HomeMy WebLinkAbout17138 (25) �,` crrY oF D�oxn s� EX P I R E D
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
E 1 �""i (909)8603 95Fa�c(909)861-3117 JUN 17 2D02 PRESS
`'%::��� BUILDINGPERMITAPPLICATION FIRMLY
o� JOBSITE f �/�� c� APPLICATION � PERMff I� I�`fl P/�
ADORESS l[e7L � � 1 W-,Da�.1GL�N DATE �- NUMBER #
$ issue o�� Zo o� TVPe occ
APN LOT TRACT DATE CONST. GROUP
p OWNER�V41J� �dLU21Gf_ YY�Y32�7N
ADDRESS [ ZONING SETBACKS
z CITY�l��m� rl A2 ZIP��,:, TEL. -� FRONT flW ❑
g TEL. < REAR ❑
APPLICANT j fs��OGZ.1� SIDE/SIDE STREET RW O
� CONTRACTOR a/,y_//.�&2 SIDE ❑
� ADDRESS PROPOSED USE r � � [.�C� IZdd
� C1T` ZIP TEL
o ARCH/ENG! �
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS ' STORIES Z BEDROOMS�,_
= CITY ZIP TEL.
� OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANAUJATION
� OWNER-BUILDER DECLARATION SFR/A�DlREM
O
w c�s�EuwFoaniEFOI OWWONREASON(SEGTOJR6B STN�ANOC OGESSIONSOODE:�cmoa GarapalCarport
U �TYNT11CHpEWIRESAGEflMITTOCONSTRUCT,ALiEfI�PROVE.DEMOUSH,ORREPAIRANYSTRUG W Pa2IDID0CI(
W TURE,ORpR TO ITS ISSUANCE.AL50 REOUIPES TME APVIMaWT FOR SUCH 7ERIAIT TO fILE A SIGNED W
� STATEMENT TMA7 HE OH SME 15 LILENSED PURSUANT TO THE VflON510NS OF THE CONTMCTORS U•
� CENSE UW(CNMTER Y(COIAMENCINCi WITH SEC710N 7000)OF�IVISIDN f OF THE BU51NE5S�ND VRO� � POOVSpd
FESSIONSGOOEIORT}UTMEORSHEISE%EMPTiMEREFROMANDTHE8A313FORTHE/LLEGEDEXEMP• (�
� 710N.ANVVIOLA710NOFSECTION70]1.68YANYADVLICMITFORAPERu1TSU61ECTSTHEAPPLICANTiO z (�e-qpp( Q
ACMLVE N�ITYOFNO7MORETWWFIYEMUNOREDOOUMS(f50ol.y
� kTASOWNEROFTHEPHOPERTY,OA�vEMPIOVEESWiT1WAGESASTNEIq50LECOM7ENSATqN, � OpmmB�tldl -
Z WILL�10 THE WORIC�VID TME S�UCTUNE IS NOT WTENDED Oli OFFERED FOR SAIE(SEC.7W�,BUSt• J
NESS AND GHOFESSIdJS OODE:T11f CONTMCTORS LICENSE LAW OOES NOTAPPLY TO AN OWNER OF
� PPAPERTYNrt108U1LDSORIMPROVESTMEREQN,ANDWHOD0E55UG/WORKHIMSELFORHERSELFOR �
� iHqOUGHHISORHEROWNEMPLOYEES.PROV10E�7HATSUCHIM7qpYEMENTSARENOTMfNOEDOR m
� OFFEflEUWRSALE�F,IqWEVER7HEBULDINGORIMPROVEMENTI550lDW1THiNONEVEAflOFCOMGIE•
Z TION,THE OWNER-BUILDER WILL HAVE iME BUi70EN OF VROVINU TH�T HE OF SHf OID NO7 BVILD OR
= MPROVE FOq TME PURPOSE OF SALEL
O I.AS OWNER OF THE PROPEHTY,AM E%CLUSNELV CONTMCTINO WRH LICENSED CONTMCTORS
� TO CONSTRUGT TF1E VROJECT�SEC.)ON.BUSINESS M1D VROFESSIONS COOE:THE COMMCTORS L4 VdIU8tI0f1 AQI.AREA
W CENSEUWOOESNOTMPLYiOANOWNEROFAOROPEFTYWFqBU0.D50RI1APROVEST/EREON,MID
� WMOCONTMCTSFORSUCHPR0.)ECTSWITH�CONTMCTOR(SJLICENSED7URSUANTTOTHECONTRAG QUANTITY DESCR�PTION FEE
� TORSIICENSEUW). .
