HomeMy WebLinkAbout17677 (37) - -----—.. ._ . - -
-
��6��✓ ��,�oriT� �`"� ,�-��d—qL�--G o8�
J� C1TY OF DIAMOND Bt1R
� DEPARTMENT OF COMIvtUNTTY&DEVELOPMENT SERVICES �
x� 21825 E.Copley Drive
(909)860-3195 Fax(909)861•3>» PR ESS
�`%."�' BUILDINGPERMITAPPLICATION FIRMLY
v DDRESS 6�- ����"' ��� DATE'CATION�,�,. �j- a-NUMBER �l'� 1t�t/� �Q
c� � ISSUE � � b TYPE OCC
APN LOT RA DATE CONST. GROUP
p OWNER �
p ADDRESS b , ZONING SETBACKS
z CITY L• — Z�p DOYD TEL. D FRONT RW ❑
g APPLICANT TEL. REAR �
� SIDE/SIDE STREET RW D
� CONTRACTOR SIDE p
� ADDRESS pROPOSED USE S l��
� CITY ZIP TEL.
w ARCFVENG/ .
z DESIGNER D NO.DWEL NO. • NO.
oW,, ADDR S UNITS STORIES
� CITY ZIP TEL l BEDROOMS
cNi� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDEH�ECLARATION SFRlADD/REM
O '
I HEREBY ACFlR/A UNDER CENALTY OF VE0.RIRV THAT 1 AU E%EMPT FROM THE CONiRACTORS L4 G8f8Q9/CBfPOR
W CENSEUWFORiHEFOLIOWINOflE/150N(SEC.70)1.68VSWESSANDPROFESSIqJSOODE:l1NYCITYOR (n
U COUNTYWHICHREd11RESAVERMRTDCONSTPUCf.�L7ERIMPROYE.�EMOUSH.OHRE7AIRANY57RUG W PatiolDack
� TURE,PRIOfl TO ITS ISSUANCE.ALSO REWIRES TNE APPLIGWT FOR SUp1 PENMIT TO FIIE A SICNED w
SiATEMENT TNAT XE OR SHE IS UCENSED PVRSUA"/T TO iME PROVISIONS OF THE CONTMCTORS Lb
� CENSE LAW(C1IAPTEF i(MMMENqNa WITM SECiION 7000)OF DIVISqN 7 0F TME 0U5ME55 AND PR0 � PooVSpa
FESSqNSCODE)ORTMATMEORSMEISEXEMPTTHEREFROMANDiHEBASISFORTMEALLEGEOEXEMP• (�
TON.ANYVIOLATIONOFSECTION70]1.6BYANYAPPLM.ANTGORAPERYITSUBJECTSTHEAVCLICANTTO Z Re-Root
A CML 7EN/�1TY OF H07 MORE iW W FlVE HUNDRED OOLURS(75�0).1:
Q ❑I.ASOWNENOFTHE7ROPERTY.ORMVEMPLOYEESWITHWACESASiNEIRSOLFCOMPENSATION, � CORI11�BfC18I �
z N"LL DO TF�E WORK N�D hiE SiPUCTURE IS NOT IN7ENDED OA OFFERED FON SALE(SfC.70u.BUSi� J
y NE55 AN�GROFESSIONS CODE:THE CONTMCTORS UCENSE LAW DOES NOT APPLY TO AN OWNEfl OF �
PHOPERTY MA10 BUIL�S OR IIAPROVES TMEREON,6ND NM1q DOES SUqI WORN HIIASEIF OR HENSELF OR
CC THROUGNMISOflHERONNEMPLOYEES,VROV10EDTNAT5Up11MPflOYEMENTSARENOTINTENDE�OR m
aOFFEREDFORSPLEIF,HON'EVERTMEBUILDWOORWVROVEMENTISSOLDWITHINdJEYFAROFCOMPL6
Z TION,7ME OWNERAUILDEfl WILL HAVE h7E BURDEN OF GROYINO T141T ME OR SHE DID NOT BNID OR
= qAPROVEfORTNEMIRVOSEOFSAIf�
w Ot.A50NNEROFiHEPPAPERTV,AME%CLUSIVELYCOMMCTPl6V117HLICENSEDCOMMCTOqS
[[ TO LONSTRUCT THE GROJECT(SEC.7Ma,BUSINE55 AND PROFESSIONS CODE:TME CONTMCTOFS LI• V3WHIio AQJ.AREA
W CENSENWDOESNOiAPPIVTOANOMMEROFAPROPERTVNT108U1tDSORIMPROVESTMEREON,M10
F_• N?qCANTMCTSfORSUGIPRQIEGTSWITN�ppNTMCTOR(S)ULENSEDPUPSUANTNTMECONTMG QUANTITY DE CRIPTION FEE
Y TORS LICENSE UW.}
� ❑IAUEXEMPTUNOEqSEC. &�VGFORTHISREASdJ U
�'}
lL �
z �AiE OWNER U i�T� �\
W `.!V
FQ LICENSED CONTFlACTORS DECLARATION —� .
