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HomeMy WebLinkAbout10913 (5) -- . . _.. __.. . . ..__ -. i ___. ` _ " --�---�._.r,`-'-�.,� '_ , _ � -- _ __.. - _ � ---��..-- CITY OF DIAMOHD BAR. .. ....... :. . _. ,.. .,:_.,: � COMMUNITY DEVELOPMENT DEPARTMENT ' ` '`' x;.•C 21660 E.Copley Drive Suite 190', . : . -,.. �, PRESS (909)860-3195 Fax(909)861-3117."• ` '`'�t ': ` • '`'", '' ""'� BUILDING PERMIT APPLICATION FI R M LY � JOBSITE:'. � . ,'' : APPLICATION �� y C'�} PERMIT;,., G a P/C• ; o 'ADDRESS . 3. DATE .•-, !/S ..I, ! 'NUMBER ��lIJ. ,;� , ;._� � . ' �ISSUE . TYPE i OCC�,._. i�� ' '' _.... . _ . .. . . , I � 'APN . ....._._. _ __ �T... ..----... TRACT -- , • DATE . . .,_,. .._ _.. ..- ---- - . ._1CONST. - - .__.. ._ -.GROUP,- pOWNER � ,L.._ ... .. iI " ADD ESS ,232 .. ONING SETEtACKS � � � ,�� ; � �►� ' , , C ,!' �" � Z i FRONT. _._...-- --- . _ - - -� Fiyy - ❑ _ . i �z CITY � ZIP_� TEL.;�C�_3S�-lY�� '� I ; �� _ I--o -APPUCANT-- - - - - 'TEL: . ; ._ .SID SIDESTREET RW ❑ ¢ ' , . . i. .'���. '� � .. ._.._...... _ _.. ._ ... . _ _ _. .. ...SIDE � CONTRACTOR � . : ._ , �.. ,"..'' ,': -... . __ . ......._. ..- ----.. ._ _ . �. : :. -. " ADDRESS—-....... ,--- ......_.. ._ --- - . ..__._ . ,. --- • - ` ¢ _ . .:, . PROPOSED USE__ -- - �-• _ , .. . o _CITY � ZIP _7EL, i':� � ,_:�.. � � l ,.. _, __.__. _.. _ __ _. _ . .. � ..� '—_ �---p ARCH/ENG! � � , .... . _ ., , _-z �ESIGNER _. _ ;....._. ,_. _._.._. . ... ., ' : � ' ' i l i .. __.._ . , ... _._ .. �_.a. .ADDRESS � � ,. �, r.. i NO.DV'/EL. NO. �::?:�. NO. .. , �-�.. ' � � � UNITS - - �-� --- -- STO S-� BEDROOMS ' ' ,��•:.- ,. � -� ---..----- ---.._..._........_.... _ .� ' ;� . _._.._._.__ ... . .� ' � - .DESCRIPTION SO:FT.-- "'FACTOR PSF"' " `ADJ.ARENVALUATION , � � . ��'� J ,. ._.�. . __.....__._.... , ....OWNER•BCILDERDECLARATION --.--... _. ^... __.. ._ . .SFRlADD/REM-� .---. . ;___----,_. ........_ . ....._ .. _..... ... . O � �1.,,... .. � , ... • -.. i _.....1 HERGBY AFFlRM UNDER PENQTY OF PERJURV THAT I AM EXEMPT FROM THE CONTMCTOfiS lF �� ' �G8f8g9/C8ry0R�•��-� -��� �' � , W CENSEUWFORTHEFOLLOWMaREA50N(SEC.7071.6BUSINESSNiDVROFESSIONSCODEANYCRYOR (f� �� � ��" � ,....... _._..._. _.... .'_ ." '_' . ..�, , . ._... U COUMYWHIp1REWIRESAPERMITTOCONSTRUGLRTERIIAPROVE.DEMOLISH,ORREPAiRAN`/SiRUG W '„Pa110JDBCk . ._ .. ...._ _. , ; ,.__. , I • � � ' � . �� . i: . � ,. � TURE,PRIOR TO fT5 ISSUANCE.ALSO REOUIRES THE�VPLIC/NT FOR SUQ1 PERMIT TO iILE A SIGNED' ' ' .....�__.. .. . ...'.,... _ .... .__.. ..... "_ � �� STAT[M[NT TMAT HE OH SHE IS LIGENSE�PURSUMti TO THE PfiOYISI0N5 OF TME LONTMCTOHS LI•� ' LL � , �--` -�CENSEUW(CHAPTERO(COMMENCWOWITHSECilON700010FDIY15qN90F.THEBUSINESSANDPHO-�.. �_ 'POOVSpB ___ _ : •. . � . . . FESSIONSCA�E)ORTMATHEORSHEISE%EMPTTNEPEFROUANOTHEBASISFORTNEALIE�EDE%E�P•: (� �� � V, TION.ANVVIOLATIONOFSECfION7071.6BVANYAPVLICANTiORAVERMITSUBJECTSTMEAPPLICANTTO �� Z �Re•Roo! � �'.