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Home My WebLink About15629 - � _�� CITY OF DIAMOND BAbt � \ DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 ,/' (909)860-3195 Fax(909)861-3117 '�/ PRESS ��'� BUILDING PERMIT APPLICATION �IRMLY � JOBSITE Q APPLICATION �'/�PERMIT �� P/C o ADDRESS �/��Q �y ��/� 1 iv G� � ~ • DATE V��NUMBER # c� ISSUE TYPE OCC APN LOT TRACT DATE L CONST. GROUP p OWNER �/�RM�1� j�U�l S r=Cf�l� p ADDRESS 3s /y 3�'►' S 7C /C:7 ZONING SETBAC S � c�nr P►v�-n,v��r�� ZIP �2fel TEL.7yc9%?7/- CL FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR � � � SIDE ❑ ADDRESS � �� E. C'v�L�iJ j� Y'1� ++� � C�Ty G l�',n 6�i ZIP �1'7�/V TE�.CaG 9/y k!�`� PROPOSED USE o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBV AFFIRM UNDER PENALTY OF PE0.NRV THAT 1 AM EXEMPT FROM THE CONTMCTORS LI- Geffl90/CflfpOR W CENSEUWWRTHEFOILOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCIIYOR (n C� COUNTI'NMIp1REWIRESAPEHMRTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,ORREPAIRANYSTRUC- W P8ii0/DBCk Z TURE,PRpR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCM PERMIT TO FILE A SIGNED � STATEMENT THAT HE OR SHE IS UCENSED PURSU�NT 70 THE PROVISIONS OF h1E CONTMCTORS LI- w � CENSE UW(CHAPTER 0(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSpB FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT 7HEREFROM AND THE BA515 FOR THE ALLE4ED EXEMP- TION.ANYVIOUTIONOFSECTION7031.5BVANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � ACIVIL VENALTV OF NOT MOHE THAN FNE HUNDRED DOLURS(i5W).): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial - MALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI� J N NESS AND VROFESSIONS COOE:THE CONTRACTORS LICENSE UW DOES NOT A7PLV TO AN OWNER OF — PROPERTY WFiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � iHROUGH HIS OR HER ONM EMPLOYEES,PROVIDED 7HAT SUCi1 IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFEHEDFORSALEIF,HOWEVER7I�EBUILDINOORIMPROVEMINTISSOLDWITHINONEYEAROFCOMPLE- Z �TIDN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO TiAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,ASOWNEROFTIEPROPEHTV,AMEXCLUSNELYCOMRAC7INOWI7HUCENSEDCONTMCTORS Q TO CONSTRUCT THE PRO.IECT(SEC.70/1,BUSINESS AND PHOFESSIONS CODE:THE CONTRACTORS LI� V81U81i0f1 ADJ.AREA � CENSE UW DOES NOTAPPLV TO AN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WFIOCONTMCTSFORSUCHPR0.IECTSWITHACONTRACTOR(SjLICENSEDPURSUMITTOTHECONTMG pUANTITY DESCRIPTION FEE Y TORS 110ENSE LAW.). O ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON � 3 � � DATE OWNER F' Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNOER PENALTV OF PEFLIURY 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCINO WITH SECTION 7000)Of DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CADE,AND Z X MY LICENSE IS IN FULL FORCE AND EFFECL � `� UCENSE CUSS D �,�.No.'� 6'S 7�/� � _ � t J V DATE �f%/4 I AU CONTRACTOH a _ �_.__ W � � WORKERS'COMPENSATION DECLARATION a � 1 HEREBY AFFIRM UNOER PENAL7V OF PERIUItY ONE Of THE f-0LLOWING DECURATIONS: � C� Q � _IHAVEANDWIL!MAINTAINACERfIFICATEOFCONSENT70SELF-INSUfiEFORWOHKERS' 2 COMPENSATION,ilS 7i10VIDED BV SECTION 370o OF THE IABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR NMICH THIS PEFMIT IS ISSUED. � � w _1 HAVE ANO WILL MIUMAIN WORKERS'COMPENSATION INSUMNCE,�S REOUIRED BV SECTION o Q 370o OF THE LABOR CODE.FOR THE PERWRMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED.MV WORNERSn'COMPENSATqN INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION jCApRIER S T�/ Tr F U�1✓� PIAN REVIEW � POLICV NUMBER /�l iJ�i t9 I�I •- n� ELECTRIC a � �rwssEcrqr�NE�no78Eoo��oFn€�w�rrswaa�EM�ooal.us�slro)oa�ss� PIUMBING f�3� �?