CC I MEREBYAFFIRM UNDER PENALTY OF VERIURY TFUT IAM LICENSED UNDER PROVISIONS OF CHAPTEfl Vr �y A �` O
(y„ Y�COMMENpN(7 YYITH SECTION 7000�OG DIVISqN�OF TNE B1151NE5S AND VHOFES510NS COOE,AND Z
X MY LICENSE 6 IN NLL FOFCEAND EFFEGT. ,�
11J O �
� LICENSE USS �IC.NO. J
�' DATE � COMRAGTOR a �
� IO" 1 �RKERS'COMPENSATIONDECLARATION � •� -�
� U
� I HEREBYAiFIWA UNOER VENALiY OF PER1U(iV OflE OF 7HE FOLLON7NG OECLAMTIONS: Z
L] _INMElWOW!LLMAMTAINACEfl71FIU7E0FCpN5ENTTOSEIidNSUREFORWORKERS 2
� COMPENSATION,AS PRONDED BV SECTION�700 OF THE LABOR CODE,FOR THE PERFORMANCE `U
' OF THE WORK FOH WHIp1 TNi3 PERMIT IS ISSUEO. � �
k"� �,IHAVEANDWILLMAiNfAINWORKERS'COAdPENSATIONIN54RANCE,A5RE0UIFEOBVSECTqN �
Q� 97Do OF THEFABOR CODE,FOR TNE iERFORMANCE OF TME WORK FOR WMidf TMIS PERMIT IS
ISSUE�.MY 5'COMPE ATIONI SURANC CMF�ER NU�IBERIW��T� CONSTRUCTION
jCARqIER_�� � u/ PLAN REV�EW • .
� POLIC9NUu8ER � ELECTRIC
0 (T/i55ECIC7NFEmND7fiE¢MiETEDOFhEPEPMT6FORO�:EM1nDFiEDDQ1Ai5(ft0o)ORLESSI. PLUMBING
Z ICERTIFYiNAY1NTHECENFORMANCEOFTMEWORNFOFWF1iCHTHISVENMITI51S5UED.l MECHANICAL �
(} SNAIL HOT EMPIAY ANV PERSON IN ANV MM1NEfl SOAS i0 BECOME SUBJfCT TO THE ( /�
N WDR7(ERSCOMPENSATIONVIWSOFCALIFORNI0.�NDAGNEETHATIi15HOUlABECOME INSPECTIONFEE v\
S SUBJECTTOTHEWORKERS'CW.�PENSATIONPROVISIONSOFSECTIONl7o00CT11EUBOR
cooe.i sN�u voarnwm�caaa�r wm�rnose vRrnisia+s. � ISSUANCE „ ,
SMIP 1��
O �ATE: APPLICANT: ^
� �� � ENERGY P/C a
WA iNG: AILU CUREWORI(ERS'COMPEN511710NCOVER�GEISUNUWF LANDSXALLBE
�y SU&IECTIINEMPIOYERTOCRIMWALPENALTtESFNDCMLFWESUPTOONEHUNDREDTFqU5AN0 ENERGYPERMIT •
OOLURS(7100.000),W IVDDITION TO n7E C0.5TOF GOMFENSATqN,OAM�GES AS PROVIDED FOR IN
� SECTpNiTOeOFTHEIABOHCOOE.INTEHEST,/NDATTORNEV'SfEES. RETENTIONFEE: �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
CC IHEREBVAFFiNMUNDERGENAtTVOFFERIURVTNATTHEREISIICONSTRUCT10NlENDWOAGENCY
0- FORTMEPEflfORMANCEOFTMEW0�7KFORWMIQITNISPERMIT�5155UED(SEG7a71,CN.C.�. �
� /
� LENDERS NAME
� LENDERSADDRE55
� ICERTIFVTHATIHAVEREADT115APVL1CATbNAND5TA7EMATTNEABOVEINFORMATIONISCARRECi TOTAL FEEyy /��/���� �
w IAGREETOCOMGlYW1THALLGTYANDCOUNTYOH0INANCE5ANO5TAIEUWSREUTINGTOBULDINO ,//i'"� �
� CANSTHUCiION,ANOHEREBVAUTF10R2EREPRESENTATNESOF7HI5CWNTYTOEMERUPONTHE
ZABOVE�MENTIONEDPROPEflT/FORIN5PEC7 Nruaaoses. COMMENTS � � !
