HomeMy WebLinkAbout16703 (42) �` CITY OF DU\I�10ND BAR
DEPARTMENT OF COMMUNiTY&DEVELOPMENT SEFVICES
c ���S� `•y�;,.�y 21825 E.Copley Drive � '
��. (909)86D-3195Fax(909)861•3117 � PRESS
\\��,;'� IIUILDING PERh1IT APPLICATION FIRMLY
o� JODSITE �7 /��L�� �����, DATE CATION ? NUM�ER � � #/C
ADDRESS L2 �� ,��
� APN LOT TF�ACT ISSUE TYPE OCC
-r� DATE _CONST. GROUP
o OWNER _� �1�1� '1/� �� !�lbW/�)�t. .
o ADDRESS ZONING SEfEiACKS
z CITY ZIP 7E�, FROPJT RW O
� APPLICANT 7��, REAR ❑
� SIDE/SIDE STREET RW O
� CONTRACTOR , f�, �(/�it/JEb�J�'I. SIDE
� ADDRES (J a� �' �/��/ PROPOSED USE ' lJ�U!/ �JC� E�CJ�
� CITY lL�Y �- ZIP�I�Sf�. TE G2b���/ 7
o ARCH/ENG/
iz DESIGNER NO.DWEL. NO. NO.
a ADDflESS UNITS STORIES E3EDROOMS
� CITY ZIP TEL.
y DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER�BUILDER DECLARATION SFFL'ADD,M1iE61
O
1 HEREBY AFFI{LU UNDER PENALTY OF PE0.1UFv THAT I 11u EXEA1�7 Fn01A TME fANTHAC70ii5 U- G0l�geiCefpOfl
W CENSEUWFORiHEFOILOYnNGHEA50N�5EC.T07t.5&151NESSAIrJGROFE55iON5CODE:ANYCITYOR (n
ZCOUNTYNMICHREOUIiIESAPEfURTTOCON5TRLICT,ALTER.IMP{10VE.DEMOLISH.OflREDAIRAVYSTRUC• W patiolDeck
'c NRE.PRIOR TO RS ISSUANCE.ALSO REOUIR[5 THE APPLICANT FOfI SUCH PEFMIt TO FILE A SICNED w
STATEMENT THA7 M[O(1 SME IS UCENSED PVRSV�NT TO TNE PROVIS�Of:S OF TME CON'MCTO�S ll�
� CENSE LAW(CNAPTER Y(COA1uCNCWG WITH SEC7�ON 7000�OF OIV'S�ON]OC THE BJSINE55 AN7 DRO� � POOUSp3
FESS�ONSCOOE)ORTXATHEOIi5HE1SE%EMPTTHEREFHOMANDIHEBAS:SFORTHEA:LECEDE%EMv (�
VTION.ANVVIOUTIDNOFSECfION70]I.SBYANVAPPLICA.YTFDRAPEHA��TSU&!EC57HEAPP�ICANTTO Z qe_qool
F ACMLPENAL7YOFNOTIbRETMANFIVEMU�DRED00LU�75(f5o0).�:
0 OL�SOYlNEROfTHEPR07ERTY.OAMYEMP�OYEESNIITMWAGE5A5TMEIRSOLECOMPCNSATqN, � COrtIrtIBfC471
Z WILL00 TNE WORK AND THE SiRUCTURE IS NOT IMFNDE�OR OfFEfiED FOR SALE IS[C.70�1.9U51- J
� NESSANO PROFESSIONS LODE:TME CONTMCTORS LICENSE UW�OES NOT APPLY TO�N OW�CH OF �
GRDPERTY N'MO BURDS DR IM PROVES TMCRE0IL AND NT1D DOES SUW/MNRK MiM.EIF OR HE RSELF OR
Q TMROUCHHISORNERONTIEA�OLOVEES,VROYI�EDTHATSUCHIAIPROYEMENTSM[NOTINTE�DEDOR m
QOFFEREOfORSALE.IF.HOWEYERiHEBVILDItiCOHIMFROVCMCNT1550lDWITHI40NCYEAROfCOMfRE�
Z TION.THE OWN[R�BUIIDER WILL MAVE THE BURDEN OF PRCVVIG THAT HE OR SHE D'D NOT BUIL�OR
� MPROVEFORTMEPURPOSEOFSALE�.
