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HomeMy WebLinkAbout17047 (42) �,` CTTY OF DIAMOND$AR � DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES i� 2I825 E.Copley Drive ', � (909)860-3195 Far(909)861-3117 PRESS ����� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE l�( Q Q ADDRESS_! u �1 LL�YI�� /_���-�� APPLICATI PERMIT p/C o OATE � � NUMBER r�V N � ISSUE 'ryPE p�C APN �OT�s�TF'ACT DATE CONST. GROUP p OWNE� � •I� �:-tI/�ON ., p ADDRE n L � �(N [ l- I R ZONING SETBACKS z CITY • ZIP�S TELY��•3�(��-1 11�( FRONT Ryy p g APPUCANT TEL. REAR p SIDFJSIDE STREET RW p Q CONTRACTOR ' SIDE p Q ADDRESS ^,�. � � CITY ZIP TEL. PROPOSED USE � ..�i v o ARCH/ENG/ ' � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � �n DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER�ECLARATION SFR/ADD/REM O p 1 HEREBYAFFIHM UNDER PENALTY OF PERAIHY THA71lUI E%[IAPT FRqA 7ME CONTRACTORS ll• G8f2g6/C8(pOR W CENSEUWiOqTNEFOLLONfINGREA50N(SEC.70.11.68U51NE55AhOVRCFE55lON5CWE:1INYCITVOR (n C.� COUNTYVMIp1qE0UIRE5APERMITTOCONSTRUCT,ALTERIMPROVE.DE/AOlISH,ORREPARANYSTNUC• W PdtiO/DeCk W NRE,PRIOR TO RS ISSUANCE,QSO REOUIRES TH[APPIICMT FOR SUCH VERIAIT TO FILE A SIGNEO W � STATEMEM iHAT HE OR SHE IS UCENSED GURSUANT i0 THE VROYISIONS OF 7H�CONTMCTORS LI• � CENSE UW�CHA7TER 9(C0IAAIENCINO MATM SECTION 7ooa)Of DIVISION]OF TNE BUSI�ESS AND VFO- POOVSpa � FESSIONSCOOE�ORTHA7HEORSHEISEXEMPTTHER[FROMANOTH[BASISFORTHEALLEGEDEXCMP� (� V TION.AN'IVKKATIONOFSECTION70]1.6BYANVAPPUCANiFORAPERMITSUBJECT$THEADPLICAMTO Z Re-Roof A pVILF�ENALTY OF NOT MORE MAN FfVE HUNORED OOlUFS(f5o0).7: Q @T,ASOWNEROFTHEVROPERTV,ORAIYEMPLOYEESWITMWAGESASTME:RSOIEGOMPENSATION, � Commercia� Z NALL UO THE WORK,AND THE STRUCNRE IS NOT MTENDED OR OFFERED FOR SAIE(SEQ 70�1,BUSb J � NESS M1D GHOFESSIONS CODE:TME CONTRACTORS UCENSE UW DOES NOT APPLT TO AN OWNER OF ? FROVEfliY WHO BUIlDS Ofl IMPROVES THEREON.AND NMO DOES SIICH WOfiN HIMSELF OR HERSEIF OR [L THROUGHNISORMEROWNE4PLOVEES,FROYIDEDhUTSUCNIMGqOYEb1ENTSARENOTINTEhDEDOR m . O OFFEREOFORS�LEIF,HOWEVE{�7NEBURDINGORIIAVROVEMENTISSOLDWITMINONEYEAROFCOMPLE- Z TION,THE OWNER BUILDER WiLL MAVE TH[BUROEN OF PROYINO TNAT HE OR SME DID NOT BUILD OR MFROYEFOR TME W PPOSE OF SACEJ. Of/�5 OWNER OF iHE PROPERI7,M1 E%ClUSNELY GONTRACTIN(3 W RH IICENSED CONTRACTORS Q TO CONSTRUCi THE YROJECT(SEC.70�t.BUSINESS 1JID PROiE55lON5 COO[:TH=CONTRACTORS LI• VelUetiOn ��- AQI.AREA W CENSEUWDOESNOTAPPLYTOANONTIEROFAPHOPERTYN?106U0.DSORIMPFlOYESiHER[ON.AND � N'IqCANTRACTSGOFSUCHPRQIECTSWITHACONTMCTOfi(S)LICENSEONRSUANTTOTNECONTRAG QUANTITY D[SCRIPTION FEE Y TORSLICENSEUW). ,, � O IAM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U V"' OATE OVINER F- O W Q LICENSED CON7RACTORS DECLARATION w [C 1HEREBYAFi1RMUNDERPENIITVOFGERIURVTNATIAAILICENSEOUNDFRPROVISqNSOFCHAFTER � d 9(COMMENCWO WITH SECTION 1000)OF�IVISION 3 OF TME BUSINE55 AND PROFE5510N5 COOE,AND Z X MYLICENSEISINFULLFORCEANOEFiEC7. , m ll! 0 LICENSE CUSS UC.NO. j V DAtE COMRACTOR d W � WORKERS'COMPENSATION DECLARATION ��, a � IHEREBYAFFIRMUNDEFPENALTVOFPERIVRVONEOFTNEFOILOWWC�ECURATpNS: Z � _IHAVEANDWILLIAAINTAINACERTIFICATEOFCONSEMTOSELF�INSVREFORWORKERS' _ � COMPENSATiON,ASVROHiDEDBYSECTION77oaOFTHEUBORCODEFORTMEFEHFORMANCE U Q OFTH[WORK FOR WHICHTM15 PERMIT IS ISSUED. ��,, � � _INAVEANDWILLAA�MTAINWORKERS'C011PENSATqNINSURANCE,A5RE0UREUBYSECTqN Q 77000F THE LABOR COOE,FOR THE PERFORNANCE OF THE WORK FOR WMCf1 TMS PERM�i IS (�� �J J ISSUED.MY WORKER5 COMPENSATION INSUFANCE CARRIER M!0 VOUCV NUMlER►RE: CONSTFUCTION a j e�aaieR PLAN REVIEW 0 va�crnur.