HomeMy WebLinkAbout16890 (42) CTTY OF DIAMOND IIAR
�''� � DEPARTMENT OF COIvIIvtUNiTY 8�.DEVELOPMENT SERVECES
E� 21825 E.Copley I?rive
(909)860-3195 Fax(909)861-31 l7 PRESS
^� BUILDING PERMIT APPLICATION FIRMLY
} JOBSITE � APPLICATION
o ADDRESS�3l�71 11')�u,nc(�e,►-�rl� G'ee�,�r,v� DATE 30 ° NUMBERI� i,C
� APN LOT TRACT DA EE O V O I TMPE ' OCC
o �WNE'��T CONST. GROUP
p ADDRESS �r � l'IU� 20NING SETBACKS
z CITY�0.YY1 D Yl/IO.BrQ�ZIP TEL. D� - r-1'] FRONT RW ❑
o APPLICANT TEL. REAR �
zd SIDE/SIDESTREET pW p
QCONTRACTOR e SIDE p
ADDRE�SS� � t ` �,�
� CIN � . ZIP � � TEL�� PROPOSED USE .LVI`DL� y�c-���
w ARCH/ENG/ � -
� DESIGNER � ,
� NO.DWEL. NO. NO.
� ADDFESS UNITS I
STORIES �,_pEDROOMS
N CITY ZIP TEL.
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER�DUILDER DECLAFiATION
p SFRlADDlREM
� I HEREBV AFFIRM UNDER PENALTY OF VERIURV THAT I AM E%EMPT GROM TH[CONTRACTORS l4 Garage/Carport
W CENSEUWFORTHEFOLLOWINCREASON(SEC.7071.58VSINESSANOFROiE5510N5CO0E:�NYCITYOq (n
U �N{yWry��R[OUIRESAPERMITTOCONSTRUCT,ALTER�MPROVE,OEIAOLISH,ORRE7A:RM1VSTiiUC- PytiO/DBCk
Z 7URE,VR�ON TD RS ISSW WCE,AL50 fiEWIR[5 THE APPLICANT FOR SUCH PERMIT TO FllE A SIGNEO W
w S7A7EA�EM TFIAT HE OR SME IS LICENSED PURSUAN7 TO TM[PRONSIONS OF THE CONiRACTORS LI-
= CENSE UW�CHAOTER i(COMIAENCINO WITH SECTION 7Doo�OF DINSiON�OF TME BUSME55 A1.D PRO- �" PooUSpa
� FESSIONSLODE)Of1iHATHEORSHEISE%EMPTTHEREFROFAANDTHEBASISFORTHEALIEGEDE%EIAP- (�
V TION.ANYVIOIATqNOFSEC710N)O]I.SBVANYAPPLIGVITFORAPERMITSUBJECTSTHEMPLIGWTM Z Fjg.Hp�( D�
A CML OENAITY pF NOT MORE THAN FNE HUNDR[D DOlURS(f500�):
0 OlA50N?IEROFTX[PPOPERTY,ORMYEMPLOVEESW:TMWAGESASTMEIRSOLECOM�ENSATION, O Commerclal
Z W�LL DO THE WORK,M!D TME STRUCTURE IS NOT INTEN�EO Ofi OFFERE�FOR SALE�SEC.7W I,BU51• J
� HE55 AND vROFE55lON5 COOE.TME CONTMCTORS LICENSE LAW DOES NOT AFPLY TO AN OWNER OF =
PROPERTY YAq BULDS OR IMPROVES TMENEON.AND VMO DOES SUdi WOfiN HIIAS[LF OR MERSEIF OR
Q THROUGHHIS OR HER OWN E40LOYEES,DROVIDED iHAT SUCH MVqOVEM[NTS�R[NOT UfTENDE00R m
Q OFFEREDiORSALE1F,IqWCVERTMEBUIIDINGOf1i1APROVEMENTI55qDW1TMINqJEYEAROFCOMP�E�
Z TqN.TME OWNER�BUILDER WILL HAVE TME BURDEN OF PROVIN6 THAT ME OR SME DiD NOT BI:ILD OR
� IMPAOVE fOR THE PURPOS[OF SALE�
w OI.ASOWNEROFTHEFROPERTY,AME%CLUSNELYLOMMCTIhGWITMIiCEN5E000NTflACTORS
