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Home My WebLink About16686 � � '��S _�� _ crnr oF n�orro s�x DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES Z�� 21825 E.Copley Drive , \..//�� - (909)860.3195 Fa�c(909)861-3117 PRE$S ��%9�� BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE O S, , � /� � - APPLICATION � PERMIT �An P/C ,�' ADDRESS � �� G�'ZQ (/W'( • DATE � � NUMBER �� q � ISSUE /_ �� TYPE OCC APN LO _�_ TRACT DATE YJ CONST. GROUP p OWNER p ADDRES ZONING SETBACKS z CITY • IP TEL. 3� FRONT Ryy ❑ o APPLICANT TEL. 2 S DE/SIDE STREET RW ❑ . � CONTRACTOR SIDE ❑ o CDDRESS ZIP TEL. PROPOSED USE ��'��C.u�rt9-a ��i� w ARCH/ENG/ � ^ r�,, z DESIGNER t.J��t►V w NO.DWEL. NO., NO. a ADDRESS t� �� . cr� UNITS STORIES BEDROOMS � CITY _�` ZIP DO TEL. N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PEN4ITV OF PERIUFV THAT I AM EXEMPT FROM THE COMqACTORS U- GefB 0/C8 h W CENSELAWFORTHEFOLLOWMGREASON(SEC.7071.6BUSINESSANDPROFESSKKJSCODE:ANYCITVOR (� 9 � � U ODUNTVNTIICHREWIRESAPERAIITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W Patio/Deck Z NRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APP�ICANT FOR SUCH PERMIT TO FILE A SIGNED w w STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� �� CENSE UW(pUPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSpe fESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� (� U TION.ANY VIOLATION OF SECTION 70J1.6 BV ANV APPLICANT FOH A PERMIT SU&IECTS 7HE APPLICANT T0 Z Re-Roof A CML PENALTY OF NOT MORE THAN FIVE HUNOREO DOIIARS(f5o0�.): � ❑I,ASOWNEROFTHEPROPERTV.ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COrtIR18fCIaI Z WILL DO THE WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPEHTVWHOBUILDSORIMPROVESTHEREON.ANDMMODOESSUCFIWORNHIMSELFORHERSELFOR ' wTHROUGH HIS OR HER OWN EMPLOVEES.PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m 0 OFFEREDFORSPLEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWRHINONEVEAROFCOMPLE- Z TION.THE OWNER-BUIIAER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR 7HE PUFPOSE OF SALE). , w ❑I,ASONMEROFhIEPROPERTV,AMEXCLUSIVELVCANTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT 7HE PRQIECT(SEC.70/1,BUSINESS AND PROFESSIONS CADE:THE CONTRACTOiiS LI- V91118tiOf1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOMIOWNEROFAPqOPERTVWHOBUILD50RIMPqOVESTHEREON,AND � WHOCONTRACTSFORSUCH7R0.1ECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECANTRAF pUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). � ❑I NA E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � DATE pyyNEq � Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PENALTV OF PERIUpV THAT I AA1 LICENSED UN�ER PROVISIONS OF CHAPTER. � . � D(COMMENCIMO WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MV LICENSE IS IN FULL FORCE AND EFFEC7, /�y� m � LICENSE CL11 S � LIC.NO.' �`� J. ,� � ' V DATE COtJTRACTOR Q'�� d W � WORKERS'COMPENSATION DECLARATION � � U � I HEREBV AFFIRM UNDER PENALTV OF PERIUHV ONE OF THE FOLLOWINO DECLAAATIONS: Z Z� _I HAVE M1D WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOR)(ERS' a Q COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERf-0RMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W W � • Q _I HAVE AND WILL MAINTAIN WORICERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTqN �0� • �� Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS J ISSUED.MY WORKERS' NSATIO INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION �7�/,,�._ w. A � CAHRIER.0-e✓'es�p�,_.-/1��B�fT+Iv,. (�1StJItt�GC_ PLAN REVIEW B�(!l /\ . Z POIICY NUMBER � I F�V M'Z�I I ELECTRIC �`� Q � fnissEcrqNn�rareEWM1PLErEoocn-EPEwarswaar+EruwnEooauRsry�m�alLEss} PLUMBING W _y Z I CERTIFY THAT IN THE PERFORMANCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � ' � (\/ C.�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE ' . � N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANOAQREETHATIFISHOULDBECAME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATION PROVISKKJS OF SECTION 37000F THE LABOR OE,I S f-0RTHWITH COMPLV WITH T�Q�ROVISIONS. ISSUANCE � � �� r p DA7E: � I APPLICANT: U/�� SMIP �' � � W "'� WARNINO:FAILURE TO SECURE WORKEHS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C J � �y SU&IECTMIEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNOREDTHWSAND ENERGYPERMIT 0 DOLLARS(flao.0a0),IN ADDIT70N TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN J SECTION�]OB OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CANSTRUCTION IENDING AGENCV � FOR THE PEflFORMANCE OF THE WORN FOR WHlpi THIS FERMIT IS ISSUED(SEC.3087,CIV.C.). Z w � LENDER'S NAME � LENDER'SADDRESS /� w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES �� / �' � � � � � I AQREE TO COMPLV WITH ALL CITV AND CAUNTV ORDINANCES PND STATE LAWS RELATINO TO BUILDINO 0 di � • � CANSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS o �j�� PV1 c`�S' � N �P�IMI77EE N ( N'� , � ��1 /� � `` ' � �SIG NREOFPERMITTEE '�T�E _ � RECPT.NO. : PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—Applicant's Copy C��'�'I �I� �a6�a�1��9@� l$31�1(� 6�9��[��"�02�� l��Ct�f�3� - �-T-- � " �� 0�� L�� 6[Y °, Cc U�"��} _� ° �c� O DD . �- �� .o SET BACK • FLOOR JOIST FTGS/FORMS/STEEL � _ _ , FH.A REC�MTS _ _ __ EL�GTRIC GROUND ��_ r / UNDER FLOOF� UUC�f _ GROUND PLUMBIMG '� �� ' ' �'' 1JNDER FLOOR CU�IDUIT SLAB GRADE FIREPLAGE FOUNDATION i Eh/iP P4WER FIREPLACE EON[YBEAM WATER SERVICE �ID HT. BONfSBEAM � ROOF SHEATHIf�G . 8 FT. BOND BEAM FRAMINGNENTILiATIOPI FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATiN.G BENCHING � ROUGH ELECTRIC ROUGH GRADING ROUGi-i PLUMBING (�./�-��`�_ FIN1S�.�RADIh1G �MnWE�/TIIB TE�T�_ � i'OOL ELECTRIC �XT. LATH/SID�NG �� ;L POOL FENCI�lG —V - -- -- - WALL INSULATI�tV � PCZOL FINAL CEIUtJG IN.SULATIQN " OFF SITE IMPS. DRYWALL NAIUNG � 1//�/02 �� DEDfCATIONS _ _ �l_ SEWER ��=� FIt�JAL ENG. � - SEPi"IC TANK LANDSCAPFJIRRIG. SEEP PtT/L.L. ON SITE IMPS. GAS AiR TEST F1NAL ZONII�G . FINfiL CONST. FIRE DEPT. F�NAL � �� FINAL HEATING HEALTH bEPT. FINAL •��-�., � FINAL ELECTRIC DEV. FEES PA!D FINAL PLUMB�NG . 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