�t w MECHANICAL ��✓ Z I CERTIFV THAT IN THE PEfiFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I (�} SHALL HOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME Sl1BJECT 70 THE � WORKERS'CAMPENSATION UWS OF CALIFOHNIA,PND AGfiEE 7HAT IF I SHOU�D BECOME INSPECTION FEE S SU&IECT TO THE WORKFRS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOH -p (� /� _ ' � CODE,I SHALL FORTHWITH COMPLV Wlhl THOSE PROVISIONS. ISSUANCE v P_1 1, /1 U p, p DATE: ✓ ' �• •• APPUCANT: SMIP n nl1RTTl�f-0� w +�I�C Q3r i�ira��,..,.,_ .��¢y ,'��. —� WARNING:FAILURE TO SEWRE WORKERS'CAMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C .+ n A�'Ki � V J � y �}�/� VL J��'•--- LL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES U7 TO ONE HUNORED THOUSAND ENERGY PERMIT B`��++`v� DOLLARS(i700.000).IN ADDITION TO 7HE COST OF COMPENSATION,DAMAGES AS PHOVI�ED FOR IN J SECTION 37oe OF hiE LABOR CODE.IN7EREST,M1D ATfORNE1^S FEES. RETENTION FEE: Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALT/OF PERIURV THAT THERE IS A CONSTRUCTION�ENDING AGENCY FOR 7HE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PENMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NAME F_ LENDER'SADDRESS /A� � I CERTIFY TMAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CARRECT. TOTAL FE ES / �� I AGREE TO COMPLV N7TH ALL CITY AND COUN7Y ORDINANCES AND S7A7E LAWS REUTING TO BUILDING � (/ . CONSTRUCTION,AND HEREBV AU7HORIZE REPRESEN7A71VE5 OF THIS COUN7V 70 ENTER UPON THE Q �YE F�0 PAOP FO INSp CT N PURPOSES. f,��,,�. ��'D�i'� �y�� COMMENTS J ��?1Z� -�p'-7�T5f S � m PERMITTEE NAME(PRIM) �� Q � �"�� .-- i�dV'�i�� SIGNATURE OF PEHMITTEE DATE �—� = RECPT.N0. PAID BY ti VALIDATION ~ WHITE—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy ( � — � iCB�'�( d�� ,�6��1�9� ��aff� �V�SV�f��B�D�I �[�C�6�� . . . � , • �I�y� o � o o Q � �p o � o� �UIN�t.r'�=�. D ��. ,� ` ,� .Q x .. . . .. . � r . . .� . . SET BACK �-., FLOOR JOIST , _ -- --- . ---- _._ _.� � _ FTGS/FORMS/STEEL ` •-• FHA REC�MTS ELECTRIC GROUND � • i UNDER FLOOR DUCT � .. _.. _._..__... _. GROUND PLUMBING . �� UNDER FLOOR CU�;�UIT_ -----_._._.... ....__..._. SLAB GRADE FIREPLACE FOUNDATION _ __ TEMP POWER � FIREPLACE BOiVD BEAM � � WATER SERVICE MID HT. BOND BEAM _ ____! ___ ROOF SNEATHING�� , 8�T'. BOND BEAM � FRAMINGNENTILIATION � FINAL BOND BEAM ROOF COVER PRE-GRADING RQUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING RUUGH PLUMBIt�G FINISH uRADING SHOWER�T"UB TEST POOL ELECTRlC EXT. LATH/SIDING POOL FENCING � ' WALL I�ISULATlON POOL FINAL CEILlNG 1�3SULATION OFF SITE IMPS. DRYWAL.L NAIUNG DEDICATIONS ` SEWER FINAL ENG. SEr TIC TANK LANDSCAPE/IRRIG. 3EE�' PiT/L.L. ON SITE IMPS. t;AS�IR TEST FINAL ZONING y FIN!'�L C�ONST. FiRE DEPT. FINAL �"�i�l�t�!-IEATING HEALTH DEPT. FINAL �i�/:�ELECTRIC DEV. FEES PAID � ' � :" �'fi.L PLUMBING ENERuY j. ._ �� ° � ----- ^ _._ �_ - - - -. . , . ' C��TS . _ , SEPTIC T/�iVK SIZE SEFP PIT/U SIZE ----_� ______.___._� 3�� _ _ _._.___. � �� ..._ _�_ -._.-------- '°� - � �.._.._ , , ___.._._. Qr � � . . < ------ . ,; ._� �- � ' ___.r._ ----.�..---____ �. �