�eEa ELECTRIC Z ¢ �nassEcnowr�mraoTeEmr.nErmaFnEVEw.rrswaax�+�.wnc�oai,v��s,ro�oa�ss� PLUMBING Z ICEHTIFYTHATPITMEPERFORMANCEOFTMEWOPKFORWNICVITHISiER1.11TI5155UED,1 MECHANICAL ���+� �-- (,7 SHILLLNOTEIAPLOY/WVFERSONWANYMMl4ERSOASTOB'eCOMESUBJECTTOTHE ' � � -�� WORKERS'LOAIPENSATIONUWSOFCALIFOFiNIA,ANDAGREETNATIF15110U�OBECOME INSPECTIONFEE SUBJECTTOTHEWORKERS'COIADENSATIDNVROVISWNSOF �TIDN77ooOFTNEUBOR s cooE.iSw�ucoanvmTHtana�vvnrH ISSUANCE / I p OATE:�'r,-�-f-o I APPLICANT. SMIP J WARNIN(i:FAILURETOSECURENIONNEPS'COIAPENSATqNCOVERAGEISUNUW�Li.A!1DSHALLBE ENERGYP/C � I � �O � SUBJECiANE47LOYERTOCPIA7:NALPENALTIESMDCMLFINESUPTOONEHUNDqE7THOUSANO �"��.F�__. � DOLURS(f10a.0aa),MADDITIONTOTH[COSTOFCOMPENSATION,DAMAGESASPPOVIDEOFORIN ENERGYPERMIT � SECTION�70lOFTHELABOACADE,WTEREST,ANDATfOfiNEY9FEE5. I RETEMIONFEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: .UO O I � IHEREBVAFFIRMUNDERPENAITYOFPEfUURYTHATTHEREISACANSTRUCTIONLENDINCACENCY FOR iME FEflFOftMANCE OFTHE WOFK FOR WHiCH TH�S fERMIT IS ISSUED�SEC.]oG],CIV.C.�. Z W � IENDER'S NAME � F— LENDER'SADORESS W ICERTIFYTHATIMAVEREMTHISAPPLICATqNMlOSTATEiMATTNEIIBOYEW�ORMATIONISLORREGT. TOTAL FEES I � '3 /� � IAGREETOCOMPLYWITH�IL�CITVANDCWNTYORDINANCESANDS7AiEUWSPELAiIN6iO8UIL01NG � � CONSTRVCTION,ANOHEREBYAUTMORIZEREVRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE Z ABOYE�MENTIONEU PROPERTV fORINSPECTION PURPOSES. �� COMMENTS 0 J � m VERMITfEE NMIE(PR1M) � Q � (/� SiGNATUREOFPERMITTEE DATE i �,,/ � ' RECPT.�O. � PAID BY G� VALIDATION� WHITE—Department Gopy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENROD—File Copy,GREEN—Applitant'S Copy • , , . ,. �. , . . ' . . . ....... . t. .. ' ' ' . .,. . ,. .. . ... . " " " � .. ... .... . ...1. ., ... .. � . . � . . . . �"i Q'�; f P f' • F• •�. •-1 ...^�^ t . � B. .'.i,�e_e���_,_. l`..�i�.I. • Y�'• ... �_. .. ,�...JE;' i. ..._.. _>. .-.� ______.�_ __ ..._..__ _ .. _.. . _ . . . .. ._ _ - ------ - -• - _ _.__ _ __ _-- -_ iF��„C�F s. �(t !�.�3 ..... !., „''.. ,'� !�,: 9rr.,. W c . ;� �f�s r1�' , .,. t���`t.�� r ��'c1C! _ . __..--�- � -- SET BAC;�: ' ; � I Fl_OCR JJIST -- - ------•-.._ ..-------__----.. _ __----�,----------------- ! 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I�TH/51UING ; - I ---i ; POOL FE�•J;IN�- - _ � ---� -1---------- -�- -------------- -- �'lALL I�dSULF,TIO�J � � � �'OOL FR�1Al_ - _�_ � — CEILIt�.G It��ULATIOtJ i � OFF SITE I',1?S. j � DRYI^JALLPd�ILIfJG I -- { ---------- -DEDICATIO'JS---- --� . __� S�1^JER ---- -�- --� _ -} � FINAL�NG. _,Ii i S�PTICTF,N}C i � I I LAPJDSC!',P�/,RFJG. I � SEEP PIT/LL. i ; � oiJ SITE IP;+PS. G�S A.IR TEST ; ! , FI'JAL ZO��I�•JG _ FI�1AL CO'�JST. ;���Ul_:._��� ' r��� D�PT. FI�Jr,! FIMAL HEF,TIP:G �_ i _ i j_HE.�LTH DEPT. F1��tAL __ � FIPd,AL ELECTRIC _ � i _ _____ ! I DEV. F�ES Pr",ID _ ; FIfdAL PLUPI�E�Ii�G � i EiJ�RG'f � I i I � --- ---- -- ---� - -�--- _ . --..___....--- _. ,.._...__- � i � : ... _ � � ,. , . . CUi��II��;E�JTS �__ SEP i IC T�,�Jf: 51ZE SGEr P1T/U SIZE -" ""-- --- -- .. --- - _ F1, -- --- ��t`� - -- -------- - - ---- b•, _ .