HomeMy WebLinkAbout17054 (39) � _ . . _
�� CIT'Y OF DIAI�IOND BE1R
� � DEPARTMENT OF COMtifUN1TY&DEVELOPMENT SERVICES
c ��,� � 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERh1iT APPLICATION FIRMLY
Q DDR'ESS�<<��-1�//a��i;i✓ 4 4 � APPLICATION � L�._�1 PERMfT ;�` P/C
o ' DATE � NUh16ER�w q
� APN LOT TRACT ISSUE TYPE OCC
DATE CONST. GROUP
p OWNE - � i �/,�
�
o ADDR� ���'// f1 / �' L ZONING SE7E3ACKS
z CINyI f/�1"/.� � ZIP�f�f���TEL.%� 1' ^ ' � FRONT RW ❑
p APPLIC�N -�r �t//� " ✓l� TEL. :/-l=��/ REAR �
� - SIDE/SIDESTREEf RW ❑
¢ CON AC O SIDE �
ADDRE S � i J rS i
� C�TN �� � ZIP EL� - PROPOSED USE�/ � �
� ARCH/ENG/ i��1LTr�AGG er- lr�i���
z DESIGNER L LrJ/'L�/l:trn.i rTr��Ir��ir'i�'7I-
a ADDRESS NO.DWEL. NO. � NO.
cn UNITS STORIES F3EDROOMS
� CITY ZIP TEL.
� DESCRIPTION Sa.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER•BUILDER DECLARATION
p SFWADD/REM
p I HEREBY IIFFIRU UNpEH P[NILL7Y OF PEFWRY THAT I AM EXEMaT FROM THE CON7MCTORS L6 G2fagElC2fpOR
W CENSEUWFORTHEFOILOWINCRLASON�5EGT0.71.5BU51NE55ANDVROFE55iON9C00[.ANYCITYOR (n
ZCOUNTYK411CHR[WIRESAPERMIT70GONSTRUG7,ILLiER��ROYE.DEMOL1511,ORREPAIq�NYSTRUG W PdtiO/DBLk
w TUflE,PRIOH TO ITS ISSUANCE,AL50 RCWIHES THE 11771ICM1T FOR SUCH PERMR TO FILE A SIGNED w
� S7ATEMCNT TMA7 HE OF SHE IS L10EhSEO VURSUAN7 i0 THE PPOVISIOhS OF TME CONTMCTORS L4
� CENSE UW(LNAPTER Y(COMMENCING WITH SECTqN 7000)OF OIVIS�ON]OF TME 8'JSINESS I1NO PR0. � POOVSpa
� FESSqN5000E1DRTHATME0i15XE15EXCUPTTXERECROraANDTNCeA51SiORTHEALLECCDE%EMP- (�
V TION-NJVVIOLATIONOFSECTION70]1.SBYANYAGRICANTiOH�PERMITSUBJECiSiHEAPPLICANTTO Z RB-Rpp}
A CML OENAITY OF NOi IAOFlE T1AN FIVE NVNDRED DOLURS�f5o0).�:
� ❑�ASONMEROFiHEP0.0PERT/,ORMYEMFLOYEESWIiNWAGC5A5TMEIR50LECOMPENSATqN, O COmrt1B�C121
Z 1MlL DO 7H[WORK,ANO ME STRUCTURE IS NOi INTEh'DED OR OFFERE�FOR SALE(SEC.70��,BU56 ,.J
� NE55 AN�GROFESSIONS COOE:THE CONTRALTORS LICLNSF UW DOES NOTA?PLY 70 AY OWNER OF ?
