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HomeMy WebLinkAbout17843 (23) �� CTTY OF DIAMOND DAR � �� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21825 E.Copley Drive "�— !" (909)860-3195 Fax(909)861-3I17 PRESS ��%+� BUILDING PERMIT APPLICATION FI R M LY } JOBSITE �1 �J��Lr�� � /�.�� APPLICATION ,,�I,.�l NUMBER�� #'C v� �� o AD�RESS ����� DATE L � ISSUE TYPE OCC -- APN LOT TRACT. DATE CONST. GROUP p OWNER � A� � ' " AD�RESS ✓��'�� 1' ZONWG SETBACKS � C�TY 1/LJ��) i' _ ZIP � 17 - TEL. '�•I FRONT RW ❑ g APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p � ADDRESS PROPOSED USE � CITY ZIP TEL o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � �n DESCRIPTION SQ.FT: FACTOR PSF J.AREANALUATION p� OWNER•BUILDER DECLARATION SFFUADDIREM � O p I HEFEBY AFFIRM UNDER PENALTY OF PE0.NRY TFIAT I AM EXEMPT FROA1 THE COHfMCTORS L4 G2fegfl�Ce�pOR W CENSEUWFORiHEFOLIOWINCiREA50NI5EC.70.7L68USWE55/WDPROFES5lON5C00E:ANYCITYOR (n U COVNTyWHICHREOUIRESAVEiWITTOCONS�UCT,AITERMVROVE,DEUOLISH,OqqEVAiRANYSTRUG W PlI�O/DOCk O � TURE,PNqii TO 1T9 ISSUANCE.A150 REOUIRES THE APPLICANT FOR SUqf CERMIi TO iILE A 51(iNED W g S7A7EMEM THA7 HE OR SHE IS UCENSED VUfiSUAN7 TO TME PROVISIONS OF THE CONTMCTORS L4 � � CENSEUW(CNAPTERO(COMAIENCWISWITNSEMION70D0)OFDIVISqN]OFTNEBUSINESSANOPF4 POOUSpB FESSIONSCOOEIORTMATMEORSMEISE%EMPTTHEHEfNOMANDTHE8A515FORTHEKGEOEDE%EMP• (� � T�ON.IWYVKXA710NOf5ECT10N7W1.58YANYAPPLICANTFOPACERMIT5l101ECT5THEAPVLICANTiO Z Re-Root A CML PENALTY OF NOT MORE THAN FIVE NUNDRED�OLURS(i5o01.1' � Z04�DWNEHOFTMEPROPERTY,ORMVEMPLOYEESWIiHWAGESASTMEIR50LECOMPENSATION, 0 COrt1rt�BfCial � W�LL DO TXE WORK AND THE STRUCfUNE IS NOT INTENOED OR OFFERED iOR SALE(SEC 7a�,BUSI. y NE55 AND PROFESSIONS COOE:THE CANiNACTORS LICENSE UW�OES NO7APPLV TO AN OwNER OF = ,`� FROPERTY WFp BUILDS OR MVROYES TNEREON.M70 W/IO OOES 5�1CM WORK MIMSELF OR MEHSEIF OR V Q THROUGHHISORHEROWNEIAPIOYEES,PROVIDEOTHATSUd/1MPROVEA/ENTSARENOTMENDEDOR m w OFFEREDFORS/�LEIF,HOWEVEq,7HEBUILOMf30RIMVROVEMEMISSqDYATHINONEYEAROFCOMPLE• 0 TION.THE OWNER�6URDER WILL HAVE TME BUROEN OF PRONN6 THAT HE OR SME DID NOT BUILD OR � MPROVE PoF TNE PURPOSE OF SALE� O 4��'�'�ER OF THE PROVERTY.AM E%CLUSIVEIV CONTMCTIN6 yATl/I.ICENSED CONTMCTORS � TO CONSTRUCT TME P(iQ1ECT�SEC.70N.BUSINE55 ANO PROFESS�ONS CODE:TME CONTMCTORS LI� V0IU8IIOf1 AQI.AREA LL� CENSEUWOOESNOTAPPLYTOMIONNEROFAPROPFNT`/WNOBVRDSORIMPROVESTHEREON,AND f NM1�OCANTMCfSFORSUCMDPAJECiSWITHACOflTMCfOR(5)LILENSEDPURSUANTTOTHECONTMf. QUANTITY D SCRIPTION FEE � TORS UCENSE UW). 0 OIAME%EMPTUN�ERSEC. &17.4fORTMISFlEA50N U 3 � LL" DATE OYMER f" Z W F LICENSED CONTRACTORS DECLARATION W � INEREBVAGFlPAIUNOERiENAIT/OFPERNRYhIA71AMLICENSEDUNDERPpOVI5iON50FCHAPTER Vr d Y(COMMENCIN�WITM SECt10N 7oD0)OF�NI510N 7 0F THE BUSINESSAND PROFE5510NS CODE,M1D z X NY UCENSE�S H FULL FORCE AN�EfFECT. � `� UCENSE CUSS � , UC.NO. �� � j H- V DA� j/'�O�- coarnneToa Qf�Ns � w � WORKERS'COMPENSAT�ON DECIARATION 4 � U � IHEREBYAFflRMUNDEHVENALTYOFVERIURVONEOFTMEfOLLOMnNOOECLAMT10N5: z a � _IHAVEM1DWIlLMNNTAINACERTIFICATEOFCONSENTTOSELF-INSUREfORY/qiNERS' $ � � COMPENSA710N,A4 PROV�DED BV SECTON]7oD OF TNE LABOR COOE,FOH iHE VERFORIAANCE � Q OF iHE WORK FOR WMICMTMIS VERMIT I$ISSUED. .