HomeMy WebLinkAbout17354 (25) � CITYOFDIAMONDE3AR EXPIREL7
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�. x�� 21825 E.Copley Drive JUN 19 ?-�'�2
(909)860.3195 Fax(9a9)861-3117 PRESS
`<:�` BUILDINGPERMITAPPLICATION ' FIRMLY
oN JOBSITE n��I� T�]„1� �e DATE CATION ,_�� ��NUMBER_I�Q� M/C
ADDRESS�( �L���-a+ ���./�
$ ISSUE TYPE OCC
APN�— LOT TRACT DATE CONST. GROUP
p OWNER \rO�P�^ LZ a Vt��}
p ADDR S��.L�f l�[L.�+ H.�t�c G�(v� ZONING SEfBACKS '
z CITY � r ZIP a,'IGf TEL. ������ REART RW Q
g APPLICANT TEL SI�E/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
p� ADDRESS r�' PROPOSED USE - r'��' a
a CIN '1 ZIP a►�7�L TEL. �,
wo ARCH/EN / —_
W DESIGNER NO.DWEL. NO. NO.
a. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
OOWNER•BUILDER DECLARATION SFR/ADD/REM
� 1 HEREOV AFFlFUA UNDER 7ENALTY OF PERNRY THAT 1 AM EXEMPT FROM THE COflTRACTORS L4 GaragelCarport
W CENSEUWFORTHEfOILOWNOREA50N(SEC.70�1.68USMESSANDPROFESSIONSCOOE:ANVCIiYOR (n
U pOUNTYWHIp1REOUIRESAPERMRTOCONSTRUGT,ALTER�PROVE.DEGOLISN.ORREPAIRANY5IRUG W PdIIO/OBCk
� TURE PRIOR TO ITS ISSUMlCE.ALSO REGUIRES T11E MCLICANT FOR SUp1 PEN.11T TO FILE A SIGNED w
.� STA7EMENT TMAT NE OR SHE�3 LIGENSED iVRSUANT TO iNE PROMSIONS OF TME COHTMCiORS LI•
� CENSE UW(CMAPTER 0(COMMENCINO WITH SECTqN T000)OF DIVISION]OF THE BUSINE55 AND PR6 � PooVSpa
^ FESSqNSCOOEIORTHATHEORSH[ISEXEMPTiMEREFiIOMINDTHEBA515FORiMEAIIE�EDE%EMP-
� TION.ANYYKK.ATqNOFSECT�ON70.71.6BYANYAPVLICANTFORAVERMITSUBJECTSTHEAPVLIGNNTiO Z Re-Root
� ACML PFNALT'Of NOT Api7E hW!FIVE HUNDRED OOLVAS�SSoO�.}
0 D�ASOY/NEROFTHEPROPERTY.ORMVEMPLOYEE5IYITMWA6ESASMEINSOLEGOMVENSATION, Q �mmercial - �
Z VnLL DO THE�RK AN�iME STRUCTURE IS NOT INTENDEO OR OFFEREO FOR SAIE(SEC.70��.BU54 _I
NE55 AND PitOFESSIONS COOE:THE CONTMCTORS IICENSE UW DOES NOT A�PLV TO AN OWNER OF
� GR07EHTYMMOBUILDSORMPROVESTMEREpJ.AN�N7/0DOE55UCHWOHKHIMSELFORMERSELFOR =
� TMROUCHHISOFiHEROWNEMPLOVEES,VRONOEDTMATSUCNMPPOVEMENTSARENOTWTFNDEDOR m
w OFFERWWRSALEG.110WEVER711EBU0.DINGORIMPROVEMEMISSOIDWITHINONEYEAROFCOMPLE
Z TIDN,TME OWNER�BUILDER WILL HAVE TME B�INDEN OF OROVWO TFIAT HE OR SHE DID HOT BUILD OR
= IMPROVE FOR TNE PURP0.5E OF SALE).
