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HomeMy WebLinkAbout12643 • , � - �� � DE ARTMENT OF COMMUNITY&D L `Xp1R�D �; . 21660 E.Copley Drive Suite 190 , (909)860-3195Faz(909)861-3117 C�O:�?�OO PRESS �*^' ' BUILDING PERMIT APPLICATION "•�• . FIRMLY o ADDRESS I�I� �I/-LJt�F= D2 DA�CATION . �1�j�� NUMB R � �Y/C / � APN LOT THACT _ ISSUE TYPE OCC DATE CONST. GROUP p OWNEFi V/� 1-�LG 1�-�-c-] � �` ADDRESS ����'f FLl IIZ��1 GE I ZONING SETBACKS � CITY��Ia/I"I�WD 1�I�Y' ZIP9LZS9 TEL �/-�L��'4�4�� . . FRONT RW ❑ APPLICANT SA�� TEL. REAR � � SIDE/SIDE S7REET flW ❑ � CONTAACTOR' SIDE p Q ADDFiESS - � ' p - PROPOSED USE �'� lJ�J . CITY ZIP TEL. _:•�; . ,. ,r. o ARCWENG/ � DESIGNER NO.DWEL. N0. NO.. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SO.FT. - FACTOR PSF ADJ.AREANALUATION � Q _.OWNER-BUILDERDECLARATION ' SFR/ADD/REM - � � ' 0 1 HERE6Y/FF7RM tR10ER PEWLLiV OF VERAIRY THAT 1 AA1 FXEUPT FROA1 THE CONTMCTORS U- G8f8Q8/Cdry0f1 CENSEUWfORTNEFOLLO'MNOPEASON(SEC.7WI.68USINESSANDPROFESSqNSLODE:ANYCITYOR (n � '� " " � U �pUHTYM/L#CHREOUqE5A7ERA/fTTOCONSTRUCT,ALTE0.�uPRO1lE,DE40lISH,OqREPA�RANVSTRUC•. W Pdt1�IDBCk- ""' � NFlE.PRqR N RS ISSUNkE,K30 REWIRES TNE MPLIGlff FOR SUUI CERMtT TO FlLE A SIGNED W � ' � � ��-�"�� ��� � �� �-' 6TATFNEHT THAT HE OR SHE LS UCENSED PURSUANi TO THE PROVISIONS OF THE CONTMCTORS ll• � CENSE Uw(GIAPTER 0(001AA1ENdN0 Wfi1/SECTiON 7000)OF DM510N f OF iHE BUSiNE55 AN�PRO- 4- PooUSPa ' � . FE59qN9 CDOE1 OR TIUT ME Ofi SHE IS EXEMPT TMEREFFiOM ANDTHE BA515 FOR 7HE/�LLEOED E%EMP• TION.ANYNOU�i10NOFSECT10N7D77.6BYANY�D7LICANTFORIIPERMITSU[UECT57HEAVPLICANTTO Z pa-p�� O r �AC7VRiENALTYOFNOTMOREIHANFNEMJNDREDDOtURSI=Sao).Y - � �l1LSOYMENOFMEPROPEHTl.ORMVEMPLDYEESWITMWAGES/STHEIRSOLECOIAPENS�TION, 0 Commerclal - � - YAIyE�TNE WOi1K AN�THL SfAUCTURE IS NOT INTENOED OR OFFERED FOf7 S�LE(SEG.7w�.BU51- J N NE55 ANO ViqFE55lON5 WOE:TME CONTMGTORS IJCENSE Uw ppES NOT APPLY TO AN OWNER OF . . PiqVEHT'fN1qBURDSORMPRpVESTHEREON.INDNM1/ODOESSUCHWORKHIMSEIFOqHERSELFOR � Q THROUfY11iSORNERpNNfldPIOYEES.VRONDE�7MATSUCHIMPROYCGEMSMENOTNTENOEDOH ' m L�J ,OfFEREDPoR3ALE6./10YJEYEit711EBUlDWOORI.IPFWVEMEMi550lDWITHINdiEYEAilOFC01IPLE• ' - � L TIDN,iHE OWNERBNLDER VYILL H�VE THE BURDEN OF PROVNO THAT HE OR 6ME DiD NOT BUitD pq = MPROVEFDqTMER1HPOSEOF91LLE1. W 04�9WVNENOFTMECRODEHTV.AA�EXd.USNELYCOMMCTINOWRHUCEN5EDO0NTR�CT00.S � TO CONSTRUCT7ME PROJECT(SEC.7W1.BUSINE55 MID PROFESSiONS COOE:THE CONTMCTORS U• VaIU2�lOf1 ,ADJ.AREA CEKSE UW DOE9 NO'TMPLY TO AN O'WNER OF A PNOPERTY YAiD BUttDS OR MPRQVES iHEFtEON.AND � N4qCONTFiACTSFORSUpIPNOJECTS'MTHACONTMCTOiySyIICENSEDPU0.5UANTTOTMECON7MG