PROPER7Y NM1fO BUIIDS OR aA?ROVES THEREON.ANO NMO DOES$UCH WOFK HIMSCLF OR MERSE.F OR
WTHROUGHHISOqNEROVlNEMPLOVEES.PROVIOEDTMATSUC/IIMPf10VEYENTSARFNOTM7ENOGDOR C�
� OFFEREDFORSALEIF,HOWEVEi�THEBU:IDINGOfiYA7ROVE4ENTISSOIDNnTHiNONEYEAROFCOUP�E�
Z TqN,THE OWNEN-BUILDER WILL HAVE TNE BVRDEN O�GHOVINC TMAT ME OR SHC:�ID NOT BUILp OA
� MPROVE FOq THF PURPOSE OF SALEF
W O1�30WNEROFTHEPROVERTY,AME%CLUSIVELYCON'RACTWGWITHLICEKSEDCONTRACTORS
� TO CONSTFUCT iME PHOJECT(SEG 70��,BUSiNE55 ANO PROFESSIONS CODE:THE LONTRACTORS ll• V31113t1Of1 ADJ.AREA
W LENSEUWDOESNOTAPVLYTOA40V1NEROFAVROPERiYW}10BURDSORIMPROVESTHEREON,AND
� YMOGON7MCT5FOH5UR1VR0.lECTSYniHAGONTMC7GR(SIIICEN5ED7L'RSUANTIOTMECONTMC� QUANTITY �ESCRIPTION
Y ToasuctNSEuw.). FEE
� OIAAIEXEMPTUNDfRSEC. B,iP.CFORTHI5REA50N Q / ��,!/{,.f� / (i�fL
� � �/ ' GD7 S O
� DA7E ONMEH F- � � � f�
� LICENSED CONTRACTOFS DECLARATION w �
� INEREBV�LFIRMUNOERPENALTYOFPERJURYTNATIAMUCCNSEDL'NOERPFiOVISIONSOF�HAPfER �
� O�COMAIENCINOWITHSECTpN7Dao)OFDIVISKKJ�OFTMEBUSINESSAN�PROFESSIONSCODE.A`!D Z
�� MYIICENSE IS k!FULL FORCEAND EFFECT. �
� LICENSE CUSS LIC.NO. �
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION�ECLARATION
� IHEREBYAFFIR4UNOER7ENALTYOFVEFWRYONCDFT/IEFOLLON".4GDECUMiqNS: ��� i ' /•' _/ / /`
� V
� _IHAVE/WDN^.LLMAINTAINACERTIFICATEOFLpNSENTTOSELF-INSUREFORWORKERS'
CAMPENSATION,AS PflOVIDED BY SECTION 710o OF TF1E IABOR CODE,FOR iME CERFORMMlCE
OF TNE WORK FOR WHlpl iHIS PERMIT IS ISSUE�.
G
� _IHAVEMIDINLLMAIMAMWOPICERS'fAMVENSATqNINSURANCE.ASREOUIPEDBYSECTION
O 7700 OF THE UBOR CODE,FOR THE FERFORAIAHCE OF TH[WpPX FOR WHICHTHIS PERMIT IS
J ISSVED.MYKORKERS'CpAPEN5AT10NM5VRANCEtARRIERIINOPOLICYhVM�EFME: CONSTRUCTION
j CARRIER PLAN R[V�EW
o Poucrr�uueEA ELECTRIC �
�
0 �nassEerar+r�[mr,orecm.auhoancvEm.rrsrrnancNu�on[ooaw�p,ac�rn�essF PLUMDiNG
w
Z I CERTIFVTMAT NTHE VERFORMANCE OF TNE WORK FOR WM:p1 TNiS PERuiTI51S5UED.1 MECHANICAL
C} SHhI NOT EMPLOY ANY PERSON IN AYY MANNCR SOAS TO BELOM[SUO.ICCT TO THE '`
(n WORKERS'CdAFENSATIONLAWSOFCALIFOfiYIA,AND�GR[ETHA7IFISMOULDBECOM[ IPJSi�ECTIONFEE _ �,J�
SU0.JECT TO 7ME WORNERS'CCMPENSATqN VqOVi510NS OF SECTqN 7100 OF THE LABOR
-�j CODE,ISHALLFORTHwITHCOUPLYWITHTHOSEPHOVi5KK15. ISSUA"JCE �� ��
0
p DATE'. APPLICANT: SMIP
� WARNING:FI0.UR[TOSECUREYN�RNERS'CWPENSATpNCOVER�CEISUNUWFULANDSHIy�BE ENERGYPIC �)
�y SUOJECTANEMP�OVERTOCRIM14ALPENAL7IES/�ltOCMLFW[SUPTOON[HUNORCDiMWSAND ENERGYPERMIT _ Q `
JDOLLARS(f t0D.000),IN/�DDITION TO THE COST Oi'COMPENSA'ION,DAMAGES AS PRONDED FOR IN -
SECTION]loeOFTMELABORCODE.INTEREST,N:OAifORY[�'SFEES. �
o� RETENTION FEE: � �
oCONSTRUCTION LENDING AGENCY PRE•ALT FEE: _
� IHEREBYAGFIqM�1N0EAPENALTYOFPERAIRYTHATTHEREIS�CONSTRUGTIONLEN�WGAGENLY
FOR iHE PERfOHMANCE OF iME WORN FOR WMIC11 T115 PEFiMiT IS ISSUEO(SEC.7C91,CIV.C.�.
