HomeMy WebLinkAbout17014 (44) �� CITY OF DIAMOND IIAR
DEPARTMEM OF CONIIv1UN1TY&DEVELOPIvIENT SERVICES �
� «.C
21825 E.Copley Drive ',
(909)860-3195 Fae(909)861-3117 PRESS
'�+�� BUILDINGPERMITAPPLICATION FIRMLY
o� JOBSITE APPLICATION a �`PERMIT � P/C
ADDRESS DATE ���rl �NUMBER ��� M
$ , ISSUE TYPE OCC
APN LOT RACT DATE CONST. GROUP
p OWNER
�` ADDRES ��p� ZONING SEfBACKS
z CITYD�S�.�/}� ZIP �� TEL.� • � FRONT Ryy p❑
g APPL`�ANT REAR
� SIDE/SIDE STREET RW� ❑
� CONTRACTO � ' SIDE p
� ADDRESS '
o CITY�j��Z�-� ZIP� TEL. ' — � (�R.jP�j'�Y
o ARCH/ENG! ,
z DESIGNER
w NO.DWEL N0. NO.
n. ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
N OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
o OWNER-BUILDER DECLARATION
� SFWADD/REM
I NEREBY AFFIRM UNDER PENALTY OF VERAIRY THAT I A1.7 E%EIAPT FROM TH'e CONTRACTORS LI• G3f3Q9/CBfpOR
W CENSEUWFORTMEFOLLONnNaREASON�5EC.70.71.69U5ME55ANOPROFE55lON5CODE.ANYCITYOR (n
C.� WUHTYNMIp1RE0UIRESA7ERMITTOCONSTRUCT,ALTE0.IMPROVE.DEMOLISH.ORR'cP�IRANYSTRUC• W PafiO/DBCk
NRE.PRIOR TO RS ISSUANCE.Q50 REOUIRES iHE A7VLICANT FOR SUCM PERMS TO FILE A SiCNED
W STATEAIENT THAt HE OR SHE IS LICENSED OURSUANf i0 THE PROVISIONS O�iNE CONTMCTORS LI- W
g CENSE LAw(CHAPiER Y(COIAMENCIN6 WITH SECTION 7000�OF OIVISiON]OF TME BUSIhESS AND ORO� � POOVSpB
'� FESSIONS�E)ORTHATMEORSHEISEXEMPTTHEREFROMANDTHCBASISFORTHEALLEGEOE%EM7• �
V TION.M7YVqLAT10NOFSECTION1Wt.58YANYAPPLICANTFOfiAGERM175U8JECT$TMEAPP�ICANTTO Z Re•Root
AGMLVENALTYOFNOTMORETWWiIYEHUNOREDDOLURS�i50a)�� '
Z ❑I,ASOYMEROFTHEPROPEHTY,OFMVEMttOYEESWITMWAGESl157HE�q50LECOMPENSAT10N, � COmmBfCidl
WILL DO THE WORK AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SAIE(SEC.104�.8U51• J
� NE55 AND PROFESSIONS CODE:THE LONTRACTORS LICENSE UW DOES NOT ACPIY TD AN OWNER OF ?
PROPERTY WHO 9URA5 OR II.IP{iOVES THEREON.ANO WHO DOES SUCH NbFiK HI45F LF Oq HERSELL OR
wTHROUGHHISOHHEROWNEAIPLOYEES,DqOVIDEDTUTSUCNIMVqOVE1AEM5ARENOTINTENDEDOF m
� OFFEREDf-0qSrLEIF,HOWEVERTMEBUILDiNCORIIAPROVEIAENTiSSDIDWITMINONLYEAROFCOMPLE�
Z TION.TH[OWNER�BUILDER WILL MAVE THE BUROEN OF FRONNO THAT NE OR SHE 010 NOT BULLD OR
� IMVROVEFORTMEiURPO5EOF5ALE} �
LLJ ❑4/��WNEROFTHEPROPEHTY,FME%ClUS(VELYCONTMCT1NCiWRHLICEN5E000NTMCTORS
� TO CONS7RUCf THE ifiWECT(SEC.701�,BUSINE55 M70 PROFESSiONS COOE,THE CONTMCTORS LI� Vdlu3ti011 AQI.AREA
W CENSELAWDOESNOTAPPLYTO/WOVMEROFAPROPERTYWHOBUIL�SORIMPROVESTIEREON.ANO
� WVIOCOHTRACTSFORSUq1FROJECTSWITMACONTMCTOR�S)LICENSEDGURSUMlTTOT1IECONTMG QUANTITY �ESCRIPTION
Y 70RSLICENSELAW.). � FEE
Q OIMIEXEAIPTUNDERSfC. B.6PC.FORTHISREASON Q
� U
� DATE OKRJER F'
p W
