HomeMy WebLinkAbout13367 �� CITY OF DIAMOND BAbt �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
I (909)86Q3195 Fax(909)861-3117 PRESS
� ��� BUILDING PERMIT APPLICATION FIRMLY
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�� ��V DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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� I MEHEBY AFFlRM UNDER PENALTV OF PER.NRV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8QB/CefPOA
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w TURE.PpIOR TO ITS ISSUANCE;�LSO HE�UIRES THE AP7LICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEAIENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
� CENSE LAW(CFUPTER Y(COMMENCINO WIT}i SECTION 7oD0)OF D�VISION 3 OF THE BUSINE55 AND PR6 � PooUSpa
FESSpNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR 7HE ALIEDED E%EMP-
TION.ANYVpIATqNOFSECTION7091.6BVANYAPPIICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Raof
� A CML PENKT'OF NOT MORE THAN FNE HUNORED DOLURS(S5o0).�:
� OI,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWIhIWAGESASiHEIR50LECOMPENSATION, � COR1111BfCi81 �
NALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI- J
NESS AND PipFESSIONS COUE:THE COHTRAC70RS IICENSE LAW DOES NOT APPLY 70 AN OWNER OF
� PROPERTYWF108UILDSORIMPROVESTHEREON,ANDNMOOOESSUCHWORKHIMSELFORHERSELFOR �
Q THROUOFI HIS OR HER ON?1 EMPLOYEES,VROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT IHTENDEU OR m
L11 OFFEiim PDR SALE IF,FIOWEVER TME BU�LDWG OR IMVROVEMENT IS SOID NATHIN ONE VEAROFCOMPLE- �
Z �TION,THE OWNERAUIIDER NALL HAVE THE BURDEN OF PROVINO 7HA7 HE OR SHE DID NOT BUIID OR
� IMPROVE FOR TH=PUHPOSE OF SAL�.
W ❑I,IISOWNEROFTHEPROPEFRY,AME7(CI.USIVELYCONTMCTINOWfTHLICENSEDCONTMCTORS
Q TO CONSTRUCT TT1E PRQIECT(SEC.70H,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTOqS LI- V91U8fI0f1 ADJ.AREA
W CENSE UW DOES NOTAPPLYTOAN ON?JER OF A PROPERTV N7i0 BUILDS OR IMPROVES TIEREON,AND
� NM1pCOHTMCT5FOR5Up1PR0.1ECTSWITHACONTRACTOH(S)UCENSEDPURSUANT70THECONTRAC pUANTITY DESCRIPTION FEE �
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F LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UN�ER PENALTV OF PEiiIUNY hiAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � �A\J U `j ��y
� i(COAIMENCWO M/(TH SECTION 1000)OF DMSION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z is 1
MY LICENSE IS IN FULL FORCE AND EFFECT. y
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� WORKERS'COMPENSATION DECLARATION a
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� 1 HEREBV AFFIRM UNDER PENALN OF PEiLIUiiY ONE OFTHE FOLLAWING OECLARATIONS: �
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� _IMAVEANDWILLAWNTNNACERTIFlGTEOFCONSENTTOSELF-INSUHEFORWORKERS' 2
COMPENSATION,ASPFOVIDEDBYSECTION]7ooOFTHEUBORCOOE,FORTHEPERWRMANCE U
Q OF THE WORK FOR NMICH THIS PERMIT IS ISSUED. �
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w _I MAVE AND WILL MAIHfAIN WORKERS'COMVENSATION INSURANCE,AS REOUIRED BY SECTION
Q 970o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS /�
ISSUED.MY WORKERS'COMPENSATION INSUFUNCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION v
jc�RpiEp PLAN REVIEW
� POLICV NUMBER ELECTRIC �
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0 �s[c.'rqNr�ra7sEoo�aiErIDOF7�aEaMrswaa�rtra�moaua�sKiroloa� PLUMBING
Z I CERTIFV THA7 IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
� SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECAMESUBJECTTOTHE
N VYORKERS'COMPENSATION LAWS OF CALIFORNIh NdD AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSA710N PROVISIONS OF SECTION 37000F THE LABOR �
CODE,I SHALL FOflTHWITI COMPLV WI7H THOSE PROVISIONS. ISSUANCE
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p OATE: APPLICANT: - �SMIP �C.L
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000).IN ADDITION T07HE COSTOF COMPENSATION,OAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF hiE LABOR CODE,INTEREST,AND ATTORNEI"5 FEES. � RETENTION FEE: �•�
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d CONSTRUCTION LENDING AGENCY pR�i�FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY THA77HERE IS A CONSTRUCTION LENDING AGENCY /F1
a- FOR THE PERFORMANCE OF hIE WORK FOR WHICH THIS PEHM�T IS ISSUED(SEC.30Y7,CIV.C.). ,
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� LENDER'S NAME •�
F- LENDEP'SADDRESS
W I CERTIFY THAT I HAVE READ TMIS APPLICATION AND STATE TUT 7HE ABOVE INFORMA710N IS CORHECT. TOTAL FEES '
� I AGREE TO COMPLY H7TH ALL CRY AND COUNTV ORDINANCES AND S7A7E LAWS RELATINO TO BUILDING
CONSTRUCTION,AND HEREBYAUTIqRIZE REPRESENTA7NES OF 7HIS COUN7V TO ENTER UPON 7HE
ZABOVE•MENTIONED VROPERTY FOR INSPECTION PURPOSES. COMMENTS �
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� RECPT.NO. PAID BY YALIDATIO
WHITE—Depertment Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
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C�TY OF DIAIVIOiVD BAR,
IVi9S(�ECTIOt�9 RECOFBD .
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SET�BACK �� � � �- ��;� FLOOR JOIST :�4�, �,.;� 1'�•.i ` : � ` �
FTGS/FORMSlSTEEL � ` ' ' � � FHA REQMTS
ELECTRIC GROUND ' � UNDER FLOOR DUCT � •; �
GROUND PLUMBING UNDER FLOOR CU�ID�111� : ',-�':'� ' ;:; , �� � :,�
SLAB GRADE FIRE , ,�� FO,U,NDA ION �'�= ::` :. '' '`'"
TEMP POWER FIRE LA E�ONb'BEAM � � �
WATER SERVICE - MID HT. BOND BEAM
ROC}�'SHEATHINCi ��'.''' �:., - • '.� : , ..�; : 8 FT. BOND BEAM �
FRAMINGNENTILIATION � � FINAL BOND BEAM, ,:; �, •. . „ , �: ;,, j
ROOFCOVER �': PRE-GRADI�1Gl �=;' _;'+''�.�:��='�.,;�'. :;:��� �
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ROUGH HEATING
BENC I�IGI' '�_,-;:•:, ;,r:,.. .��_s'�_; r1� �•:;
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUM1/IBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRlC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK _ .,_, LANDSCAPE/IRRIG.
SEEP PIT/l..L. � � � \� � C�N SITE IMPS. .
GAS AIR TEST FINAL ZONING
FINAL CONST. p , � FIRE DEPT. FINAL
FINAI.HEATING ' HEALTH DEPT. FINAL
FINAL:ELECTRIC DEV. FEES PAID
FIfVAL PLUMBING � ENERGY
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