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Home My WebLink About10560WJll 13118 i) :.z CITY OF DIAMOND, BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION ADDRe,ESS Z J A -164t� �I APN LOT TRACT OWNER C, kid ADDRESS 41-m Assrolony or CITY I4maid 4 r �IP I 1746y TELF61 &'5&3 APPLICANT" ddb lim 'rAdr TEL. r 'YC CONTRACTOR /70C k M bAi ADDRESS /i i J ne 1-f- 4P CITY 6. to ro ZIP 24-iWl TEL. Y 5-- lq ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY, OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U - CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANYCITY OR COUNTY WHICH REOUIRESA PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. CENSE LAW .(CHAPTER 9(COMMENCING WITH SECTION 7000) OF DIVISION OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- iTION. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO 'A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (55007J: ❑ I, AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, :WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. TION, THE OWNER -BUILDER THEBUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE•' UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ [,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ,TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U - CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND "WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC. TORS LICENSE LAW.). 17 I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HERESYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCET. AND EFFECT LICENSE CLASS 6 s3 C LIC. NO. :70 -7/ry f DATE 7 `I k- 2 CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY CF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: I HAVE AND WILLMAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OFTHE LABOR CADS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSUR CE CARRIER AND POLICY NUMBER ARE: CARRIER C's �,:gqA�.'-'7 rZ�.��Ie'"4 ,3 POLICY NUMBER. r w ,✓ :�7-O 7 d (THSSECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100)ORLESS). 1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALLNOT EMPLOYANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECTTO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL LyFORTHWITH COMPLY WITH' TTHOSE PRO PNS. DATE: n f ` / APPLICANT: ; s WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00)), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST ANDATTOFNEY'S FEES. - CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. A& PERMITTEE N; �. 'i if3 I'®l It— V7 SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION DATE PERMIT iG NUMBER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE 1191, ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRAADD/REM Garage/Carporl W Patio/Deck W Pool/Spa ZRe -Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q V H- U W LU W CD e /0 U) CO J Q. U_ aZa 2 W CONSTRUCTION PLAN REVIEW EL PL y MECHANICAL INSPECTION FEE o ISSUANCE ' UY ..� " SMIP ;1'k ENERGY P/C ENERGY PERMI T n� MA 0 -24 RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATI WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Appwann Copy CITY.OF DIAMOND, BAR SET Oso FLOOR JOIST _ a FTGS/FQI MSISTEEL -. FHA REQMT S ELECTRIC GROUND UNDER FLOOR DUCT .. GROUNDRLUIL3t�d fi L AGER F LOOR`00�1I3Ui7 F SLAB GRACE F REPLACE EPLA u FOUNDATTION -� ---- -- TEMP POWER J FIREPLACE BOND BEAM WATER SERVICE MID HT.,Bf.3ND-BEAM u ROOF SHEATHING_ 77 8 FT. POND BEAM pyy V vv'°EiJ, A�1g!Til- B TION i E30NDBEAM 0qq� R��7t FINAL ROUGH HEATING BENCHING i ROUGH ELECTRIC l ROUGH GRADING ROUGH PLUMBING FINISH GRADING —L _ SHOWEW"UB TEST POOL ELEGT'RIO EXT. LAN -USING POOL FENCING 4mIn9_ INSULATION PcbL FINAL CEILING WSULATION OFF SITE IM . ISRALL NMLING - r �i DEDICATIONS FINIAL. ENG. GEPT�O TANK LANDSCAPE/IRRIG. _ _ w DEEP PIT/L.L, CN SITE IMPS. GAS AIR TEST - FINAL ZONING FINALE C{OPZ�. ` a FINAL HEA°��"!I4±?�d ----� FINAL e_ EL.EGTd�. # PLUIVIBING i i i FIRE DEPT. FI3NAI_ HEALTH DE€�gTF.��rf�AL GELS. FEE'S.PAIV ENERGY r� I _ ?4 ''I Z- I MT . -- J I SEPTIC TANK SIZE SEEP PIT/U SIZE Few