HomeMy WebLinkAbout16805 (19) crnr oF v�orr�a�x EX P I R E D
^----��-- DEPARTIvIENT OF COMMUNTfY&DEVELOPIvfENT SERVICES
21825 E.Copley Drive J U N 18 1002
(909)860-3195 Fax(909)861-3117 PRESS
��"�»��� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE �j'7o �'�� �, GO(,���� S�N(�S O�Z. APPLICATION � �1 a PERMIT I /\` P/C
¢ ADDRESS � #
o DATE_ I O NUMBER <D �+v
�, ISSUE TYPE OCC
� APN LOT�, - TRACT DATE CONST. GROUP
p OWNER _• AR�✓V � (,(J{.�EIJ
p AODRESS��� l�i N, CoOL���hI SPR� I�D�. ZONING SETBACKS
Z CITY�Af�UN �Ir{R ZIP �II")bS TEL.ald�l 8�^S� FRONT qyy p
� APPLICANT TEL. REAR p
� ^ SIDE/SIDE STREET RW ❑
CONTRACTOR�FIFLONS NEA1�/1�� � SIDE p
� ADDR SS � ( �. I�f.IN
� CITY �Ll��._ ZIP�17�i TEL.q�) 1LEA� � PROPOSED USE
w ARCH/ENG/
z DESIGNER
a ADDRESS NO.DWEL. NO. NO.
cn UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q • OWNER-BUILDER DECLAAATION SFR/ADD/REM
O
p I HEREBV AFFlRM UNDER PEN4ITV OF PERNRV THAT I AA1 E%EMPT FROM THE CONTMCTORS LI� G8f89B/C6fPOR
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.5BUSINESSANOPROFESSIONSCODE:ANYCITYOR (n
U COUNTYN?11CHREWIRESAPERMfTTOCANS7AUCT,ALTER.IMPROVE,DEMOLISH,ORflEPA1RPNV57SiUC�
w NRE.PRqR TO ITS ISSUANCE,ALSO RC-0UIRES THE MPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI�
CENSE LAW(CHMTER 0(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � PooUSpa
� FESSqNS CADE)OR THAT HE OR SHE IS E%EMPT THEREFROM Ml�THE BA515 FOR THE ALLEGED EXEMP� (7
U TION.M7V VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOF A PERMIT SU&lECTS iHE APPLICANT TO Z Re-Roof
A GVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLAFiS(f500).�:
� ❑I,ASONTJEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COffIR16fCIel
Z WILL DO THE WORK�D THE S7RUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,BUSI- J f
� NESS AND PFOFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNEF OF �
VROPERTV WFq BUILAS OR IMPROVES THEREON,/W D WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wT1IRIXMH HIS OR HER ONTI EMPLOVEES,FqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
0 OFFEAEDFORSALEIF,FiOWEVER711EBUILDINOOFIMPROVEMENTIS50LDWfTHINONEVEAROFCOMPLE�
Z TION,TME OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN�THAT FIE OR SHE DID NOT BUIID OR
� IAIPROVE FOR THE PURP0.5E OF SALE).
�yJ OI,ASOWNEROFTHEPROPEHTV,AME%CIUSIVELYCOMRACTINOWfTHLICENSEDCONTMCTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7WI,BUSINESS AND PROFESSIONS CODE:THE CAMRACTORS ll- V81U8t1Of1 qp,�,qqEq
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWFqBUILD50RIMPROVESTIEREON,AND
� WHOCONTRACTSFORSUq1PROJECTSWITHACONTRACTOR(5)LICENSEDPURSUAN"fTOTFIECANTMG QUANTITY DESCRIPTION FEE
Y 70R5 LICENSE UW.�.
0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q �
?� U
� DATE OWNER ¢
Z U
� LICENSED CONTRACTORS DECLARATION W .
� I HEREBY AFFIRM UNDER PEN/LL.TV OF PERIURY THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
LLI �Y��ENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLAS/S` LIC.NO. 7�v'�Y� �
V DATE �/ �� CONTRACTOR. 7 d
W
� WORKERS'COMPENSATION DECLARATION Q
N Z - i�s C — r tr�.T .� , .