❑L AS OMMER OF iHE 7ROGERTY,AA1 E%CLUSNELY CONTMCTW�WITH LICENSED CONTMCTONS
� TO CONSiRUCT TNE 7flQ1ECT(SEC.70M,BUSINESS AND PPOFESS�ONS CODE:THE CONTMCTORS LI- V8IU8�1OR ADJ.AREA �
W CENSEUWDOESNOTM7LVTOANOWNEROFAPqOPERTYWNOBUIIDSOHIMFROVESiNEREON.ANO
� NM1IOCOMMCTSFO(15UCHPR0.IECTSWITHACONTMCTOR�S�LICENSEDPUNSUANTTOTHECONTRAG OUANTITY DESCRIPTION . FEE
� TORSLIGENSEUW).
� O I AM EXEMPT UNDER SEG B.�P.0.FOR THIS REASON U
� �
LL' OATE OwNER V
F LICENSED CONTRACTORS DECLARATION �j ��
� IMEREBYAFFlRMUNOERPENKTYOFPERNFVTHATIAMLICENSE�UNDERVRON5pN50FGUPTER Vr ',
p� Y(COMMENC�N(IWITNSECTION1DOo�OFDrvIS�ON70FTNEBVSINE55ANDPROfES510NSCODE,ANO z
X M'ILICENSE�SNFULLFORCEANDEFFEC7. m
�
� LICENSE CUSS G� � _LIC.NO.�,�� J
V OATE����� G, CONTRACTOR a
W
� WORKERS'COMPENSATIONDEC RATION Q
� U
� � IHEREBYAFFIRMUNUERFENALTYOFFERJURYONEOF7HEFpLL01MNGDECU�Ti0N5: z ��
Q
' ��-� �/I�VE/NDWILLI.UMTA1N110EFTIFCATEOFCONSENiTObELF•INSUREFORYYDRKERS' _ �- � �- • �� - �� -
� CAMPEN N,ASPROVIDEDBYSECTIONI7ooOFTHEU.80qCWE,FORTHEFENFORMMICE �U
Of ORK FOR WMiCH TNIS VERMIT IS ISSUED. �
0
_I HINE AN�MnIL 1AAINTIUN WORKER5 COMPENSA710N INSURANCE,AS flEW IREO Bv SECTiON
Q �7000FTMELA90RCODE,FORTHEPERFORMMICEDFiHEWORKFORWHICHTMISVEWA�T15 .
� LSSUED.MVY�WOwR^K7E—RS''C,O,AIPENSATIONINSUHANCEGRHIERANDPOLICYNUMBERME: CONSTRUCTION
� GRRIER�l.v�1� PLANREVIEW
>
� POUCYNUMBER W C A�-IA lR" ELECTRIC
p (MSSECiIOf�NEmNOTBE00R4;EiEDOFhEiERMTBFOi10NE/Ul%iEDDalA2SRt0o)diLE55) PLUMBING
Z ICENT�FYTMNT W THE PERFORMANCE OFTHE WORK fOR WHICHTNIS PERMiTI5155UED.1 MECHAN�CAL
(} SHALLNOTEIAPLOV/�NYPERSONWANYMANNERSOASTOBEGOMESU&IECTTO7HE
� ypRNERS'C0IAPENSATIONUWSOFCALIFORNIqlWDAGREEMATIF15/10ULDBECOME INSPECTIONFEE
S SU9IECTTOTHEWORKERS'WMPENSATIONPROVIS�ONSOFSECTION97000FTHElABOR ^_' ,._
000�.isHULrormrv�mHcaua�rvnn� � ISSUANCE �� -�
O ,� �-"l,/._..,. �: ..-f.
p OAiE:�1�� APPLICAg��� SMIP
J ENEAGY P/C
WAANM6:FA0.VRE TO SEGUflE WORKER PENSATION COVERACE IS UNUWFUL,AND SHALLBE
��—y SUBJECTANEMPLOVERTOCRIMMALPENALTIESANOCMLFWESUPTOONEMUNOREDTMOUSAND ENERGYPERM�
DOIlAFiS(ftao.aaa).N A[101T�ON TO THE COST OF COAIPENSATqN.DAMAGES AS iROVIDEO FOR IN
¢ SECTqN7)0lOFTMELABORCOOE,R7TEHEST,�NDATfORNEY5iEE5. RETENTIONFE � •
W CONSTRUCTION LEN�INGAGENCY PRE•ALT FEE: BY�
O ------ ...__
LL 1HEREBVAFflRMUNDER7ENALTVOFPERNMTMATTHEREIS�CONSTRVCTIONLENOW6AGENCY
—_�'-_.:. .. .__...._.._.
