HomeMy WebLinkAbout18394 (21) I, C1TY OF DIAI�iOND DAR �
�� • DEPARTMENT OF COMMUNPII'&�DEVELOPMENT SERVICES
� �
21825 E.Copley Drive
��'"` (909)860-3195 Fax(909)861-3117 PRESS
'%� BUILDING PERMIT APPLICATION FI RM LY
� JOBSITE APPLICATIO PERMIT P/C
o ADDRESS 23 - r• DATE j ��Z.� NUMBER I$39�. �
c� ISSUE TYPE OCC
APN LOT TRACT DATE y CONST. GROUP
p OWNER � �
"" ADDR SS / • ZONING SETBACKS
z CITY � r ZIP 'TEL.QGC�4/-C.0'�Q FRONT RW ❑
o APPUCANT ^ yIEL.G,,,�. �' REAR ❑
'�isk`� SIDEJSIDESTREET RW O
� CONTRACTOR � SIDE ❑
� A�DRESS PROPOSED USE � L K
o CITY 21P TEL. (� ����
w ARCHIENG/
w DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TH�.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
Q �, OWNER-BUILDER DECLARATION SFR/AD !R
O
p I HEREBY AFGIRAI UNDER OENALTY OF iER1URY THAT I AM ENEMPT iROM iHE CONTMC70R5 LL Gaf3�@/CyfpOR
W CENSEUWFORh1EFOLLOM��NGREASON(SEC.)�]1.58USMESSANDP90FESSqN5CO0E:ANYCI7YOR �
U COUNTINhUCHREOUtRESAPEMpTTOCOHSTRUCT,11tTER��°ROVE.DE�.bUSM,CRREPAiRANVSTRUG W poli0/DOCk
WTURE,GRqH TO RS ISSUANCE.AL50 REOUIRES THE AFPLIGWT FOR SUp7 PERMIT TO FILE A SiCNED
STATEMENT THAT HE OR SHE IS UCENSEO PURSUMlT TO TNf PRONSIONS OF TN[fANTMCTOAS L6
� CENSE UW(CMAPTER Y�COMMENCMO IMTM SECf10N 7000)OF D1YIS10N 7 CF THE BUS�NESS ANO PRO� LL PooUSpa
0 FESSIONSCODE)ORh1ATNEOHSHEISE%FMPT7NEPEFROAIANO7NE0ASISFORTHEALLEGEDE%ENP�
V TION.ANYVIIXATqNOFSFCTION70J7.SBTNlYAiPUCAN�FORAPERMIT5U9JELT5THE�PpLICANTTO Z Re-Roof
� ACMLPENALTYOFNOTMOREhIM1FNEHUNONEODOLUaS�fseo))�
� WILL DO T E WOWC AND TNE STRUCT RE�N�T IMEND D OR OFiEFED�FO SALf(SFC.)OUA&1�I• � �mm@�Ci01
Z J
NE55 AND PHOFESSIONS CODE.TME CONTMCTORS UCENSE UW DOcS NO:APPLY TO�h OWNER OF
N VRODERTVWFIOBU4DSOR�PNOVESTIIEAEON.ANOYMODOESSUCHWORNHIMSELFOHHERSELFOA =
� TMROUfiHH150RNENOWNEMFLOYEES,GAOviDEDTHAT:UCMUdPROVEMENTSAFENOTW7ENDEDOA m
111 OFFEHED FOR SALE G,110WEVER 71�E BUID'NC OR IMPROVEAIENT IS SOID 1MTMwONE YEAR OFCOMP�E•
� TION,iHE OWNEF�BU�IDER 1MLL HAVE THE BUROEN OF PFOViNC iMAT ME OR SME Di0 NOT BU40 OR
Z MPROVE FOR TME P11N705E OF SALEA
_ ❑4il$ONTlEROFTHEPROPERiY,/WEXClUSNELYCANTRACTMGWITNLICENSEDCONTMCTORS
Q TO�iSTRUCT TME iHQ1ECT ISEC.)ou,BVSiNE55 FND PPOFESSIONS CODE:ME COMMCTORS L4 Valuation ' ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEFOFAOROPERT'VR�OD'JM.OSORIIAPPOVESTNEREON.IIND
� WMOCONrMLT5FOR5UCM7R0.iEGT5WITHACONTMCTOR(S�LICEhSEDPUHSUANTTOTMECONTMG �UANTITY OESCRIPTION FEE
Y TORS IICENSE UW). ,
� J
� O IAM EXEIA�T UNOE0.5EC. B.i i.C.FOR THIS REASON U
�— �� �I� Y-,i' � V
DATE s�
� LICENSED CONTRACTORS DECLARATION �
� w
I MEflEBV AFiIRM UNOER FENALTY OF 7ERJURY TNAT I AM UCENSED UNOER PROViSiONS OF CMAPTER U.
