan�winicor,��.rwm�r arnnsar�s. ISSUANCE �
� ���U��Z SMIP
p DATE: APPLICANL
J WARNINQ FAIIURE TO SELURE MK)RKERS'COMPEN511TION COVERAGE IS UNUwFUI.AND SHALLBE ENERGY P/C
�y„ SUFfJECTANEMPLOYERTOCRIIAINALPENALT1E51WDpVILFWESUPTOONENUNDRE0TH0U5AN0 ENERCaYPERMIT
OOLLARS(Stoo,000),IN ADDITION TO THE CAST OF COMPENSATION.DAAIAGES AS PHOVIOED FOR IN
� SECTIONl70eOFTHELABORCOOE,INtEREST,ANDAT70RNEYSFEES. AETENTIONFEE:
pw., CONSTRUCTION LEND�NG AGENCY PRE-ALT FEE:
O
� IMEREBVAFFIRMUNOERiEN/LLTYOFPERIURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY
� FORTHEPERFORMANCEOFTHEWORKFORNA/ICHTHISPERMITI5155UED(SEC.70o7,CIV.C.).
Z
W
� LENOEfYSNAME
� LENDERSADORE55
� ICERTIFVTMATIHAVEREMTHISAPPLICATIONANDSTATETNATTNEABOVEPlFORMA7IONISCORRECL TOTAL FEES �/
W I AGREE TO COAIPLV WITM ALL GTY ANO CAUNTY OROINANCES AND STATE UWS REU71N0 TO BUILOING
� CONSTRIKTION.ANDMEREeYAUTHORIZEPEPRESENTATIVESOFTMISCWNTVTOENTERUPONTME
Z �BOVE�N NTIONEOOROOERTVFORINSPECTIONPURPOSES. COMMENTS
� �� lI
_
4 VEM1ITfEE �—/` / G�
C!) (J a
(n SIGNANREOF PERMITTEE DATE
� RECPT.N0. PAID BY VALtDATION
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENR �File Copy,GREEN—ApplicanPa Copy
.. - . ,:....,,_�.e�.�x,......... ..v-�^ ..r.r.:�••---,��. ,,� ..y.n ....�,_..,.-p..� . u' ��. . , . � K A� "_y;... . r . - - -' ,- . . .. .. . .
{���ir f�F �il�P6�iOP�� F3��
1P�Si�E�,r'1(J`� R�C�6sC.�
�.��. i_,; -
�I�y�-��l�c'^EC.��1�M �')�CI'-�M 11►!}-`1. ac !'�a:{ „ I►`E-�1C���.'.'�l�l�`6 c���r� I(����;����''�Q1��
_. _ _ _. . .
____.----_-------__ __. ._..._._. _.._. ....__. ._--..... ___.._-----_---.----..__� ---__—_ _____._.__.__�__� __.__�__._�__
SET E3ACK _� � FLO�R JOIST �__ •
FTGS/FQRMS!STEEL � i � FHA REQh1T5 i
ELECTRIC GROUND � � U��dDER FLOOR DUCT I
GROUND PLUMBING � I UNDER FLOOR CU�!DUIT
SLAB GRADE I FIREPLACE FOUNDATION
TEMP POWER I FIREPLACE BOND BEAM
WATER SERVICE I _l h11D HT. �OND BEAPA
ROOF SHEATHING l I fi FT. BOPdD BEAM
FRAMINGNENTILIATION I ; FINA�E3�ND BEAM I
ROOF COVER I ~ PRE-GRADING
ROUGH HEATING I BENCHING
ROUGH ELECTRIC � I ROUGH GRADIfJG
ROUGH PLUMBING I FINISH GRADING
SHOV'JERITUB TEST 1 POOL ELECTRIC
EXT. LATH/SI�ING I POOL FENCING
WALL IPJSULATION POOL FINAL �
CEIUNG IN�ULATION � � OFF SITE IhAPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPElIRRIG.
SEEP PIT/L.L. � ON SITE I�/IPS.
GAS AIR TEST FIVAL ZO�JING
FINAL CONST. � � GIRE DEPT. FIfdAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC —� DEV. FEES PAID
FINAL PLUMBING � ENERGY
���-�r_ r�" ��Ii;.r---__.__`--__�. I
COMMENTS
SEPTIC TANK SIZE
SEEP PITIU SIZE
I�"�P ^1
���� i��I
�
I '
� I --- � _.