�. �'. � � � A CML PENnLTY OF NOT MORE THAN FIVE HUNDRED DOLURS(3500).1: ' � �' . � : �� � � OI,ASOWNEROFTXEPROPERN,ORMVEMPLOYEESWIh1WAGE5A5THE11150LECOMPEN5AT10N,'� �' 0 i�mmercial I � �,�: �� I.��"� � ' Z 'ri1L100 THE WORK�ND TME S7RUCiURE IS NOT INTENOED OR OFFEREO FOR 6QE(SEG 7UN,BU51• J � � '' NE55 AND DROFESSIONS CODE:iHE CONiRACTORS 110ENSE LAW DOES NOT A7PLY TO AN OWNEN OF N .,PflOP[flTYNh108URDSORIMPFlOVESiHERE0N,M1D'MiODOESSUCHWORKHIMSELFORHEFSELFOR' _ ' �� '�f�„'�1 - C[ THROl1GH HIS ORHEN OWN E4PLOVEES,PHOVIOED TNAT SUCH IYPROVEM[NTS ARE NOT WTENDE�OR � m �_Q OFFFAEDFORSALE.IF,FqWEVERTM[BULDINGORIMPROVEAIENTiSSOLDWITHINONEYEAROFCOMPLE� �' � i .. '�+^ • •� � Z ��T10N,THE OWNER�BUILOER WiLL HAVE 7HE BURDEN OF PRONNO THA7 HE OR SHE Oi0 NOT BUtLp OR -- , � , . ... , . . � = IMPROVEFORTHEPUPPOSEOFSALE. I : � .. i.. �.1. . � , . .'i. '_ ) �•-w� ��.-. -pI,ASOWNEROFTMEPROVERTY,MAE%CLUSIVELYCOMMLTWGMA7HLICENSEDCONTMGTORS . � � .._ .. .._.. ...__.... . ._._.. , Q TO CONS7HUCT THE PR0.IECT(SEC.70��.EUSINE55 AND PflOFE5510NS CODE;TNE CONTRACTORS LI• r-r � !VelU81i0R ' AQI.AREA � ��� ��� �� � VAIOCAMRACTSFDHSUCHPR4)ECTSNATHACOMAACTOR(S)UCENSEDPURSl1ANTTOTHECONTµD � � � w�a. . ; QUAIJTITY .. . DESCRIPTION-�-�------... . -- FEE�; -- ...... .. _ CENSEUWDOESNOTAPPLYTOANOWNEROFAPR07ERTYNRIOBURDSORIMPpOVE4TMEREON W TORSLICENSELAW.). I ��� � J ' _� . _ . _� .----------. . . . __...._ ,. _.._ .. . ,� .�_, _.._.. ) - - - .. ..;_ ._ . . . . , � ❑I AM EXEMPT UNDER SEG. B.i P.C.FOR TNIS REASON : Q � � ! G G�O i��(,�j�rf;� _ � i . � . , -. _..: .�'.. , _� ___......._.. . ._.. ..... .-----.._...._._......_... _...... .--- _ " .. �__ . O�► - - -- ' - - - .. . � � � OATE, ' OWNER � ,..,.', ". � ., � ... . ... ' ., — . . S ► o. ... � .�...... . ..+C r -- � � _.. .._ r LICENSED CONTRACTORS DECLARATION : _ ._. J ' ' , � . , , �....� . _..... ..._.._ W � - � • :// ' .. _. , .. � _ __-- _. � IHEREBYIIFFIRMUNDERPENALNOFVERJURYTNATI�MLICENSEDUNOERVflOV1510NSOFCMAPTfN� � _ ��� ��'�' %, ' ('. r'� ':1�. '._ � �� Y(ODMMENCINO K7fH SECTION 7000)OF DMSION 70F THE BUSM[55 M7�PROFESSIONS COOE,M1D Z -�� - �--��� ��� �-� 7 � � � Yp,i ►/Y LIGENSE IS Pl FUIL FORCE AND EFFEGT ` - � � '"' � .. ..... a '� m : I � "��..', �.` �l � � � �. '�' ..��. . . ., . �, i i. � ,..� � .; _. . _....,_...... .... ......'_"'_"_'�..._". ._ -_._ � � LICENSE CUSS LIC.NO. � � � j ; � . ...._'-'. ..._ ._._..... ._._ _...,_...'-'.._..._..._..... F'-' �ATE CONTRACTOR. ... � •.• . n. • . ., . . ..... . . �, . .. . � . .��,. . ..:, . �. � ' . W .. .. . .... . . . ._..._..._. . . .., , ,. ' ,.. ., . � � � � WORKERS'COMPENSATION DECUiRATION a � N IHEREBVAFFIRMUNOERPENALTVOFiER1URYONEOFTMEFOLLOWINGGECWUTIONS: Z "� ,,,,�•• ' '__" " _ .....""'