p„ 0(CO�AUENCIN6YNTH5ECTiON7000lOFDIVISqN]OFTHE9US�NESSAhDPP.OfES5AN5CODE,AND Z
X MYLICENSE IS IN FULL fOHCEAND EFf ECL m
lL �
� LICENSE CU55 UC.NO. J
V �ATE CONTRACTOR �-
_ .W - . -- �- - �
� WORKERS'COMPENSATION OECLARATION a
� 1 HEREBVAFRBM UNDER GENATYOF GEILIUHY ONE OF TNE fOILOW�NG DECLAM1qN4: U
� Z
Q
� _INAVEAN�wRLLU�NTUNACERTIFICATEOFCAN5ENT70SElFaNSUREFORWORKCRS' _
Q CpMPEN5A7qN,/SPROVIDEDBVSECT10N97000FTHEUIOORCOOE.FORTHEVERFORMMICE �U
OF THE WORK FOR WXICH TMIS OENAl1T IS ISSUED. �
�
_I HAVE ANO W4LMAINTAiN WORI(ENS'COIA�ENSATiON MSURANCE,AS HEOUIRED BY SECTION .I��CY)
dQ �tooOfTNELA90RCODE.FORTHEPERFORMANCEOFTNEWORKFORWHiCHTMISPERMiT15 �N�
ISSUED.MYWORKERS'COMPENSA710NINSUMNCECARRIEHM1DPOlICVNUA/BEFARE' CONSTflUCTION
jc�aaieq � PLAN REVIEW '
0 va�crnuMseA � ELECTRIC
z
¢ (i/a55ECf10NNEmNOT8E001.slETEDOFifEPEi+ANTSiOROhENUKNim00L1/ifLSR70�Oq1E551 PLUMBING
G
w 10ERTIFYTHATINTHEPERFORMANCEOFTMEN�ORKFORNMICHTHbFERMITISISSUED.1 MECHANICAL
Z
(7 SHALINOTEMPLOVANYPERSONINANYMANNER50A5TOBECOMESUBJECTTOTNE
�J WOHr(ERS'COMPENSATIONUWSOFCALIFORNI►.ANOAGREETHA7IFISHOULOBECOME INS?ECTIONFEE
S SUBlECTTOTNEN/ORKERS'GOMGENSATIONiROYISiONSOFSECTION�7o00FTHEU80R ISSUANCE �S r�
OOOE,I SHALL FOATMw�TM COMPLY NnTM TNOSE PROV�SiONS.
� SMIP •h�
p DATE: APPIICANT:
� ENERGY P/C
� WAflNING:FAILUPETOSECUREW�DRNER4'CAMPENSATIONWVERAGEISUNUWFUL.ANOSHAILBE
�y SUBJECTANEMPLOYERTOCRIYINALVENALTIESMIDGV�IfINESUVTOONEHUNDREDTNOU5AN0 ENERGYPERMIT �
DOLURS(f 10D.000�.N ADDITON TO iHE GOST OF COMP�NSATION.DAAIAGES AS VROVIOED FOR IN
J SECTbN]7aeOFTMELA80RCO0E.INTERESLANDATfORNEYSFEES. RETENTIONFEE: � �'��
�
w ; CONSTRUCTION LENDING AGENCY PREALT FEE: "
n.