� OIAMDtEMPTUNDER5E0. B.1P.C.FORTFIISREASON U
� ¢ .
LL' DATE "�� �p I OWNER V
Z W
¢ LICENSED CONT ORS DECLARATION w
OC IHEREBYAFflRMUNDERPENALTYOFFERNRVTHATIMIUCENSEDUNDERVROV15lONSOFC1uPTEF �
� i(COMMENCINO WfTM SECTION 7000)OF DMSION J OF THE BUSINESSAND VROFESS�ONS GODE,AND Z
X MYLICENSELSINFULLfORCEANDEFFECT. m
11J �
0 IICENSE CUSS LIC.NO. J
�j DATE CONTMCTOR d
W
� WORKERS'COMPENSATION DECLARATION ¢
N IHEREBY/�FflFUAUNDERPENAL7VOF0FRIURYONEOFTHEfOLLOWINGDECLARAT10N5- U '
f%) Z
Q
0 �IHAVEANDVnLLMAMTAINACERT�flCATEOFCONSENTTOSELF-INSUREFORWORI(ERS' 2
� COMPENSATION,Il5 VROViOED B�5EC710N]70o OF THE UbOH CODE,FOR THE VERFONAANCE �U
OFTME WORK FOR WHIp77M15 PERAIIT IS ISSUED. �
0
�I HAVE AN�WILL MAiNTAIN WORKEFS'C061PENSAT�ON INSURANCE,AS REOVIREO 9Y SECTION
Q ]7000FiNElABORCDOE.iORTMEVEHFORMANGEOFTMEWOW(FORNTIIp1iM�5iEM1IT15 �20� ��
ISSVED.MYWORKERS'CdAPENSATIONINSUpANCECMRIERANDPOLICVNUMBERME: CONSTRUCTION
jCARRiER PLAN REVIEW
� PoLICVNUABER ELECTRIC
� (f�assEcnarN[mruoreEoa.e�rEoa7�EPEw.nsPoRa+6M��oauJ+sR�ro)oRtEssl PLUMBING
Z 1 GEflTIFY THAT W THE 7EHFORMhNCE OF TME WORK FOR WHIp1 THIS 7ERMIT IS ISSUED,1 MECHANICAL
(,�J SNALLNOTEMPLOVMlYPERSONINANVMANNERSOASTOBEOOAIESU9JECTTOiME
� WORNERS'COMPENS�TKKiU�W50FCALIFORN10.µDAGflEETHATIF15HIX/IDBECOME INSPECTIONFEE
CODE,I SHALL FOR MWITH COMPLY WIT17FIOSE PRpy�5qN95ECTION�/0a OF iHE U80R ISSUANCE �(�
pDAiE: AVPLICAM: SMIP � (���
� ENERGY P/C
WARNINC;FA0.URE t0 SECURE WORKERS'COMPENSATqN COVERAGE IS UNUWM.AND SHALLBE
�y SUaIECTANEMPLOYERTOCWMINALPEIULilESM�DCMLFWESUPTOONEMUNDRE0TFKK14AN0 ENERGYPERMIT
OOLLAFIS(f f 00.000).M!ADDtT10N TO THE COST OF COMPENSATICN,DAlMGES AS iROV10E0 FOR N
� SECTION�)0lOF1HELABORCOOE.NTEREST.ANOATfORNEY5FEE5. RETENTIONFEE: ,
d CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
� IMEREBVAFFIRMUNDERPENKTYOFPERIURYTHATTHEREISACANSTRUCTIONLENDINGACENCV
� FOR THE VERFORMANCE OF iXE WORK FOR WMlq1 THIS PERMIT IS ISSUED(SEC.7097,CIV.CJ.