O IASONMEROF7ME VROPERtt,AM E%CLUSIVELYCONTRACTING WTMLICEN:EO CONTMCTORS
Q TD CONSTRUCT 7HE PR0.IECT(SEC.70N.BUSINE55 ANO P�OFESS�ONS CODE TM[CONTMCTORS LI- V31U3(IOfI ADJ.AREA
W CENSEUWDOESNOTAPPLYTOIWOWN'cROFADROPERTVWNOBUtLD50R1uPROVESTMEREON.AND
� W/pCONTMCi5FOR5UCNVRQIECTSWITHACONTR�CiOR(S�LICENSED�URSVANTTOTH[CONTMP QU/�fJTITY DESCRIPTION FEE
Y TORS LICENSE UWJ.
� ❑I AM EZEMPT UNDEfi SEC. 8.6 iC.FCR 1Ni5 RE�SON J
O ¢
J U
� �
OATE OW�CF U
� W
� IICENSED CONTRACTORS DECLARATION W
� IMEflEBYAFFIRMUI.'DEAPENALTYOFGERNRYTHATIAAILICENSEDUNDERVROVISiO\SOFCHAPTER �
d, i�COMY.[NCWCWITHSECilON7000�0�DIV15�ON]OFTNEBUSINESSANOPHOFESSiON5CO0E,AN� Z
YY tKCNSE IS M FUL FORCE M1D EF FfT. �) /
� UCENSE GUSS� � `� LIC.NO._[_!Z'�Z� J
...,._'_ 'V -DATE�� ��_CONTRAC70ti j���f�J� a .
W
� W RKEiiS'COMPENSATION DEC ARATIOY �
� 4
� IHERC6YAFFIRAIUM1DER7EtiALTYOFPERNRYON[OF7HE�OLIOW:NGCCCLAMT�0Y5. U
� Z
Q
0 �IHAVEAN�VnLLMA1NiA:NACERTIFILAiEOF�ONSEMTOSELF��NSUREFOPWORKCi15' S
� COMPENSATION.AS PROViDED BV SECTION 77�o OF TNE IABOR COOE,FOR THE VCRFORIAANCE W
OF iME W0�7K FOR WMICM 7M15 VERMIT IS ISSVCD. �
� �
W _�IMRVEANDWILLMAIN7AiNWORKERS'COA�PEYSATIONINSVRANCE.�SREWIRE�BYSECTION
Q ]100 0F iNE LABOR COOE,FOR T1[GERFORAIANCE OF THE WORK FOR WHICH MIS 7EH/AIT 15
J ISSUED.MYWORNERS' �+A7�I�y"JRAN �A�' aicvnvMeEa�a[: CONSTFUCTION
r
j C+tqpiEn ���L � � PLAN REVIEW
Zva�crr.viu�¢n������.�f ��� T ELECTRIC
¢ ��^
� (f�5EGT10NhimNOT9CCD.4;E�EJOF1)fPERv/i6WRONE�l1�1CDD0UM5T�o�OfiLE55; PLUMBING
Z ICCRTIFYTHATPlTHEPERFONA0.YCEOFTNEWORKFOFWII:CMTM'SPCRM:TISISS:IED,I MECHANICAL
(} SMAL�NOTEIJGLOVANYVERSONIN�YVYANNERSOASTO6CCAl1C5UBJ[CTiOiHE INS?ECTIONFEE
� WORNEFS'CdAGEN5AT10NU�'.'SOFC�UFO�NIA.ANDAG�CEiMATIFIS1i0ULDDEC0IA[
SU[ilEtT 70 THE WORKE RS'C0IAPENS�710N GROV1510N5 OF SCCTION]IOG OF T11E U90(i
S COOE.I SNALL iOFlTMWITH COMPLY WiTH TNOSE PRON510N5 ISSUANCE
� S�11P
p DA7E: APRIGAM:
J ENERGY P!C
W�RNINC:FARURf TO SECURE M.OfU(ERS'CW�EN51110N COVERAGC IS 11M.AWFUL,Ml�SHAIL BE
� SVBJ[LTANEMGLOYEflTOCflI4YALPENAL11E5ANOCMLFM[SUP70CNCMUN�RfDTMOUSAkp ENERGYPERMIT
DOLLARS(5100.Oo0).N/�DDITION TO TH[COSTOF CAMPE�SATqN,DAM�GCS AS FROV10CD FOR IN
� SECT�ON7l0eOFTHEU[iORCODE.INiERESL�NDIITTORNEY5FEE5. RETENTIONFEE:
' a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHEREDYAFFIRAIVNOERPENAITVOFPE0.JUAYTHA7THCREIS�CONSTfiUCTIONIEN�IYGACENCY
n' FORTMECERFORMANCEOFTMEWORKFORWHICHMISPERM:TISISSUED(SEC.IMl1.OVC.�.