� TO CANSTRUCT TH[iR0.IECT�SEC.70��,BVSINE55 AND iROFE55�CK5 CODE:T/1E GONTR�CTORS Lb VdIUZtiIXI ADJ.AREA
W CENSEUwDOESNOTAPPI�TOANOWNEHOFAPROPERTYWMOBl11LD50HpAPiqVESTNENEON,MlD
� YYFqCONTMCiSFOqSUCHPRQIECTSNnTNACONTMCTORI5ILICENSEDVUHSUAVTTO7NECON7qAC• QUANTITY DESCRIPTION
Y ronsuc[Nseuw�. FEE
� OIAME%EM?TUNOERSEG B.tO.C.FORTHISREA50N Q
U
� �
DATE OWN[R F-
Z U
� LICENSED CONTRACTOFS D[CLARATION W
� 1 HER[BY AFFIRAI UNOER VENAI.TY OF PENURV TNAT IAA1 UCENSED UNDEII 7ROVISiONSOF CHAPTER �
d 0(COMMENCINO YnTM SECTqN 7000)OF DNISION 70F TME BUSINESS AND GROFESSiONS CODE,hN� Z
X MV LICENSE IS IN Fi1lL FORCE AND CFFECT. m
LLJ /t Q
� UCENSE CUSS �l � / �IC.NO. ��I �
,__. . V DA7E CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q
NIHCREBYAFFlRMUNOERPENALTYOFPENUFlYONEOFTHEFOUAW:NGD[CURATiOKS: .—,V,
� �IMAVEANDWILLIAAINTAINACERTIFICATEOFCOf�'SENTTOSELF-INSUREFORWORNERS' _ .
COAIPENS�TqN,ASFROVIDEDBYSECTION]TooOFTNEUBORCODE,FOR7/1EOERiORMANCE U
Q ` , OF TME WORK FOR WNICH THIS FERMIT IS ISSUE�. �
w ,[,�INAVEANDWILLIAAINTAINWORKERS'COUGEN5AT10NIN5URANCE.A5RE0UIRED8V5FCTION
Q �70oOFTHElA00RC00E,iORTHEPERFOHMANCEOFiNEVlOP.KFORWMIp/TM15PERMITIS ��( • IO
J 65UED.MYYJORI(ERS'CAMPENSATIONINSURANCE 11RRIERAN 4lILYNUMBERARE: CONSTRUCTION
� LARHIER meri a r h •�a� PLAN REVIEW
0 va�crr+urneea — � �'�D ELECTRIC
�d
0 (ndssEcnor+ntmr+oie[m.stt��anEVErr�rsFonorcMrors000unas�sioc�rntcss7. PLUMDING
w
Z ICERTIFYTXATNTNEPERFORAIMlCEOFTHEWOfiKFOFiVn1ICHTH15VERA11T15155UED.l h1ECHANICAL
U' SHAILNOTEMPLOVANY7ER50NINANYA10.4NERSOASTOB[CAIIESU6JELTTO7HE
(n Y/OflKENS'COIAFENSATIONLAWSOFCALIFORNIA,AN'J�GREE7IUTIF15/10ULDBECOYE INSPECTIONFEE
S SUBJCCT i0 THE WORKEKS'C0IAPENSAT Vf10VISIONS OF SECTiON 17oa OF TNE LMOR - � �
COOE.ISHALLFOATI'MTHCONP�YWI T ',15EPROVI ioe�s. ^ ISSUANCE '"���= ' C�
� fy +�� �� ✓ SMIP
p DATE:�'V� APpLIC0.NL
� WARN:NC:FA4UR[TOSECURFWORKERS' ' 'SA'IpNCOVERAGEISUl:UWFIR,ANOS�ULLBE ENERGYPlC
r �nn�
�y, SU6IECTANEIAPLOYERTOCRIM:NALFENALTI NUCMLFWESUPTOONEHVN�REOTHOUSAND ENERGYPERUIT
� DOlURS(f100.000),M�DDITION TOTHE GOST COMPE`lSATqN,DAMAGES AS PROVIDED FOR IN
SECTqN7]OEOFTIIELABOIlCOOE.INTEAEST. NOATTORN[75FEE5. REjENT1ONFEE: �
OCONSTRUCTION LENDING AGENCY pRE•ALT FEE: `---'- — �
� IMEREBYAFFIRMVNDENPENALTYOFPEMIRVTHATTMEREIS�CONSTRUCTION�NOWGAGENCY
FOR TME GERFORMANCE OF T/1E WORK FOR WHiGM iMiS VERMIT IS ISSVED(SEC.]a9�,CIV.G.�.