�
� LENUEN'S NAME
� IENDENSADDNE55
W ICERTIFYTNATIHAYEREADTMISMPLICATIDNANOSTATETHAtTHEABOVENFORMATIONISCORRECT. TOTAL FEES � ����
� IAGREETOCduO�YWITH�LLCfTYANDCOUNTYOADINANCESiVJOSTATEU'NSRELATW6TOBUILOINO
CONSTRUCTqN.AND XEREBYAUTHORIZE REPRESENTATIVES OF THiS COUMV TO ENTER UPON TNE
Z ABOVE��ENTqNEDVRO�ERTVFO(i1NSPECTIDNOURPOSES. COMME�'ITS
� �
m PE TEENAUE(vRiNTJ
Q � �O
�
y SI E MI t DATE
RECPT.NO. PAID BY VALIDATION
� WHITE—Department Copy,YELLOW—Financa Copy,PINK—AssessorCopy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy
�
.. � ���c i�;t ,.4�.�'>�• �':j,'�i: . .. , :!�� ..���v���c-,t'' —r��sa.� .����...yi! ,.ra . a•:•.:��.v: � ,,..�. — ..�_.,,.... T..., .. .-. .,. ..r�a_. �. ,,� . :.t� ...� , -. .. , , � .
ci-r•ti� o�= ���r,roi to s��
ir����c s oor� �rcc��r,
'li�k-�Ka�c��'(�7►'t~^ s):.a��'_ _~�1i�4-� �=���l1caR� 1���-`t:l ;�`�'(����€ m) Lir'c i����.���e`P".�).��
. . .
____._�..______..�__�.__ .._ ___.�__.�_.. _ _�_______ .� __. .__.__._ . _.__._--._ _._.._ .____._._______�_____��____._
SET BACK �. ' I ; I FLOOR JOIST i _
FTGS.�FORh1S/STEEL � ; � FHA RE�MTS �
ELECTRIC GROUND 1 � Uf•dDER FLOOR DUCT. �
GflQUND PLUMBING __�_I UNDER FLOOR CUP�IDUIT 1 __ _
SLAB GRADE FIREPLACE FOUNDATION I
TEMP POWER I FIREPLACE BOND 6EAM I
WATER SERVICE I MID HT. E30ND BEAti1
ROOF SHEATHING _r/,Z�`�f �_��� i • 8 FT• BOND BEAM _
FRAMINGNENTILIATION I � j FINAL E30ND BEAM I
ROOFCOVER ' PRE-GRADING
ROUGH HEATWG BENCNING
ROtJGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER,rfUB TEST � POO�ELECTRIC
EXT. LATHJSIDING i I POOL FENCING
WALL INSULATION POOL FINAL �
CEILING WSULATION ' � OFF 51TE IiV1PS.
DRYWALL NAILING DEDICATtONS
SEWER FINAL EP�G.
SEPTIC TANK . i � , Ll.NQSCAPE/IRRIG. ;
SEEP PIT/L.L. I ON SITE I�APS. j
GAS AIR TEST FINAL Z�NING
FINAL GONST. � I ! �!RE DEPT. FINA!
FINAL HEATING � HEALTH DEf'T. FIPJAL
FINAL ELECTRIC ( DEV. FEES PAID
FINAL PLUMBING � ENERGY �
-- — — ----._-T—_ c�c4'��'t �.:�=E��, ..___ ______....�
COMMENTS
SEPTIG TANK SIZE
SEEP PIT/U SIZE
i���
; r�v� s!I
��� � � �. � �