HomeMy WebLinkAbout17560 �,` crrY oF n�orro Bnx EXPIRED
� DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES
� y Ziau E.copi�a��� JUN 191(h?Z
(909)860-3195 Fax(909)861-3117 PRESS
"%�� BUILDINGPERMITAPPLICATION FIRMLY
� JOQSITE APPLICATION PERMIT P/C
o ADDRESS DATE___����d 2/ NUMBER 1�J�60 �
$ tssue nrPe occ
APN LOT TRACT DATE CONST. GROUP
p OWNER
" ADDRES ZONING SETBACKS
z CI ZI TEL. FRONT RW ❑
g APPLICANT TEL. REAR D
SIDFJSIDE STREET RW ❑
� CONTRACT � SIDE O
ADDRE
� CITY ZI �TEL. ( PROPOSE�
o ARCH/ENG/ �'S�
� DESIGNER NO.DWEL. N0. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 MEREBY AFFlRM UNDER PENALTY OF VERAIRV THAT I MI E%EMFT FROM iME CONTMCTOFS U• Gaf398/CBf�OH
W CENSEUWFORTHEFOLLOWMQNEASON(SEC.70�t.68U51NES5ANOPROFES510N5LODE:ANYdttOH (n
U WUN7YWHICHREWIRESAPERMRTOCONSTRUCT,ALTER�PROVE,DEMOL.ISN.ORREVNRANVS7RUG W P2S10/OBCk
Z TURE FRqR TO�TS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUpi PEKMIT TO FILE A SIGNED
�l� STATEMENT T71AT HE OR SME 19 LICENSEO FUfiSUANT TO THE PROV�SIONS OF 7HE CONTMCiORS LI� W
� CENSE UW(CNAPTER Y(COMMENCW6 WITM SECTION�000)OF OIVISION�OF TME BUSINE55 AND PR6 LL' P��Oa
fE55qN5 COOEI OR iHAT HE OR SME IS E%EMPT TMEFlEiROM AND TIE BA515 FOR TME ALLEGED E%EMP•
� TION.ANYVKKATqNOFSECTION70�1.6BYANYAPPLICRNTFOflAPERMITSUBJECTSTNEAPPLICANTTO Z Re-Roof
� A pVIL VENALTYOF NOT MORE THAN iNE NUN�REO DOLURS p500).):
0 ❑II�SOWNEROFTHEPROPERT'.ORIAVEMPLOYEESW�THWAGESASTHEIRSOIECOMPENSATqN, � COTmefCial �
z WILL00 TNE WORK,ANO iHE STRUCTIIRE LS NDT IMENDED OR OFfEREO FOR SALE ISEC.YOu,BU51• J
� NESS ANO DROFESSIONS CODE TME OONTMCTORS UCENSE LAW OOES N�T�PPLY TO�11 OWNER OF ?
PROPERTYVI1108U0.050RIAIVROVESTHEREDN.�NOWHODOESSUd/WORKMIIASELFORHERSELFOR m
� THROUGHHISORHEROWNEYVLOYEES,PROVIDEOTHATSUCHIMPROVEI�IENTSAFElqTINTEN�EDOR
QOFFEREOFORSALEIF,HOVYEVERTMEBULDINGORIMPROVEMEMISSOILWITMNONEYEMOFCOMPIE-
Z TON,IHE OYVNER-BUILDER WILL HAVE TME BURDEN OF PROVINO THAT HE OF SHE DID NOT BUILO OR
� MPROVEFOR7MEiURPOSEOFSAtE�
W OI�SOWNEROFTHEPROPEilT1;M1E%CLUSIVELYCON7MCTIN�WI7NLICENSEUCONTMCTORS
[L TO CDNSTRUCT THE GR0.IECT(SEC 70N,BUSINESS AND PROLESSIONS CODE:THE CONTRACTORS LI• VdIU2I1 ADJ.ARE/1
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORMPROVESTHEREON,AND
� YAIOCONTMCTSFORSIICHPRD.lECTSWITHACONTMCTORIS)LICENSEOVURSUANTTOTHECOHTM4 QUANTITY DESCRIPTION FEE
Y TORS UCENSE LAW.).
� OIJWEXEAIPTUNDERSE0. B.1P.C.FORIHISREASON U
� ¢
u" DATE OWNER �
Z W
� UCENSED CONTRACTORS DECLAHATION W
IHEREBVAFFIRMUNDERVENILLTVOF7ERNRVTHATIAMIICENSEDUNDERCROVISION50FCHAPTER �
� 0(COAIMENCING WRH SECTION 7000)OF DIVIS�ON a OF TME BUSINESS M1D PROFESSIONS CODE.MIO Z
�� IAY IICENSE IS IN FULL FORCE AND EFFECL m
� LICENSE CLASS � UC.NO.���� � ��/
V DATE� '� CON7RACTOR�,����� a
W
� WORKEFiS'COMPENSATION DECLARATION a
� U
� I MEREBV AFFIRM UNOER FEWLLTY OF PERIURV ONE OFTHE FOLLOK1NC DECUMTIONS:
� Z
Q
� _IHAYEMIDWILLAWNTAINACERTIFIGTEOFCONSEMTOSELF•INSUREFOfiWORKERS' _
� COMPENSATION,AS PROVIDED BV SEC710N�70o OF TME I/�BOR CODE,FOR TME PERFORMANCE U
Q OF 1HE WORK FOR WHIp17HI3 PERMiT IS ISSUED. �
G
W �IHAVEANDWiLlMAR17NNWORKERS'COMPENSATIONINSUMNCE,A5RE0UIRED8Y5ECT10N /�
O J7000F iHE UBOR CODE.FORTHE VERFORMANCE OF THE WORK FOR WHIp1TH15 PERMIT IS y� /t�
ISSUED.WWORK/Eg�S�C/OMPENSATiONWSURANCEGARIERINDPOIICVNUMBERME CONSTRUCTION r�
� GIRPoER `7/�r� – PLAN FiEVIEW _.._...