_"_'.,.._. . ; ��... ! � _IHAVEANDWILLMAINTRINACERTIFICATEOFCONSENTTOSELFdNSUREFONWORKERS' 2 � ���� � " '- � �����"��� -'"'""'"-"' -- COAIPENSATION,ASPRONDEDBYSECTION77ooOFTHEUBOHOODE,FORTHEVER�ORIAMICE �U I.... � ,, ,_OF THE WORK iOR WHICH THIS VERMIT IS ISSUED._ -p ' ' "__...... _._..... .. --.."'_ '... � ...._. .' --._._.. _..._...__._.... --. "-_.- ....._ .... _......_ .. . _._,...... . _ _........... W _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION �, _Q 970o OF THE UBOR CODE,FOR 7HE DERFORUANCE OF THE WORK FOR WHld/THIS DERMITIS ISSUED.MY WORKERS'COMPENSATION INSURANCE CMRIER AND POl1CV NUMBER ME: "��-� -' �'�"'CONSTRUCTION "-'�"""'" �'-- ��-��•-�- -------� I — __ .._....._. . .......... ....... . j CARRIER P W _. .._. . ........ ......._. _. .....__'_' Q .. . ... ..._... ...."".....,.. ._.... . .. _. . .,. POLICY NUMDER . . .. .. . .... ....-._... . .. ..._.... ._.._......._ ....._._...__. _....' � ELECTRIC I: � ......._..(ry�I55ECIri��EmN0TBE0D�.�lEfEDOF1IEPERMf6KQONEW�D(7EDOOLUfLSK�0010RLE551,. ... ... .PLUMBING.. ..... I Z ICERTIFYTMATPJTF7EPERFORMANCEOFTHEWORNFORWHIpiilIlSPEflMITI5155UED,l MECHANICAL � ��-C7 � -��- SH►LLNOTEMPLOYANYPER:ONINANYAIANNERSOASTOBECOMBSUBJECTTOTHE_....____._. � WORKERS'COMPENSATqNLAWSOFCALIFORNIA.ANDAGREETHATIFI5H0UlD0ECOlAE INSPECTIONFEE�� �� ����'�--'-'"""'-` " .,........' "_.._'._'__.'..� " "'. � � SU6IECTTOTNEWORNERS'COIJ�PENS�TIONORONSIONSOFSECilON770DOFTHELA80R . � � ,,,� GODE,ISHALLFORTT/WIhICOMPLVWITHiHOSEPROVI510N5. �SSUANCE � . O . . ... . ._._.._..... ,._.. "'"' " .,_ .. .,.. .. -_.. .,._.....--....._.....'"' . . ...' __ .' .__ ._..._ ._..,__.... � SMIP _........ ........._ p DATE: APPLICANT: ....... ._ ; � WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,�AND SHALLBE�"" " - '-ENERGY P/C , �--- ; LL SUBJECTANEMPLOVERTOCRIMWALPEN�LTIESANDCMlFWESUPTOONEMINDPEDTKK15AN0 ENERGYPERMIT � I } pOU,ARS(fl0o,o00�,IN ADDITON TO iHE GOSTOF COMPENS�TION,CAAIAGES AS PROVIDED FOR IN J SECTqN77DBOFTHEU00flCO0E.INTEREST,AN�ATTORNEY5FEE5:..'...... .._. ...�_., ..._._._ .... _. _ ......."""' F . ... _.. ..""""'�.. ........._ ..."' ''.. . . � p� RETENTION FEE: � �-' ^ ' ' 1 _O _ CONSTRUCTION LENDING AGENCY PRE•ALT FEE: �•-��•��-�-�-�--� �� � ��� � ,.__... .. ..-----•. ... ..,....._. .. .. .. ... _. ...-- -��-- /� --._. .._ . .. _... ... _ _. _... � IHEREBYAFFIRMUNDER7ENALTYOFPERNRYTH�TTHER[ISACONSTRUCTIONLENDINQACENCY (�� a+... ,. '�����• FOIl TME PERFORM,WCE OF iM[WORK FOR WHlql iHIS PERMIT IS ISSUEO�SEC,3097,CIV.C.�, �. ..... . ..... __..__._.._ _..__..—.. _. .._ .. .._.."_' ., .. ._._._.... ..._."'_... ... . . _. _ _..._........ ... . . ., • L LENDERSNMAE . ' � . . � , �. . � ......_'.___._.......... , . � . ., � - LENDERSAODRE55 ........