0
CL I HEREBVAFFlRM UNDER PEN�L7Y OF OEMIFY TMA7 TMERE IS A LONSTfiUCTION LENDING AGENCY
n- FOR TME PEA�A��NCE OF TME WORI(iOR WHICH THIS PERMIT IS ISSUEO(SEC.7097,CIV.C.)
W
� LENOEN5NNAE
F- LENOER'SADDRE55 '
� ICERTiFVTHATIHAVEREADTMiSAPVLICAT�ONANOSTATETNATTHEABOVEINFORMAT10Ni5COHRECT.
TOTAL FEES �%
d IAOREETOCOMPLYWITHALLCT'I�NDCOVNTVORpWANLES/�NDST�TEUWSNELATWGTOBUILD�NC
CDNSiRUCTION.AND NEREBV AUTIqflIZE NEPRESENTA71VE5 OF THIS COUNTY TO ENTER UPON THf
Z ABOVEMENTIONEDPROVfan'F00.1NSVECTIONPURPOSES.
COMMENTS
o --J%Y/�- �—�/' i �
� �if
� PERMITTEE (PRI , � �. ��
Q l f
� SICNATURc�s`4E �. E� DATf .
_ � RECPL N0. + _PAIO BY VALIDATION
~ VJHITE—Departmont Copy.YEU.OW—Finante Copy.PINK—Assessor Copy.GOLOENROD—File Copy,GREEN—Appl�cant's Copy
Gi�`1` �U� Dl.�ft��9�� F3A�
� iP��r�E��3'lU�� �E�COi�D
.,,'..,...._.__.-..�...�...�,...�.��..t-.�. � -
�C��,�-�.�����1�►�.Jki�i�"���=•��:�s�:���;�`��a41�-� '�. ;j��:�=��:����.C`�R �.;�_���., � � . �
SET BACK � 1a � � 1rFLOOR JOIST ' �� +
_ .....�,i - ---- i.;.. _ __ I _
�
FTGSlFORMS/STEEL � � FHA REQMTS
—��---- ------I------ -
ELECTRIC GROUND f ' ' . UNDER FLOOR DUCT •
---�----
GR�UPdD PLUP�IBING I __�_ Ut��DE:R FLOOR CUPIDUIT { I
SLAB GRADE __ I ^FIREPLF,CE FOUNDATION i
TEMP POWER i _:_1 F�REPLACE E30rJ�BEAM _�
WATER SERVICE I i I MID HT. �OPJD E3EAh1
ROOF SHEATHING ___^ �. 8�PJD BEAM
FRAMINGNENTILIATION i rIhAL E30t•dD BEAM
ROOF COVER PRE-GRADING
ROUGH HEATiNG BENCHIPJG
ROUGH ELECTRIC ___ ROUGH GRADING ___
ROUGH PLUMBING FINISH uRADING
SHOWER.rfUB TEST � _ —i j POOL ELECTRIC
EXT. LATH/SIDING �- � -�l� �1 POOL FENCING �
WALL INSUtATION i P��L FI^JAL j
CEIUNG INSULATION i OFF SITE IMPS.
DRYWALL NAILING _ _ � DEDICATIONS
SEWER j FIPJAL ENG. �
SEPTIC TANK � LANDSCAPEIIRRIG. � _
SEEP PIT/L.L. � � ON SITE IMPS.
GAS AIR TEST ; FINnL ZOrdirJG
FINAL CONST. �(�'L i � F�RE DEPT. FRJAL
FINAL HEATING ; �HEAt7H DEP"f. FINAL
Fi�JAL ELECTRIC � ; j DEV. FEES PAID
FINAI.PLUMBING i i .E��ERGY
i --
.0���t.� �.:�.��_.__
CUMfJIENTS
SEPTIC TA�,1K SIZE �
SEEP PIUU SIZE -
_._._-----_-,..�...-.-.,_r-.,
;��� i -- .
� .
- •#�� -.
,l�y�' �` ��i � .
i
I .
i
•. � � , - .
