HomeMy WebLinkAbout18281 (28) _�... _ ci�oF n�oNv B� EXPI�ED
� DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES
21825 E.Copley Drive 0 C T Q 9 1G�i2
"'�' (909)860-3195 Fa�c(909)861-3117 PRESS
��'-��� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE � /� �j� APPLICATION l�
o ADDRESS / t3T-'J �S "�NUMBER ��� #/C
DATE
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �L• �Y�
o ADDRESS ZONING SETBACKS
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o APPLICANT TEL. � S DE/SIDE STREET RW ❑
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Q ADDRESS • � PROPOSED USE
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o ARCH/ENG/
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a ADDRESS UNITS STORIES BEDROOMS
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u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENAL7V OF PERJURV THA7 I AM EXEMPT FROM THE CON7RACTORS LI- Gele9B/CBfPOR
W CENSEUWFORTHEFOLLOWINGREASON�SEC.7o31.5BU51NESSANDPFiOFESSIONSCODE:ANVCITYOR (n
U COUNTVWHICHREQUIRESAPEFiMITTOCONSTRUCT,ALTEfi,IMPROVE,DEMOLISH,ORREPAIRANV57RUC- .
w TURE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� � CENSE LAW(CHAPTEH e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUS W ESS AND PRO- V" PooUSpa
O FESSIONSCODE)OqTHATHEORSHEISEXEMP7THEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- �
V TION.ANV VIOLATION OF SECTION 7031.5 BYANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
A CIVI�PENALTV OF NOT MORE THAN FIVE HUNDRED DOLL4R5(f500).):
❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESAS7HEIRSOLECOMPENSATION, �
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Z WILL DO THE WORK,AND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7044,BU51- J .
, � NESS AND PROFESSIONS CODE:THE CONTflACTORS LICENSE LAW DOES NOTAPPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
i QOFFEREDFORSALE.IF,HOWEVER,hiEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALEJ.
W ❑I,AS ONMER OF THE PROPERTV,AM EXCLUSIVELV CONTRACTING WITH LICENSED CONT(iAC70RS
� TO CANSTRUCT THE PROJECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8IlOf1 ADJ.AREA �
� W CENSELAWDOESNOTAPPLYTOANONRJEROFAPROPERTYWHOBUIIDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENSEDPUfiSUANT707HECONTRAC- �UANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
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� ❑I AM EXEMPT UNDER SEC. B.6 P.G FOR THIS REASON Q �V i/�
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DATE OWNEil �
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O II
Q �ICENSED CONTRACTORS DECLARATION w
OC I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESSAND PFOFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
� LICENSE CLASS L���^ � LIC.NO. ���� ' j
V DATE ?� V� CONTRACTOR d
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� WOFiKERS'COMPENSATION DECLARATION Q �t
��'� � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOILOWING DECLARATIONS: Z
+. Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
¢ CAMPENSATION,ASPflOVIDEDBYSECTION37000FTHEU80RCODE,FORTHEPERFORMANCE �U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKEFiS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� CARRIER PLAN REVIEW
Z POLICV NUMBER ELECTRIC O
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� (I}iI55EC110NNEmNOTBEOJMPLEfEDOFiHEPERMfTISFORCNEHUI�DREDDOIWiS(5100)ORLESS). PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL
C.�} SHALL NOT EMPLOV ANV PEFSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE
� SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSO ECTION37000FTHELABOR �
� CODE,ISHALLFORTHWITIICOMPLVWITHT OV � 5. ISSUANCE
p DATE:��a�APPLICANT: _ SMIP
J WARNING:FAILUpE TO SECUFE WORKERS'CAMPENSAT'N OVERAGE IS UNLAWFUL,AND SMALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDC FINESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT
DOILARS(5100.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
JSECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: U
Q �J
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBYAFFIRM UNOER PENALTY OF PERJURV THAT THERE IS ACONSTFUCTION LENDING AGENCY
FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
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S LENDER'S NAME
�
H LENDER'SADDRESS
wICEFTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES � �����
� I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUIL�ING
� CONSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATNES OFTHIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
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¢ PERMITTEENAME ) /�,i!
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N SIGNA7UREOFPERMI EE DA7E
= RECPT.NO. PAID BY �, VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
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FTGS/FORPJIS/STEEL � ! FHA RE�MTS
ELECTRIC GROUND � ' UNDER FLOOR QUCT � �
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GROUND PLUMBING __�-_ __ ; UNDER FLOOR CUf�!DUIT_� ___ _
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SLAB GRADE r ._ _�__FIREPLACE FOUt�DAT(ON__ _
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TEMP POWER _ _�',._____ FIREPLACE BUND BEAM '
. ---....,._.._ ____ ------ ----
WATER SERVICE � � MID HT, BOND BEAM
_ ..__.� -- -- -._._._ � -.._. ._ ___ �
ROQF SHEATHING 8 F-f. B�ND BEA(�" �
- --- --_._ _ __ __- ..} -- ---___-_�_ .. _ .- ---- ---._
FRAMINGNENTILIATION __ � I FINAL BQND BEAM i
-- � ___- ------ �---- -._� __ __ - -------, -- ... __
ROOF COVER � __ � PRE-GRADING ' '
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ROUGH HEATING 1 BENCHING ___ j __^ _
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ROUGH ELECTRIC , ROUGH GRADI►VG J_
,-- --- -..._...-- ----- - ---
ROUGH PLUNIBING ';, FINISH GRADING
' - -- ---- --._._.__.---.
SHOWERlTUB TEST � POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL If�SULATION POOL FINA�
CEILING INSULATIOIU OFF SITE IMPS.
DRYWALL NAILIRIG DEDICATIONS �
; ----
SEWER FINAL ENG. _�__ __
SEPTIC TANK LANDSCAPE/IRRIG. ;
SEEP PIT/L.L. ON SITE IMPS.
_..._-- __.__.._�_ �--
GAS AIR TEST, _ �I FINAL ZONING _ _ _
FINAL CONST. ' , � ��RE.DEPT. FINA�.
F)NAL HEATING � -���__ �l HEALTH DEPT. Fi
� � I�AL
J ! � DEV. FEES PAID _ _______._ �._�----..__..
FINA�ELECTRIC
f=1NAL PLUMBING ; __ � ENERGY --_._.---- I ----,-
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SEPTIC TA�lK SIZE
SEEP PIT/U SIZE - -._._._._.. ___._..__
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