_...._... .. ....__"",...'_ '_'." . _'__' L__ ^ ICERTIFYTHATINAVERE�DTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORMCT. TOTAL FEES � '�• � �: • . ' I ACREE TO COI.IPLY WITN ALL pTYAN�COUNTY ORD�NANCESAN�STATE UwS RELA7ING TO BUILD�NC� , „ " ""��"""'��� ��"�• � � � • � ' '� � � CdJSTRlKT10N,ANDMEREBYAUTNORREREPR[SENTA7!VESOFMISCWNTYTOEMERUPoNTXE .. " , ' � . , • ! _ AWVE-MENTIONEOPROPENTYFORINSPE IONPURPoSES. � ,� - - � ' .. _. .. ._. _.�. . .-�� �- -- -- - - �---. _-___- ._._.....- �- -- •COMMCNTS , . ' •�r --L �. 0 x J �� � m PERMI EN ��PW ' . . ...__ ...�. ..... ._. _.� ..'.-"'... __'____' _ ""'_"' ' ' ' Q '�f cn /l � r 0- �. _ --- � , , , �'"-�� 'sro?AIUH OF PE MIT DATE ' ��� - � ��. � .. �Y . : — RECPT.NO. PAID BY � '�"' VALIpAT10N /�� • • •� � � WHITE-Department Copy,YELLOW�inance Copy,PINK-Assessor Copy,GOLDENROD-Fite Copy,GREEN-ApplicanCs C � • - � • . ., � , t� " ��-., � .. --,- .,. , . ., . . .-E.,ir. .... r �. . .. - . , . . - . . . , . , . i �_ \\ - �' ` CITY.OF DIAMOND BAR ' ', �. `` � 1\ � INSPECTION RECORD ..;: �, , . , � , , . �,.._ _ __ � . . . .�� �i , � � � � , . � . . � 1 � . � . SET BACK _ � ' �` FLOOR JOIST �- - ',: - FfGS/FORMS/STEEL FHA RECIMTS " ' ,' ; . - i ... ELECTRIC GROUND � UNDER FLOOR DUCT:�, ; . , � �' �,�• � � GROUND PLUMBING - - - ' UNDER FLOOR CONDUIT . .' ` �, . . : ; SLAB GRADE - ' ' ' FIREPLACE FOUNDATION ' -� � ' ' ''�" ' ' TEMP POWER � - �- � . FIREPLACE BOND BEAM �• ` ' WATER SERVICE- � - � - � ' t �� � �-- � MID HT.80ND BEAM �, RQOF SHEATHING ' 'i ' ' � 8 Fr.BOND BEAM � FRAMINGNENTILIATION ! FINAL BOND BEAM - ' RDOF COVER - - PRE-GRADING ' ' '� ROUGH HEATING - -� ' - = =` BENCHING ROUGH ELECTRIC , - - ROUGH GRADING ' ROUGH PLUMBING � � FINISH GRADING ' SHOWEF�/TUB 7EST - � � POOL ELECTRIC EXT.LATH/SIDING FOOL FENCING , WALL INSULATION POOLFINAL . CEILING INSULATION OFF SITE IMPS. ; DRYWALL NAILING i DEDICATIONS SEWER. .._. ._.. �. . _ ! .. . FINAL'ENG. � �i SEPTIC TANK � . . . - ' LANDSCAPFJIRRIG. _. ._ I ,SEEP�PlT/L:L.--' _, ... --- __ _ , . ON SITE IMPS. �GASAIATEST�'; ••.' . ' -'. �= � •'' '': . ' • FINALZONING � I FINAL�CONST. ' • � '•' •' ' ' ' '- - "• • • � ' FIR�DEPT.FINAL I FINAL HEATING ' �� �' " '•;' �• ,' ' - -`:' HEALTH DEPT.FINAL ; - - � �� - '� DEV.FEES PAID � F1NAL�EL'ECTRIC-- =_; l . , , ' FINAL PLUMBING � � ' ENERGY • _. .. -- - -- __ __...----- - � • - .. - -- __-- _ __- - - . i COMMENTS - - -- i : _ ; _ . . , . __�. . . _ . - �---.� . -- - �--- . _ _ , ; t � , - _ , .., , � . , � � , , , _ . � . . _ .. `Z:�P� ;��:� , .I ; . . . ' ...... SEPTIC TANK SIZE � ' , -, ..._ _ . _ . SEEP PIT/U SIZE - ,,r,� . . �� �,.!�� , , , , � _ . , _ _ � � , , : ,� •� �. _. _ . ,., �� • t��, r�• . , ` � � . . • � , ,` � . �� ' , . \• � , .. , , -.• ' '� � , • � , ,