Z
LL1
� LENOCR'SNM1E
� LEN�ER'SADDRESS
w 1 CERTIFYTHAT I MAYE flEAU THIS APPLICATION AND STATE TM4T THE�90V'c INFORAIATION IS GOMCCT. TOTAL FEES � � � 1
d IAGR[ETOCOMPLYWITMALLCRYANOCOVNTYOR�INMlCESMlDSTATEU'MHEUTW0706UP.DING
CONSTRUCTqN,ANDMEREBYAUfHOfi:ZEREPRCS NTATIVESOFTH:SCWhTYTOEN'FRUi'ONiNE
� A90VE-MCNTIONEDPRO HiVFORINSP[C7IONP iPO5L5.
z coun+ENTs
0
J
� _
m PE � nunE ulrn
� � � f�iirr�i� G� 6J
�
(n �:GN JNLOF E �•�� fEE a1E
� RECPT.NO._ _ _ _PAID UY _VALIDATION _
WHITE—Department Copy.YELLOW—Fnance Copy.PINK—Assessor CopY•V OLDENROD—Fde Cepy,GREEN—Applicant's Copy
--• - - . ... ........:: - - - - - - - �-
. ...
.� _
CE i:' �F �1/':f�,^f�� f�„R
9��'.:;ii'C-"�iC�i�? i=�:CG�:D
I►�ti�C?.�c"r►e'1►ti! _......--- F'.i__ =.... I►`!-'�.��:e �c�q�`-----;l,;�=1:�_:z �r�c��,-__...____.____--es,:�T�'= T I►��.`I:1�c�c1.3 �
---�------- -- - - - -- -- - - ..... . ._. ._ ._..... ....... . ... .. . ... ...._._....._ . . ... ..----- ....- ------------ __..____._--�----
5ET BF,CY, ' ---- � ' ------- � � FI..OJR JOIS"i'� ` — • -1 -----
FTGS'FORt41S!STE�L �^ __i • _�_� Ff-�r1 REQ'.'TS _ i _� _
, ELECTRI�GROUP�D I I I I U^d'JFR FLOOf� DUCT � �
GROUi•JD PLUPA6ING 1___ I_ UNDER FLCOR CU�,IDUIT I ___
SLAB GRF,DE _� I ___ ^_� i FIR�FLACG FQU'•JDAi IOt� I ) _
TED.1P PO�^JER I ; I � FIREPLf;CE EON� E3EAtv1 �___ I _ __
bVATER SERVICE I ` I I �•."ID HT. I30PJD BEFP: I I
• ROOF SHCATHIIJ i� l — - ��E3 f7. BO".� d�f1�,1 a— �- —I -- _
FRA��J�ItdG,NENTILI,ATIOPd I � �__� � FI^:AL E30�JD BEAP;1 .�_ - � _____
ROOF COVER I I _ FRE-GRF�DIPlu _ _�`� I
ROUGH HEATING I BEr`CH!t•�G % I� I�_ "
� ROUGH ELECTRIC I �_� ROUuH GRADI��G �
ROUGH PLUP."B1�dG I ' FIt�dISH GRADIfdG _
SHOI"JERlTUB TEST �__ ;} POOL ELECTRIC � � _
E.XT;�LATH!SIDING � _ � I PO�L FENCI�J�3 _ � �
b•'lALL INSULATION � � POOL Fli•1AL � �
CEILING IfJSULATION 1 � OFF SITE Ii.1P5. �
DRYb"Jl1LL NF,ILRJG � l_ � DEDiCATlO'JS � _
• SEVVER � ; FIfdAL EfJG. �
SEPTIC TANK � � LANDSCAPE/IRRIG. � .
SEEP PIT/L.L. I � � ON SITE It,1PS. �
GAS AIR TEST � �FINAL ZOPdifJG �
FIhAL CO.NST. � , ! FIRF DEFT. FI'J�,L �
FINAL HEATING � HEF�LTH DEPL FIfvAL , �
FINAL ELECTFIIC � � j DGV. FEES P:�ID � ,
��It��L PLUPfBING -� , .���(-o� � � � ENERGY � ' i
: I j - . T.
...� i l i _ _ __ .....__..__�.�
�•-,�.�.�
• .
, . ••.. .
I � . �
, � � ...
_+
,
� :.'
I`
- ------ --`.------------'' --��`:�,�----•--'---'---^; -... ...� � "=' . �
: . . . . '� ' ' --' . . ..__ ..... _.�._�:_._.__ ...-•---_
_ . _ i
CUP��MENTS �
�
r ,
• i
SEPTIC TA�dK SIZE �
SEEP PIT/U SIZE � , -
` f� ��I, � ,
� �
�.
, tl�,� - — • .
` —
+�.