HomeMy WebLinkAbout17138 (23) _�� _ ci�oF o�orro a�x EXPI RED
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 J U N 17 2002 Pff�ESS
"''-���'�`` BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE r , A N DATEICATION _ NUMB R I� I �`a g/�_
ADDRESS !�e�G I � � E ►7.aG►IGL]-. -
� ISSUE p� I Z 0 p TYPE OCC
APN LOT TRACT �
DATE CONST. GROUP
p OWNER Nr�1� DdLulL�s YY��AfLs�N
o ADDRESS ZONING SETBACKS
Z CITY�1QYY�r�l��AfL ZIP�'17/n� TEL.� -I FRONT RW ❑
o APPLICANT ��j�_y� TEL. �'� S DE/SIDE STREET RW ❑
z
¢ CONTRACTOR !1(�✓/��.(L SIDE ❑
� ADDRESS ,�,��
� CITY ZIP TEL. PROPOSED USE � �� 1�"L�G� RO�d
o ARCH/ENG/ �
z DESIGNER
w NO.DWEL. NO. NO. �
a ADDRESS UNITS � STORIES �Z BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- G8f8QBIC8fpOfl
W CENSEUWFORTHEFOLLOWINGflEASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVqTVOR (f�
U COUNTYWHICHREDUIRESAPEHMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W patio/Deck
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED W
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PRO� � POOVSp2
FESSIONSCADE)ORTHATHEOFSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� �J�
� TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICAN770 Z RB-ROOi OV V
A CIVIL P NALTV OF NOT MORE THAN FIVE HUNDRED DOILAFiS(f500).):
ASOWNEROFTHEPROPER7Y,ORMYEMPLOVEESWITHWAGESASTHEIRSOIECOMPENSA710N, 0
Z Commercial -
WILLbO-THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,BU51- J
� NESS AND PROFESSIONS CODE:7HE CON7RAC70RS LICENSE lAW DOES NO7 APPLV 70 AN OWNER OF �
PROPERTY WHO BUILOS OR IMPROVES THEREQN,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� 7HROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHA75UCHIMPROVEMENTSARENOTINTENDEDOR m
QOFFEREDFORSALE.IF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSNELY CONTRACTING WITH LICENSED CANTRACTORS
� TO CANS7RUCT THE PRQIECT(SEC.70�a,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI� V31Ue�lOf1 ADJ.AREA
W CENSELAWDOESNO7APPLV70ANONRJEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
� U ,
� ^` �
DATE '��/ �� � OWNER �
Z W
� LICENSED CONT ORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND z
`X MV LICENSE IS IN FULL FORCE AND EFFECT. m I
� UCENSE CLASS I.IC.NO. j �
H J
U DATE CONTRACTOR d
W
� WOAKERS'COMPENSATION DECLARATION �
Q
= U
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z � �
Z _I HAVE AND WILL MAIN7AIN A CER7IFICATE OF CANSENT TO SELF�INSURE FOR WORNERS' 2
Q CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS(7EOUIRED BV SECTION /// J�
Q 37000F 7HE LABOR CODE,FOR THE PEFFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS { �O, �{,/
ISSUED.MY WORKERS'COMPENSATION INSUHANCE CARRIER AND POLICV NUMBER AFE: CONSTRUCTION 1
J
� CARRIER PLAN REVIEW
Z POLICYNUMBER ELECTRIC ,
Q
0 (fHLSSECTIONNE�NOTBECI7MREfEDOFTHEPERMITISFOHONEHUrDREDDOLLARS(5100)ORLESS). PLUMBING
W
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
�} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE -
� WORKERS'COMPENSATIONLAWSOFCAUFORNIA,ANDAGHEETHATIFISHOULDBECOME INSPECTIONFEE
= SUBJECT TO THE VlORKEHS'COMPENSATION PROVISIONS OF SECTION 3700 0F THE LABOR �
CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE p� ^�
� SMIP � !1�l
p DATE: APPLICANT:
J WA(iNINC FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100.000�,IN ADDITION 70 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OG THE LABOR CODE,INTEREST,AND ATfOflNEY'S FEES. RETENTION FEE: �I
I a CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THATTHERE IS ACANSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HIS FERMIT IS ISSUED(SEC.3097,CIV.C.). .
Z
W
� LENDER'S NAME
F- LENDER'S ADDRE55
� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES � ��(��
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS REIATING TO BUILDING
d
� CONSTRUCTION,AND HEREBV AUTHORI2E REPRESENTATNES OFTHIS COUNTV TO ENTER UPON THE
Z ABOVE�MEN710NED PROPERTV FOR INSPEC710N PURPOSES. COMMENTS .
0
� � �
m PE EE NAME(PRIN7)
� � �0
� SI MI DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�-File Co GREEN—A licant's Co
P PY. PY. PY. PY, PP PY
. . . .,..., . , . � . . ..�.. ._ .. . . . . .. ..
.. . . . ,. .. ,
�6�1'� �f� ���(�i(�k�R(�' [��(�
��1��'���'06�� [�C��Cc�G�C�
.�_.. --�--�- .. ,, ,, � . �me,� . , _____��� ����:.
OG1�� �QJi C.� [����3 . ,O�C� C�QU��� (1�p" .o ' .��
---- -
SET BACK � � —� , j FLOOR JOIST I �
_..- --.._..._.--r___._..__ i.._--..._._ -- —� --.._ .._..____ _-1.._,_..__.__ ....._..._.__
FTGS/FORMS/STEE� ; ' FNA REQMTS
--r---- —�---- - --- _ ------ ----
EL.ECTRIC GROUND ' UNDER FLOOR DUCT
— - �-�-- -- - -- ---
GROUND PLUMBING ; _____ _„ _ ____ � U�lQER FLOOR G��(��DUIT � '
__. ____.- --�--.. —___. _....
SLAB GRADE � FIREPLACE FOUNDATION � _
TEMP POWER _ �_ _�_�__ FiREPLAGE BOND BEAM
---....--------- ----._._.._.
WATER SERVICE ' � ' MiD HT. BC3ND B�AM ____
ROOF SHEATHING ��`,t y G� �� �1�'0'"' 8 FT. BOND BEAM ------ ---- � ------
F R A M I N G N E N T I U A T I O N I � ___ __ _� FINAL BOf�lD BEAP�1 '
- -- ____ __ ___---- _.__.. _.-...
ROOF COVER ' PRE-GRADING
ROUGH HEATING BENGHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINiSH GRADING
- -- - --- —- ------
SHOWERIfU6 TEST � � PC?OL Et_ECTRIG
�.._.. -- __�.----------
EXT. LATHISIDING POOL FENCING
WALL IiVSULATION POOL FINAL '
----- ------- --._...�.
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL(VAILING DEQICATIONS
SEWER FINAL ENG. - - -
SEPTIC TAIVK • , LANDSCAPE/IRRIG. �
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FI�IAL Z�i�ING �
FINAL CONST. � . F!RE DEPT. FINA! _
FINAL HEATING ; HEALTH dEPT. FlNAL �
FINAL ELECTRIC � '� DEV. FEES PAID ��
FINAL PLUMBING ENERGY !
--- ---.- -- --.---.....__ ; __......_..
�
� i
��'�o �
COi1(iNrEN�fS
SEPTIC TAiVK SIZE
SEEP PIT/U SIZE —
� ._- -.---._ _____ __....____._._.
� � ---
� . �. � . _._.—...__
�.