� �, 1 C�"I a'R-- ��� —�7.,1�, i —
m
¢ VEiUAITTEE N/JAE RINn ^ �
� � � V
� SIGN U Of P I DATE
� RECPT.�O. PAID BY VAUDATION
� WHITE—Department Copy,YELLOW—Finance Capy,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Appti nt's Copy
.a;'. ,, u .� - �. . ., .4., . .., n.r+�.a.. �cr, „ .� �,r.: �`x �F ��-"+'�sr �?:r-,. " � . ... . , .. . . .. . . . .. . .. .., ,� � . .
� � ~\. .��'/' ,�\ , � '� `'\\. . .
�:i�4� c��= �i��.c�i c�r�ca �n r�
�r���r=��-�so�� ���ot=�a
._..._ .�___� .....,_.
;I�`�-y'a��'�['f�la�� r�,i;!'-. ,I�`�'i.��c �ca:i' �l►�F=i:�-�c �:tc�i�y[ R oi_u�'�: I►�F-7:��c�;lto7�}
r.�i i
...__...____._._ ...�._.._.:'_. '_.�__.. ...�...'. .i.-__..,.._._..... .. .. �_ ... _......._.�..__....____. ..�..._.. ..__--`_. ..�._..._...._._�..�..__.___. � �._._L._.�.:..Y.....__.,._._,
SET BACK j _ � � _ � FLOOR JOIST :-• �
F7GS/FORMS/STEEL � ' , ' FHA REQMTS � �
ELECTRIC GROUND � ' ' UNDER FLaOR DUCT � �
GROUND PLUMBING � � UhJDER FLOOR CU��DUIT
SLAB GRADE � FIREPLACE�OLtiJDATION I
TEMP POWER ' I FIREPLACE BOND 6EAM �
WATER SERVICE I i MID HT. �'�Nd BEAM
ROOF SHEATHING I �' ~ � 6 FT.BONQ BEAr,,t
FRAMINGNENTILIATION (�'Z 2D02 � � FINAL E30ND BEAhA
ROOF COVER —� I PRE•GRADING' ' ;
ROUGH HEATING BENCHING '" `�� I
ROUGH ELECTRIC it. �-- ROUGH GRADING � •
ROUGH PLUMBING _p2 � FINISH GRADING
SHOWERIi'UB TEST POOL ELECTRIC
EXT. LF�THl51DING � POOL FENCING ,
WALL INSULATION POOL FINAL I
CEIUNG INSULATION OFF SITE IMPS.
� DRY�"JALL fJAILING o2't'IflZ,�—' DEDICATIONS
SE1h�ER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/LL � ' � ON SI7E IPJIPS.
GAS AIR TEST <� � FINAL ZOhJING
FINAL CONST. � � ? " FIRE DEPT. FINA!
FINAI.��-1EATIiVG `4 b _�_ —t �,� HEALTH DEPT. FINAL
FINAL ELECTRIC I� �� t+ � � � �� DEV, FEES PAID
FINAL PLUM6ING � ' ENERGY
.{
--,.T,•,..-.._..,._.-�-,._'
__ + 1_�.'�_� ...4',Ir �J--.._..-'--.-.._..___
connc,�Er�Ts � `� �_: , .
� . . , . , ,
�. , , ;
SEP�'IC TANK SIZE
SEEP PIT1U SIZE
'��
1��� ,�,�I
I
� `
�
.� � i`
,
' ' \