Z
w
� LENOER'SNAM[
S'
� LENDER'SADORE55
�
W ICERTIFYTMATIMIIVEREADiHISAPPLICATIpNANpSTATETHATTHE1190VE1NiORMATq415CORRECT. TOTAL FEES
d IAGREETOCONCIV �TNA;LCI7Y�NDCOUNTYOR'JINANLES�NDSTATEUWSP[LATINCTOBUILDING
� CONSTRUC7 , hUM REBYAUT REpEPRE5EN7ATNE50FTNISCWN7YT0ENTERUPONTHE ����0
Z ABOV F EDD FEHTYf 'INSPECTIONVURPOSES COM�JIENTS
m 111� � �.1_��� �
Q ui �NudG�oaniN I �. /' .��
N ���� ����
(n SIGNRTUNI:OF PCRMIT7EE DATE
� � RECPT.NO. PAID BY VALIDATION
WHITE—Depanment Copy.YELLOY�—Finance CaDY.PINK—Assessoi Copy.GOLD[NROD--F�Ie Copy.GREEN—Applicanfs Capy
•- -- .. . . ..._.._ .. . ... . . ..
. . . , , . � �� . . . , . . . . . .. . . . .
CIT'� J�= L�!/+-.f,;Q��Q �.�E�
ii�!�P�v 9 IQf�•! F;�CO;[�
I���'9:1:c=C(e)►+1 e);�.: .I��EyC�=;e;�Cc]ct . —.�f11=i'l.�c'T�c�:l►`1 _ ! ci�'i['- ^ � -
— i►1-`�.;..��e;'re):�
---�--�----�------ —=...� _.._ ..._.....� ...- -..._..:- -- -._...._.�_�......: ..._ - - - • _.... _._ _ - . .- .
1 _..... .__....... . .... .J....._ . ' . ... .� �
S�T B�1C� � .... _.._.. _.. .._..... .__..._...�. _..---"-�...._-- •-_`
� � • I _
---�--- ' _ I I FLOORJO;�T.- _. .__ �-- --------
FTGS/FORMS/STEEL ` �j FHA REQ'.�TS I I
�-- - — -
ELECTRIC GROUND � i i I UiJD�R f=LQOR DUCT ( �
GROU�JD PWb1BING � I U;•1DER FLOOR CU��IDUIT I i
SLAB GRADE I � I FIREPLACE FOUNDATIO�� I I
TEP.1P PO'.NER I __1 FIREPL'r^,CE�OfJD BEA�Y7 �_
�NATER SERVICE I � i PfID HT. ��"�D BEAF.1 ; �
ROOF SHEFiTHING � _� ' � I 6 F-T'. B7iJD E3EF�":1 I`_ i
FRAh"R•�G.NENTILIATIOPd � � � FINAL BO(•:D 6�At;' I �
ROOF COVER I FR�-GRP,DING I I
ROUGH HEATING � � BENCHIt•dG I I
ROUGH ELECTRI� � I � F;OUv^ti GR�.DC•JG �
�-,_
ROUGH PLUh."BIP�G � � � � Fi�JISH GRP,DIfJG �
SHOti"JERITUB TEST I � � ('OOL ELECTRIC —�
EXT. I..F�TH!51DIP�G � I POOL FEPJCIFlG � __
bVALL INSULATIOPJ I POOL FINAL �
CEILING R�SULATIO^J OFF SITE IfviFS.
DRYVVALL NAILING � � DEDICATIOWS j
SEWER � ' FI"d!',L ENG.
SEPTICTANK LAhdDSCF,PE/IRRI�. �
SEEP PIT/L.L. ON SITE IP��PS. �
GAS AIR TEST FINAL ZONIfJG j
FINAL CO��ST. �_I � � '� FIRE DEPT. FIPJAL �
FINAL HEATIiJG `� H=ALTH DEPT. FINAL
FINAL ELECTRIC I � I I DEV. FEES PAID
FINAL PLUPJ'BING � EfvERGY
-_,_....R.,.-_-.w-.-.--,-.�-
�
.;-..... ,��_. .-:.:�
connMENrs
� —
SEPTIC TANF<SIZE
SEEP PIT/U SIZE
���
�►�r� _
�
.;