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Home My WebLink About18302 (28) % ci�oF D�orrn s�►xx , [�XPI RE� �—- �'` —�� DEPARTMENT OF COIvIIvfUNTfY&DEVELOPIv1ENT SERVICES I 21825 E.Copley LTrive 0 C T 0 9 2002 - (909)860-3195 Fax(909)861-3117 PRESS �� BUILDING PERMIT APPLICATION FIRNALY o� JOBSITE r APPLICATION�^7 PERMIT �j? P/C ADDRESS � ' OATE / � Z �� NUMBER 'J JO 7'�# � ISSUE TYPE OCC APN L�O.,T TRA T DATE � ��-- � � CONST. GROUP p OWNER T— o ADDRESS ' ZONING SETBACKS Z CITY �G--.-a-��PI�...ZIP 9/�b L. ' • � FRONT RW ❑❑ o APPLICANT TEL. S DE/SIDE STREET RW ❑ � CONTRACTOR C�M'� SIDE ❑ ADDRESS � ' p PROPOSED USE ��-C�'^-�� 3 CITY ZIP L TEL� I. o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENALTV OF PERJURV THA7I AM E%EMPT FROM THE CONTRAC70q5 LI� G8f89Q/CBfpOR W CENSEUWFOR7HEFOLLOWINGREASON(SEC.703t.5BU51NESSANDPqOFESSIONSCODE:ANVCIiYOR (n U COUNTYWHICHRE�UIRESAPERMITTOCONSTRUC7,AlTER,IMPROVE,DEMOLISM,ORREPAIRANVSTRUC� w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIfiES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck S7A7EMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CHAP7ER B(COMMENCING WITH SECTION 7000)OF DIVISION 3(1F THE BUSINE55 AND PRO� � POOVSpB FESSIONSCODE)ORhiATHEORSHEISEXEMPTTHEREFROMANOTNEBA515FORTHEALLEGEDE%EMP� (� � TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICAN'fOR A PEFMIT SUBJEC'�S-ME APPLICANT TO Z Re-Roof . A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOIURS(5500).J: � Z ❑I,ASOWNEROFTHEPROPE(i7Y,ORMVEMPLOVEESWi7HWAGESASTHEtRSOLECOMPENSATiON, � COmmCfCi01 WILL DO THE WORK,AND THE STRUCTURE IS NOT IN i ENDED OR OFFEREO FOR SALE(SEC.70dt,BU51- J � NESS AND PfiOFESSIONS CADE:THE CONTRACTORS UCENSE LAW DOcS NO'APPLV TO AN OWNER OF � PROPERTV NRiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m - w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROfCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING'MA7 HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PUFPOSE OF SALE). = OI,ASOWNEROFTHEPROPERIV.AMEXCIUSIVELVCONTRACTINGWITHLICENSEDCONTRACTOPS W � TO CONSTRUCT THE PRQIECT(SEC.70a1,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V01U3�1Of1 � ADJ.AREA � W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOdUII.D50RIMPROVE57HEREON,AND — � NTIOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�I.ICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). [[ J � ❑I AM EJ(EMPT UNDER SFC. B.8 P.C.FOR THIS REASON Q � U � — ¢ DATE OWNER � - Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBYAFFIRM UNDEH PENALTV OF PERIURV THAT IAM LICENSED UNDER PROVISIONS OF CHAGTER � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PP.OFESSiONS CODE,AND Z X MY LICENSE IS IN FUL�FORCE AND EFFECT. � UCENSE CLASS D _ LIG.NO. ��l_!/� j J V DATE � � CONTRACTOR �I I� d W � WORKERS'COMPENSATION DECLARATION -� ' � Q � I HEREBV AFFIRM UNOER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSUqE FOR WORNERS' _ � ¢ COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. � � w _I HAVE AND WILL MAINTAIN WOFKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION Q 9700 OF THE IABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS'COMPENSATION INSURANCE CARFIER AN LICV NUMBER ARE: CONSTRUCTION Q �./� � CARfiIER I�i �/ PLAN REVIEW Z POUCYNUMBER Q�O�d ELECTRIC Q � (iHISSEC�IONNE�NOTBECt7MPLEfEDOFi)iEPERMITISFORONEMIPOREDDOII?fiS�ft00�ORLESS). PLUMBING W .,r. Z I CERTIFV TNAT IN THE PERFORMANCE OF THE WORN FOH WHICH THIS PERMIT IS ISSUED,I MECHANICAL 5 (3 SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJE�T TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME / INS?ECTION FEE SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F TH BOf� /j�e � COOE,ISHALLFORTHWITHCOMPLVWITHTM EPR IONS. j ISSUANCE � �L '� Q T�Z/ p DATE: I� 'a/� V APPLICANT: SMIP J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVE E IS UNLAWFUL,AND SHA BE ENERGY P/C � SUBJECTANEMPLOVEFTOCRIMINALPENALTIESANDCIVILFINESUGTOONEHUNDREDTHOUSAND ENERGYPERMIT • DOLURS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN Q /�r` ' J SECTION 3708 OF THE LABOR CODE,INTEREST,ANDATfORNEV'S FEES. RETENTION FEE: 1.CJU \ W d CONSTRUCTION LEND�NG AGENCY PRE•ALT FEE: ' O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV n- FOR THE PERFORMANCE OFTHE WOFK FOR WHICH THIS PERMIT IS ISSUED�SEC.3097,CIV.C.). Z W S I.ENDER'S NAME � 1— LENDER'SADDRESS /� ( � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES IJ�J�� w I AGFEE TO COMPLV WRH ALL CITV AND COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING ' � � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE � Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS O �rJ C� m PERMITTEE ME(PRIN7) a ' Z°� � -- � S NA7UREOFPE EE DATE = RECPT.NO. PAID BY VALIDATION � ~ WHITE—De artment Co YELI.OW—Finance Co PINK—Assessor Co GOLDENROD—File Co GR IicanYs Co , P PY, PY, �Y. PY, — PP PY ��'�l �� fl�9�►��4R�3 �A6� 6i��`�'8�i°� �� . . m-F-�-� �am a.^-F' ;`^!Y"�L•--"�."^^.��. .,. . - ��. B � . '.� o :. ��° , �•.. � .Q�� <, � o .» �� • °�� >� ,�:�� o � , � � p a . .; �� .; . .�. . �. � �,�, . . _ . . ,. ,, .. , _ , a - , -, . � � . . SET BACK � � � I I �'LOOR JC�,IST � � � � --- --- --- — --+-- --- —_ _ ._._. } ._ .._._.__ — FTGSlFQRMS/STEEL ; ( FNA RE�MTS � � _ _.— —. ___ ______ -- —.. --- ELEGTRIC GROUND __ , j __ _ __� � UNDER FLOUR DUCi � .� .._._ .___ _ . ___ — - - -- ----- —-— -- GRt�UND PLUMBING ' � UNQFR f—LOOR CC)h�DUIT ' - '• ' _� _ . ___ ___ ____. --_______ _ __ -- 1 _ - -�---- _ , . SLAB GRADE ; � F!RFPLACE FOUNC�ATION_ �_ ' ! --- __ __----- --- " --- --..._� ; TEMP POWER � ' f�IREPLACE BQND BEAM____ i____ � , -- — -- __ _— _. __. WATEFi SERVICE � ; I MID HT. E30ND f3EAM � — ---- _-----.. __ *.—�-----._ ..__ ---- -------- ROOF SHEATHING � 8 �T. Bf�N'D BEAM � — — — — -- ---- --- -----—, — --- FRAMINGNENTIUATION I _ _ __ _ FiNAL E30ND BEAM — -- _ _ ---- —-- -- — ROOF COVER ; __ ___ _� PRE—GRADING_ ___ ; --------- ROUGH HEATiNG � g��%�� _ -----r- ---..._.____ _---_—_. ____.------- ROUGH ELEC7RIC I � HOUGH URADING ___._ _ _� .._....__—_ -- ---- ------- _ _....--- ---.. . _. _--—— _.... ROUGH PLUMBING ' _ ? FINISH uRADING --- --- ..— -----_---.---- -- _...---- SHOWER/TUBTEST �' ' ; POOLELEGrRIC .. _--- — --- —,--- EXT. LATH/SIQING --- � —�_.--_ —j ' PQOL FENCING ; WALL INSULATION �— i __ s POQL_FINAL —.__ — ---- CEILING IN�ULATION ' ___ � OFF SITE (MPS. __ _ __ � DRYWALL NAIUNG ; — ' DEDIC�471ONS _-- ------------ ---- --— — ------ -- -- - SEWER 1 F(NAL ENG. � ----- _ _.__ — - -------•— �---- ._.._�_------- � LANDSCAPEriRRIG. SEPTIC TANK I _ �___. _._ ._._� _ ...----- ._____.— `—__ _.___..._ SEEP PIT/L.L. ' ON SITE IMPS. _._. _--�-------._�—.--1� _. _..__ �__....---- -- GAS AIR TEST f ; FINA�ZUNING —�----�- ---._---- --____— ----�— _.. FINAL CONST. � I ' , F!RE DEPT. FINAL• '--i--....__�__ �— FlNAI HEATING �—� � IHEALTH D�P"f. FINAL � __ ---!------- — --• FiNAL ELECTRIC � ; DEV. FEES PAID _ _ FINAL PLUMBING ; 's I ENERGY I --�— -------- ----- ---—.._.-- --}--- ----—........_ — .____ ,. o � d .,, ._ .,., i _ —�_------..----- °",� ----- . � ------- CUNifViENTS �__ _.- � --. -- . � - ----=�- SEPTIC TANK SIZE SEEP PIT/U SIZE ------ ------.......__--- ------------____._--- --------- � a ----- ----- ------ . �. , � : , y� -------- - ------ ------- a � . . . � . �.--- �� —--- � __ �