Z oaicvNuraeEa_� �.�D ELECTRIC ' ^
0 (fH55ECI1CNNEmNO78E006FLErEDOFnEPERb(rSrqioNElxl�uiEDDolLVa4(StaolotitE55} PLUMBING i_ . ' . .
Z 1 CERTIiV TMAT W THE PERFORIAANCE OF TNE WORK FOR WHlpi THIS OERMIT IS ISSl1E0,I MECHANICAL � ��^� � '� � n n
(J SHALL NOT EMPLOY ANV PFRSON IN ANY MANNEH SOAS TO BEODME SUBJECTTO THE ���II
� NORKERS'COMPENSATIONUWSOFCALIFORN10.M'DAGREETNATIFIS//OUIDBECOME INSPECTIONFEE
SU&IECT TO THE WORI(ERS'COMPENS�TION ORONSiONS OF SEGiION 7i00 OF iHE LABOR �
cooE,�sw�u FORn+wm+cor.�a�r nnn�tnose vnovisior�s. ISSVANCE
� SMIP l- � .. � �
p DATE: APPLICANT: ...
J ENERGY P/C
WARNINO:FA4URETO SEIXIRE WORKERS'OOA�PENSATqN COVEMGE IS UNLAWFUI.AND SNALLBE
� SUBJECTANEMPLOYERTOCRIMINN.FENALTIESANDGVILFMESUPTOONEHUNDREOTHOUSANO ENERGYPERMIT
DOl1AR5(3100,00�).W�D01710N TO TME COST OF GOMPENSATION.DAMAOES AS PROVIDED FOR IN
J SECTION 770!OFTHE LABOR CO�E.MEREST,ANDATTORNEYS FEES. RETENTION FEE: ��
Q
a CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
Q INEflEBYAFFIRAIUNUERVENALT/OFPERIURYTHATiHERE�SACONSTRUCTIONLENOMCAGENCV
0- FOR TNE 7EFFORMANGE OF THE WOHK FORYAIICH 1HI5 VERMIT IS ISSUE�(SEC.�oY1,CN.C.).
Z
w
� LENDEHSNAME
� LENDERSADDRE55
w ICEHTIFYTHATIHAVEREADTNISAPPLICATqNANOSTATETFUTTHEABOVEINFORAIATpNISCARRECT. TOTAL FEES l` .�
� IAGREETOGOMPLYWITNALLCRYANDCOUNT70RDINANCESANDST�TELAWSREUTINOTOBVILDINO
CONSTRUCTION,AND HEREBY�UTMORIZE REPRESENTATIVES OF TMIS COVNTY TO EMEN UPON THE
Z ABOVE�MENTIONEDiROPE FO n+svEcranv�aaoses. COMMENTS
�
J
�
m PERMITTEE NAAAE(PPI
Q �� � ������
�
y SIGNATURE OF CERIIITTEE ��
� RECPT.NO. _PAID BY ��9 VALIDATION
WHITE—Department Copy.VELLOW—Finance Copy,PINK—Assessa Copy,GOLDENROD—File Copy.GREEN—ApDlicanCs Copy
c�-���� C?F D1,�af��G�P�9D F3�'�,R
(f�l��-EC i'iOf�? €��CC��D
_.�___ ______ �_______._...�_ __ ..___�.._
�I���'1.a=Z�.iCl��l►�! ry��,�'-. I►�E�#,a=e"I'e�.�� (►�F�.�.�c,��Ce.�►�� o��tii'�. .1►��-�:��c�i�o1�{.
_____._.---__.____.__.__.____._ ._� ._._ ----_ __..__._ .___.._... _,_ ____..,_._____.�.. _.__.____._. .__._�_____.__._�.._._�_...�.__
SE1'BACK I_ • � � FLOOR J�15T. `.
FTGS/FORP�IS/STEEL _ I � FHA REQMTS
ELECTRIC GROUND � � UNDER FLOOR DUCT .
GROUND PLUMBING � i Uf�lDER FLOOR CU?�IDUIT '
SLAB GRADE FIREPLAGE FOUND/1TIO�d - '
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE I MID HT. BOND BEAP�1
ROOF SHEATHING ����.4- ' � �� � e FT. BOND'BEk�h1
� FRAMINGNENTILIATION —��Y ' ~ FINAL BbND BEAPJt
ROOF COVER • PRE-GRADING
ROUGH HEATIPJG BENCHING �
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUMBING FINISN GR�DING ;
SHOWEFi/TU8 TEST POOL ELECTRIC
EXT. U`,TH/SIDING � I POOL FENCI�dG �
WALL INSULATION . � POOL FINAL i
CEILING W�ULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FIPJAL ENG.
SEPTIC TANK , � LANDSCAPE/IRRIG.
SEEP PIT/L.L. ��' OfJ SITE It�1PS. �
GAS AIR TEST FINAL ZO�dING
FINAI CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
_ _ r�:� , ^i-i lc��s: ,.__...
COPJIMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
��r
�1��� � .�
=� � , . .