pUANTIIY DESCRIPTION FEE _I Tp6 UCENSE UW.1. � O I M1 IXEMPf UNDEN SEG B.a P.C.FOq THiS REASON Q � V . � uZ' DATE � _OWNER C� �J . U . F LICENSED CONTRACTORS DECLARATION W _ � INERCBYAFFRWUNOERVENALTYOFPEftA1RYTHATIAMUCENSEDUNDERPHOV15lON50FG1MTER � , p, 0(OO�.wENCW�'MMSECTqNToOo)OFOMSiON]OFIHEBUSINESSAN�VROFESSiONSLODE.M�D Z X W�IGENSE IS N F1JL�FORLE IW D EFiEGL m � UCENSECLASS LIC.NO. � J �j pqTE � COMMCfOR a ___. _'_.W .._ _.__. ._ _. ___ . t� WORKERS'COMPENSATION DECLAAATION Q . � U y1 NEREBYAFi1RA1 INDER PENKT!OF FE0.AJRY ONE OFTHE FOLLOW:NC DECLAMTIONS: -� �� Z �� � �� 6 � �IHAVEANDYnLL1MMLVNACERi�f'IGATEOFCpNSENTTOSElFdNSUREFORNORKERS' _ COUPENSATqN,.45Vi10VIDE�BV6[C77ONl7ooOF1f1ELA80RCODE.FORINEPERFORAUNCE' W OF T/1E VYOPoC FORNT11G1 TXiS PERMIT R ISSUED. � � �I H�YE MID WILL MNNTAN WOPoCERS COMPENSATION MSUMNCE,�S RE WIRED BY SECTIDN O � Q l7000F1HEU180qCO0E.iORTHEDERFORMANGEOfTHFWORKiOR1N�ICHTF115GEN�R15 ISSUED.MY WORKERS'001APENSATION INSURM7GE CARRiER AND POLIGY NUAIBERARE: CONSTFiUCTION juaAieR . _ . _ PLAN REVIEV! — _ -- .� _ ._.. . _ 0 POIICYNUM6CH ELECTRIC . � (11�sECIqNNEmra7BE0o�s�ElEnOcnEPEw.fi6i0a0nE�a+di[oDotUns�T+mloatE55� PLUMDING z ICERTIFYilU71NTHEPFRFORIAMICEOFTHEWORNfOqWMiCHTNISPfN41Tt5155UEQl MECHANICAL (�' S1/�LL NOT EMPLOYI1M/PERSON W IWY M�NNER SO AS TO BECd�f SU&IECT TO THE N MAPo(EAS'C011PENSATIONUWSOFGLIFORNI�ANOAGREETIMiIFISM0ULD9ECOME INSPECTIONFEE S SUBJECTTOTIEWOPxERS'Cq.�PEN5AT10NFRW1510NSOFSECTqN�IooOFTMEUBOR ' � COOE,I SHALl fOH7HNIM LOMPLY 1M7H 7MOSE PROVi5qN5. �SSUNNCE � � SMIP �A Q ' p OATE: APPLICANT: . . j'J � ENERGY P/C WAANINfi�FAILURE i0 SECt1RE WOPo(ERS'COMPENSATION COVERAGE IS UNUWFUL.AND SMIILL BE �y SUBJECTANEMPLOVERTOCWIAINALPENALTIESIWOCMLFWESUPTOONEHUNDREDTHOUSAND �� ENERGYPERMIT (1]TSJ/lr�l1�[��TT�r��� DOLUHSIf100.00ol.NMD�TIONTOi11EGO5TOFCOMPEN5�71DN,0�GE5A5PROViDEDFORIN L�jZ 1"QI-1�iri'�< <• L� J SECTIDN]7oeOF1T1EUBONCOOE,IH7ERE5T,ANDATTORNEYSiEES. •. '•��y � ' RETENTION FEE: 7�nr�n.►r r.`•"' nW. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �41Lv1i�'��T���i c i� �'t�' . . O . � IHEHEBYAFFlFMIRAERPENALTYOFPERNRVTIUTTMEREISACONSTRUCTIONLENOINO�GENC`! ' Z FOR TNE PERfOflMANCE OF iFIE WOP1C FOR WNIG17Ni5 GERM�T IS ISSUED(SEC.10Y7,CIV.CJ. W � LENOERSNAME . . . ' � �ENDER'$�DDRE55 /y W 1 LEHTIFY TXAT IMhVE RF1D iM5 AFPL�C�TION�NO STATE TNAT iMEA90YE NFORlAATION IS CORRECT. TOTAL FEES n-� ���� , V p., IAORESTOCpAPLVWITHALICT'AN�COUNTVORONANCE5AND5TnTELAWSREU�INOTOBURDING � CONSTRVCTION,INDHEREBYAUTHOFiIZEREPflESEMATNE50FTH15COUHiVTOENTERUPONTHE . ' 1100YE�,IENTIONEOiROVEHTI'FORPIS�EC�UNPURVOSES. COMMENTS �r� `� DAvID D.ELGr4a��-�-� � m PERM EENAIAE�PiVNTj ' Q �^� /� (n ' `� . . r.. I_ / � nnTUREOFiER1AI E DATE � 2 . . . RECPT� PAID BY VMJDAT70N F WHITE—Depertment Copy.YELLOW—Finenee Copy,PtNK—Asseeaor Copy,GOLDENROD--f2e Copy,GREEN--Applicam'a Copy - - - , _ . .. . .... ... . . _ . . . .... ... .. . . . - , ,- . ., . .., . , , . .