Q LICENSED CONTRACTORS DECLARATION w
Q INfREBYAFFIRMUNDEFlPENALTVOFPER1UpVTHAiIAMIICEN5E0UNDERPROYISI0450F�W�PTER �
d 9�COMMENCRIOWRHSECTION7000)OF�IVISqN90F7HEBU51NE55AN�OROFE551ONSC00E,FND Z
X MYLICENSEISINFULLFOHCEI�NDEFiECL m
0 LICENSE C SS G UC.N0.����� �� �
V DATE��r Z�.�' �r COMMCTOf�"�'(��, d
W
� WORKERS'COMPENSATION DECLARATIOH , ¢
NIHEREBYAFFIHMUNDEHPENALTYOFiEiWPYONEOFTMEWLLOYMlGOECURA7qN5. z
� �IHAVEANOWIILMAINTAINACERTIFICATEOFCONSENTTOSELF�INSVR[FO�WOHKERS' _
GOMPENSATqN,ASPROViDEDBYSECTION]IOOOFTMEUBOqCAOE,FORTMEFERFORMANCE W
Q OFTHEWORKFOFYMICMTHISPERMITISISSUED. '�, �
W �IHAYEANDWILLI.�AINTAINWORKERS'C(M17ENSATIONINSURAN[E,ASREOUREDBVSECTION .}�
Q 77000FTHELADORCO�E.FORTHEPERFORMANCEOFTHEWORKFORWFIICHTHISPERMITIS 1 ' `� ��1
J ISSUED.MYWOfy(ER��N�GECARRIERANOGOLICYNUMBERME: CONSTRUCTION { l! 1
j CARRIER� PLAN REVIEW
0 POLICYMIM9ER� �'7,-��-"'�l � ELECTRIC
4
� (nasSEcnoNr+Emr+�reEoonnErmoFnEc�ra,rrswaa:E�a.w��oDatfrsR+m�or��[ss�. PLUMBING
Z ' ICEHTIFYhIATINTHEPERFORMMlCEOFiNEWOfiKFORWHICHTH:SFERAnTISI55UED,l MECHANICAL
C7 SW�ILNOTEMPLOVANYPER50NWMlYMAN4ERSOASTOBECOMESUBJECTTOTHE
� WORKERS'COMPENSATIONLAN50FCALIFORNIA,lW�AGREETHATIFISMCULOBECOME INSPECTIONFEE �"" � -� - •
SUBJECTTOTMEWORKERS'COuvENSATiONDROVISqNSOF5ECT10N77o00FTNEUBOR (�'".//-1� , �
s OOOE,ISMAU.FORTMYATNCOMPIVYATMT1q5EPROYISIONS. i ISSUANCE ' :�O
� '' SMIP __n..n �e e � � �
p DATE: APPLICANT.
J WARNiNG:FARURETOSECUREwORKEHS'COAIPENSATIONCOVERAGEISUNUK'FUI.ANDSHALLBE ENERGYP/C � Y
�y SU&lECiMJEMPLOYERTOCPIMWA�PENiILTIESANDCMLFINESUPTOONEHUNDREDT110USMlD ENERGYPERMIT
OOILAFiS(f t0o.00a).N ADDIT70N TO TME LOST OF COMPEYSATqN,DAMACCS AS PROVIO[D FOR IN `
� SELTpN7T0EOFTHEU�BORCODE,WTEREST,AND�TTORNEY'SFEES. �� RETENTIONFEE: J,�Y�
a CONSTRUCTION LENDINC,AGENCV ' PRE-ALT FEE: � � � ���� � -
O
� IHEHEBYAFFIPMUNDEROENALTYOFPERNRYTHATTHEREISACONSTRUCTIONIENDM�ACENCY
FOR TME FERFORMANCE OF THE WORK PoF WHICH THiS FERMIT IS ISSUED(SEC.70Y7,CIV C.�.
Z
W I
� LENDERS NAME '
H lEN0ER5ADORESS �
w ICENTIFYTHATIM�YEREADT1115APPUCATIONAN75TATETUTTMEABOYEWfORM/,TpNISCORRECL TOTAL FEES I �\J � O
� IAGflEEiOCOMVLYWITNIILLCITYAN�GOUNTYORDMANCESANDSTATELAwSREUTIN4TOBUIIDING `J �
� CONSTFUCTKKJ,ANOHEREBYAUTFIORIZEREPRESENTATIVESOFTHISCOUNT'/TOENTERUPONTHE
Z ABOVE-MENTIONEOPROPERTYLORiNSPEGTIONVURPO5E5. �' COMMENTS
0
J
m �-7~,�i
a PERMITTEE NUAE�PRINn ///
� , ���_
� SiGNATUREOFPERMI d����� DA7E
� � � RECPT.N0. � PAID BY - � � VAUOATION
WHITE—Depanment Copy,YELLOW—Financa Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—AppticanYs Copy
. . , , . . . ,,., - , . , . . .. , , . . . . . .