�- FOR THE CERFORAIANCE OF TME WORN FOR WMiCH 1MIS PERIA�T IS ISSt1ED(SEC.]097,CIV.CJ. ,
Z
W
� LENUERSNAAIE �
� IENDERSADDRE55 r � ^ ,
w ICERliFYTHATIIUVEREADTHIS�PPLICATIONANOST�TETHATINEABOVEINfORA1I,TqNISCARRECL TOTAL f EES v
� IAGREETOLOMPLYYATH/�LLCRYIW�COIMTYORDINANCE5�NO5TATEUWSRELATMIGTOBURDINO
VCT�ON,AND MEREBY AUT/10RRE REPRESENIATNES OF THIS COUN7Y TO EMER UPoN iHE �
ZvE� NTqNE�PROVERIYFOFINSPECTI�N7UflPO5E5. COMMEMS
O _ �
�
m � , �vaiN
Q � ���
�
� NRF EE DATE
� RECPT.NO. PAID BY _VALIDATION
WHITE—Department Copy.YEILOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy.GREEN—Applicant s Copy .
� �. l�.� �. 'P.. . -.,1..:..'1�.1. . ' .. .� ��M � '1�.�'.F�'f .. f �_'"_' _._ . . .... .� . ° �. �. .��.1.. , �. .. . .. � . ..i .�. i� � .....i. . . . . . .
�;��°tr cr n«,r��or�D ��.�,
Et+'S�z�C:iCf� RECC)i�7
. _ _ _a�. _.__��r��__--_��� .� � .�� ►(�=�r•� ��r�,_--.� � �:r:. I►�-`�c:�� ^�'_
_.�_____._
; I►�E-'3F��c� E�f� ►.I e� t' I `�;�.. �� Cn., .s �� ._ c�elc�` r � c e7:� �
_ _.�_...___._�.. _: . ._.._ . ..__ .._..____ ._____ _-
- -- - -- ----__ i- --__._ _ __�_.-------
SET BACY. --•----- _ �i_ . . _ ( , ; � FL�OR JO1ST , '-- �. - — —.
FTGS/FORMS/STEEL` ! FHA REOh9TS
- �-— ,
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUM6ING I Ut�l�ER FLOOR CU�IDUIT � � • �I � �
SLAB GRADE � FlREPLACE FOI�ND�TIOtJ ' " '' `
TEhAP POWER I I_ FIREPLACE BOND QEAM 1
WATER SERVICE � j_ MID HT. BOND E�APn _ '
RO�F SHEATHING �����0 f��. /i'�`'°"� � 8 FT• BONO BEAM.
FAAMING,NENTILIATION I. ( � _� FINAL E30ND BEAP.�
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHI�IG
ROUGH ELECTRIC � ROUGH GRADING
ROUGfi PLUMBIPJG {_I FINISH GRADING _
SHOWER/TUB TEST l 1 POOL�LECTRIC
EXT. LATH/SIDING I I POOL FENCING I
WALL IfdSULATION POOL FIidAL �
CEILING IN�ULATION I OFF SITE IMPS.
DRYWALL NAILING � DEOICATIONS �
SEVJER i FINAL ENG.
SEPTIC TANK � . LANDSCAPE/IRRIG.
SEEP PIT/L.L. � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATIPJG � HEALTH DEPT. FIfJAL
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING � ENERGY
I
�':=i�fm:_`_i��`.le,�J _�_.�; �
COMMENTS �
SEPTIC TANK SIZE
SEEP PIT/U SIZE
I��� �
,
i
i
yd1� ��i
i �
" i .
�� `,;