- . . ,. . ... . . . .. .<..,,..., , . . _..,.-�,.. . , r. , , . ,,. .. .., .. . ............ ....,-. • .. . � �,.��q;.r TY DIAMOND:BAR ; .:•:.. � ;::: �-''- . � TION RECORD:� :�� ' � . , _ ... . ,, ��.. �`�1L , . • ' -' ' . � . . . . . �„";; : - � � ,. . � � - � � � • , � ` � SETBACK - , , � , �• , , .., . FLOORJOIST " , �'. :,'.. �'_.'�i. � ',-�a'. , . ! . FTGS/FORMS/STEEL ` � • FHA REQMTS � � - � - � �-- � - ' ELECTRtC GROUND- -- _ UNDER FLOOR�UC7 . . �. " � - � ,_ �� ,�:�•, . . . GROUND PLUM8ING � • � UNDER FLOOR CO�IDUIT � •� '� '. ••�� �• • � � SLAB GRADE � • FIREPLACE'FOUNDATION� �! � . .._ , ,,,. . , ,� , . TEMP POWER -� -- -- - - � - � � ��� ' FIREPLACE BOND BEAM . � - � �- ' ' ' 1NATER SERVICE _ _ : . - ----� -. :-- MID HT. BOND BEAM . . . -. -, ; � - _. . ..... : ROOF SHEATHING r- � ' �I-a0 . �_ .�_ _ 8 Fi.BOND BEAM • - �� FRANIINGNEIVTlL1ATION � � � � � � � FINAL BaND BEAM ' ' ; ' _. _ _._. .... _ ROOF COVER:.`. PRE-GRADING -� � � '; ROUGH HEATING- - _. .. .. . _. _ . . _. . BENCHING - . • , ; .- ROUGH ELECTRIC -'. -- ROUGH GRADING ; : -ROUGH PLUMBING . - - --� -� � FINISH GRADING ' ` •SNOWERlTUBTEST' � � POOLELECTRlC "� EXT.LATH/SIDING� : �: � POOL FENCING ' ' ' WALL INSUTATION ; .; :�;�• POOL FINAL • - , . CEILING INSULATION OFF SITE IMPS. • � DRYWALL NAILING DEDICATIONS ' ' _ FINAL ENG. .. ; � SEW _._ .._. ._.. - ---._.. .. .. . _. _ _. . SEP71C TANK..-. . _- . _. ..-. LANDSCAPE/IRRIG. -SEEP PIT/L.L. .. . .:-... • '- . - ••;;'''• ON SITE IMPS. - � GAS AIR TEST -- �--- - - - FINAL ZONING � •FINAL CONSTc- - - �- - - FIRE DEPT.FINAL - ' " FINAL�HEATING� - �- � -- -- � � HEALTH DEPT;FINAL_ , . � � '� •� � • ' " FINAL:ELECTRIC � � � - � , - � DEV.FEES PAID ` � � � FINAL PLUMBING ENERGY ' � ' ' - � � a_r e" ee � _. � � -- -....-----.. .. .... . . . ...... . _. ._ . �. COMMENTS- - � ' �'� _.. '.. - - -- -- _. � _.. � , , , . , , - - . ..� �� � _ � - - _. _ _ _ , . . , � �. r. .. . .._ . . ��r ; , � n•`r r• 1 � . . � ,.. . .� . UY� : . . .. . SEPTIC TANK SIZ�� � �- . . >• .:��� •:�.. , :,., . . . ' : . . , , .� ;V 1\1 SEEP PIT/U SIZE .� . ' . � 1 �w , � . . -- .. . . . .. _ . _ _ . . � - ._. . , � . . , , �:; � . . . . , � - _ . ; , _.. _ . _... . . ,_. . , ; . � II - ' ^1 � ; . . , . � _ � ` _` . ! . . . �