N I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF 7HE FOLLOWING DECUMTIONS: '
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ J� J^� /�� �✓
COMPENSATION,AS PROVIDED BV SEC710N 37000FTHE LABOR CODE,FOR THE PERFORMANCE U ''7��G/�/ O~� /"
wOF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. � � �
�I HAVE AND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REOUIRED 0Y SECTION �
Q 3700 Oi THE LABOR CO�E.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORNERS'COMVENSATION I UHANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
J �-TtLF��
� CARRIER � PLAN FEVIEW
� POLICY NUMBER Z��) �Q �Il�r ! �� ����_ ELECTRIC
� (iHISSECIqNNE�NOTBE00MPLEfIDOFTHEPERMTiSFORONEMJI�DREDDOIIARS(t100)ORLESS} PLUMBING
W
� C HAT IN THE PERf-0RMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C H P�OY ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(,/J `' R'COMPENSATIONLAWSOFCALIFORNI0.N�DAGFEETHATIFISHWLDBECOME INSPECTIONFEE
BJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION 70oOFTMELAeOR
~ � CODE, SHALL OFhIWITHCOMPLVWITHTF105EP VISIONS, ISSUANCE �
�
O ' ���j , .O
p DATE:YZ���- APPLICANT: �j� SMIP '�. . — I
W
J WARNINO:FARURE TO SECUFE MlOFiKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SH/�LLBE ENERGY P/C
� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100,oa0),IN ADDITION TO THE COST OF COMPENSATqN,DAMAOES AS PROVIOED FOR IN
� SECTION 3708 OF THE LABOR CODE,MTEFiEST,AND ATTORNEV'S FEES. RETENTION FEE:
OCONSTFUCTION LENDING AGENCY PRE-ALT FEE: S�: __
� I HEREBY AFFIqM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDINO AGENCV `
f-0R THE PERFORMANCE OF h1E WORN FOP WHICH iH15 PERMIT IS ISSUED(SEC.3087,CIV.CJ.
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS
w ICERTIFYTHATIHAVEREADTHISAPPLICATIONlWDSTATEhIATTHEABOVEINFORMATKKJISCORRECT. TOTAL FEES � � I,U
� I AGREE TO CqMPLV WITH ALl CITV AND COUNTY OPDW/WCES ANO STATE LAWS RELATING TO BUILDING �
� CONSTfiUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES, COMMENTS
�
-� ����
�
m PERMITTEE NAME(PRINn .
Q
cn G
� S ATURE ERMI EE D TE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—As;essor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy -
(GOT�f �D� [C�6Af��D�49� [�I,�I�
OG�I�(�I��u 0�6�I f����V�3�
° : D�� L�GJ� OG�G°��[�' , �; .��C� DGJ rt`� OG' °l��
5Ei'BACK � FLOOR JOISI"' '
FTGSlFORMSlSTEEL � FNA REQMTS � �
ELECTRIC GROUND I UNt�ER FLOOR DUCT
GROUND PWMBING UNDER FLOOR CU�IDUIT. ~ �
SLAB GRAQE FIREPL•ACE FOUNQATIUN
TEMP POWER � FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM �
ROOF SHEATHING 8 Ff. BOND�BEAM � � .
FRAMINGNENTILIATIOhI FINAL BOND 6EAM
ROOF COVER PRE-GRAGING
ROUGH HE,4TlNG BENCHING
ROUGH ELECTRIC � RQUGH GRADING �'
ROUGH PLUP/IBING FINISH GRADING �
SHOWER/TUS TES7 POOL ELECTRIC �
EX7. LATH/SIDING POOL F�NCING
WALL INSULATI(�N POOL FINAL
CEIL{I�lG INSULATI�tV OFF SITE IMPS.
RRYWALI.NAILING DEDICATfONS '
SEWER FINAL ENG. V�
SEPTIC TANK LANDSCAPEJIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST F�NAL ZO�fING
F1NAL CONST. � GlRE DEPT. FINAL
FINAL HEATING HEALTH bEPT. FINA�
FINA�ELEC7RIC ' DEV. FEES PAID �
FINAL PLUMBItJG ENERGY
'C�G�O�,��
CONlMENTS � - . _ .
.`
SEPTlC TANK SIZE
SEEP PITIU SIZE --
�
�, �
� � � , . � � " �