�J� .^' ,....- l.'i r,i'-.:i�'_.':`� ;:, ',i
!i _.:!�.:� � 8.�`k, . .,.s�.,�_j. ...,
-----------_-�___._.___-- ._..... . ..__. . . _.. - - •--- .... _ _. _..._----- -_ _. __. ___ . .. .. �-- -----__ . _..
i►+1�:iC��f�"��1�.1��� �' ,�,"r Ei'I=�:�='� '{)C. I�';=l.':, � . 1:��`". .._,'f' t�'1-:'=;C� E'il��
_ . .....----
SET Bl';Cf: i I ' FLO�F JO;ST . , I
---
- - ; .- - ----- ----------- ---- --- --i-- -
FTGS'FORh�1S;STEEL � ' I FF1,� {ZEQ'�":i S ' ___
--- -.-.. _.._
'------- -----• �- ------- -
ELECTRiC GR�UPID ' I Ui1DEF;, FLOOR D`JCl
� � ' -- ------
-----�-- �:— ---- � ------
Gf;OUfJ� PLUiv131NG � 1 I i Ut1�ER FLOO�CUP�D'JIT _
---- --,------ - --- -
-- � ----- i---- ----- rlfiEPLf1C� F:�Ut1���T10,'1 �---- ,
SLA�GRF�D� I -- ---------� r -------- ----
TEt:�? PO�'JCR � - ------ -----�- FIREFLAC�== EO?�D Gt,4":1 i I
� -------- —--� _ .__--_, _ _---
-----
WATER SER�ri�E I : ; f�nlD HT. �OPJD E�l�^," � � �
_ -. ---- ------•- - -------------�---= '---
ROOF SHcr"1TH!idG � ' � � � f-1. E_;�1D BEAh,'_ i ____ ;_ __
FRAf�^i�G'VE�JTiLiAT10�� � ----I--------�--I � �Ii.AL�O�:D EEA".' ;- � --
- - ---1-�-- ----- ---•---
RO�F COVER I I ! F;;c-G;�',DIFJG '
--___-� �- -- '—
ROUGH HcATIP�lG I I � t3E(��^F'1i�1,-. I
ROUGN ELECTRIC-- ; � ---- ' � ROUGIi GF3=,DIfJG I
F70UGH FLU'��1FI�dG I--- --- ---__;.-j Fi�JISH uR�,DItJG --- - --
4--- ' � -- ----
------- -- -
SHO�^dER,�TUB TEST � ; I_�'��L ELEC i RI=__ _ _
EXT. LATHISIUING � ; ! PO�L f'��d�IP;G __ _ _
�,'JALL IfJSUiATi0P1 I----�----- ---� ,-F'07L Fi',.%,L ------- ----I ---
CEILIfJ'3 INSULATIO"J �, I 'I O'�F SIT�I'v"P5. I
� — --- ---�-- - -------- - � -- ---� --
- ------
DRl'l^J„LL �JAILRJ I �� D�DICATIO�:S _� � __ _
SEl"JrR ---- - - - ---- ---_� FI'�AL Ef�:G. _l_
SEPTIC TA�•4{< I L�',,i�JDSCF,PE�`IRFIG. � �
�l�---
SEEP PIT;L.L. � i � C�J SITE IL1PS. . _ I I
i I � FIi�AL 7_O�JIi�!G
GAS AIR TEST � , __ _ I __
FINA!CO^dST. ' � .� F!r=�,c D�?T. Fli�l1!. �
' - �-, -
FIfJAL HEATiP.� 1 � l I HcF,�Tt{ DEPT. FIiJ�,L I �
------- -------�----.-_,_
FIN�L ELECTRIC � j I DE\�. FE�S PF,ID ;
FINAL PLU.'.151NG ( � E I E�d�RGI' �— �
� ..-- - --- -
� � � I ��
- -- -�-�- .. .....,_.._..___.._.,___.. _.-
I . .... .
i . . � �. i
f CC)i,:1i•lIEhJTS --- - - ----_ _ ---
3
SEPTIC TANK SIZE
SEEP PIT/U SIZE ------ �----
',Y --- -- --
r,r; - -
—S-'= — ---
::, ' , � �