� �INAVEMIDWILLMAINTAMWORKERS'CO�APENSATIONMSUMNCE,ASREWIREDBYSECTpN ' n I •/�O 0 i7ooOFTMEUBORCODE,iORTNEPERFORUMICEOFTHEWORKFOqWHiCHTHISVERAUTIS 1C ' 1 ISSUED.MY WOFNERS/C�OM�PENSATI N INSURANCE CARIiIEA�ND VttICY NUMBEaME: CONSTRUC7ION . A(,.� 1 j CARqIER -s7r�t't'� ��A PLANREVIEW — .�._ Z VOLIGY NUMBER � ��S`I ZS�� - - ELECTRIC ¢ � (n+ssEcna�r�nrnreEm.s�rmaFnErEr�r.riswaa��0alu�scs�mlOa�EsS� PLUMBINO Z I CENTIFYTNAT M TME PERFORMANCE OF iHE WORK iOR WMICH TIIS PERMIT IS ISSUED,I MECHANICAL U' SMALLNOTEUPLOYANYOERSONWINV�IMNERSOASTOBECOMESU6IECTT07NE — � � WpqKERS'CdAPENSATqNlAW50FCALIFORNIA,�NDAGflEET11ATIFISHOUIpBEWME INSPECTIONFEE SUBJECi TO THE WORKERS'COM7ENS�TqN PROVISiONS OF SECiqN noo OF TNE UBOR CODE,ISMALLFOR7HWITHCOUPLVVATHTHO E7ROVISiONS. � ISSUANCE w � � ro.-��•,,� • � — U� p pA7E: � �O2- APPLICANT:�� SMIP Q � ENERGY P/C J WARNINO:FMIURETOSEWHEMARKERS'COMVENSATqNCOVERACEISUNUWFUI.ANOSHALLBE ! � SUBJECTANEMPIOYERTOCWY�NALPENALTIE9FNDCMLFWESUPTOONEHUN�REDTHWSµD ENERGYPERMIT G OOLURS(f 100.000),W IDDITION TO THE COSTOF COMPENSATqN.O�AGES/15 PHOVIOED FOR M /- J SECTION 7)00 OF THE LABOR COOE,NTERESi ANOATfOANEYS FEES. RETENTION FEE: � /j ) a CONSTRUCTION LENOING AGENCY PRE•ALT FEE: v O � IHENEBVAFiIRMUNDENCENALTVOFPER1U17VTNATTHEREIS�CONSTRUCTIONLENDN6�GENCY d FOR THE PEAWRMANGE OF THE WORK FOR WHIdITH15 PERMITIS ISSUED(SEC.70c7,CW.C.). Z W . � IEN�ER5NMIE L— IEUOER'SADORE55 � Cc � w ICfRTIFViMATIHAVEREADTN15APOLICATIONANDSTATETUTTNEABOVEINFORMA1qNISCORRECi TOTAL FEL�.J d IAGflEETOGW.�PLYMATHALLCT'ANUCWNTYOiWINANCE5AND5TATEUWSREUTINOTOBVILDINd ///---��� \ G . CONSTNUCiIIXJ.AND HEREBV AUTMORIZE NEPRESENTATIVES OF THIS LWNTY TO ENTEfl UPON TME �i1 .y' Z PBOVE�MENTIONEDVROPERTVFONNSPECTIONVURPOSES. COMMENTS 1 � �(�Drs,sl . N FER�E N�E(P n n � � �_ � / /L'� � 0 �� �0.y.a}flJl (A SiGNATUREOFPERMI E OATE � RECPT.NO. " PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENRO�File Copy,GREEN—Applicant's Copy -�- , � � , �-. , .. . . . ..�. .. . ... , . -S ..._.. . . '' .. 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POO�FENCING WALL INSULATION /„���Z � j POOL FINAL I CEILING INSULF,TIDN '��g OFF SiTE IT1PS. l DRYWALL NAILING � � DEDICATIOfJS SEVJER FIPdAL ENG. SEPTIC TANK ; � - LANDSCAPE/IRRIG. � SEEP PIT/L.L � � ' ON SITE IMPS. GAS AIR TEST � FINAL ZOPdWG FINAL CONST. , .• � �IRE DEPL FINAL �"i�"�- . � FINAL HEATI�dG � HEALTH DEPT. FINAL FINAL ELECTRIC I DEV. FEES PAID FINAL PLUMBING � ENERGY �� ������ I- �` .- ------- �_�._.__. — c�. r c�,� c �i;e COMMENTS SEPTIC TANK SIZE SEEP PIT/U 51ZE — ��1 ^ �+`� �'! , � �� .