Z
W
� IENDER'S NAME
� LENDERSADDRE55
� TOTAL FEES UZ.(�O
� ICERTIFY7MAi11uVEREA�THI5AP7�ICATIONANpSTATETIUTTME�90VENFORAIATqNISCOPRECT.
w IAGREETOCOMPLVN7THALLCITYANDCWNTYORDINnNCESANDSTATElAW5REU71NGTOBUILDIHG
� CONSTRUCTION,ANDHEREDVAUT110FIZEPEPRESENTATNESOFTHISCOUNTITOEN7EAUPONTHE
Z AOOVE�MENTIDNED VROPERN FOFlINSPECTIDN PURPOSES.
0
COMMENTS
J
�
m GERu 7 .NAA1�(P 4T)
¢ -3
�
(n SIG :=OFVERMIifEE DATE
� RECP7.�O. PAID BY � VAUOATION
WHITE-0e0ariment Capy.YELLOW—Finance Capy,PINK—Assessor Copy.GOLDENROD—File Copy.GREEN—ApphcanPs Copy
._ . _. .. ,.. .,. ..._.,._ ,. ...._._...__. . .__..._... .. __._ . . ._ ... . _ _. . . .. . . . _ .._.. ..
, , , , . , . . . . . ,., .rv ,. . . . . , . . . . . .. �
� ' C.� 1 `r v1� lJ!�.^��i I'�L�.i�\�iJ �i�,f"'i
li�.'.�i t=C"��Cy��•,a �E_rC.=;�
_. _. .. ...-
------.— ---..—�—•-- --.___._._._.—__._-- --- -- --_�_._____--- — ---•
___�._-----...
li'E�:�='�::�Fl�l►`! �)��y;r� 1►�E=1:�=:f.:�����•� 1���=1C�-..c: �tcl���. �j�\:C� .1►�f=1:1�c`.'�l'e1.�
-- ---=-----'�--...._-- - - � "- - - - -�---------._ . .� . ..._. ....._.__ ..... .. . .._.. . - - -- -...---..__..------..._�..__.._..._..--
SET EACK ; I � �LOJR JGIS1 � � i .
--- ---- -- - -- — �- ---
FTGS/FOR'�1S'STEEL � � i FH:^,REO'.1TS I I
ELECTRIC GROU�JD � I _I.I UhJDER FLQOR DUCT ; I.
GF70UND PLUi�1F�li�G � I � ! UIJD�R f'LO�fi CU�•fD'.ilT � �
SLAB GRADE I � �_�. FIR�PL/,Cc FOUiJC/',i IOPJ_ � ___ � _
TEh9P PO4VER � I I_I FI��PLAC_FO�JD E�JLNPv� _�I I
4^�ATER SERVICE ! �� i P:1�7 HT. �'��PJD E3�{'.t: � �
ROOF SH�ATHING $'^2—c�i. I "`—__ -� � n F�". G�,��:���..r:� _-�------ ---
FRAP�rI�dG.NE�JTILiATiOPJ I � I FIfdAL F..O�:D E3EAt;r I _ ___
ROOF COVER �—{>�_ ��� PRE-GRADItJu ; I
� .— —
ROUGH HEATIPJG I ' I I 6E�•dGHIPJG I
. ROUG!�i ELECTRIC � I _ _ I I_ROUuH GRADIPdG I
ROUGH PLUI��iBIt�G � I � FINISH GRr,J1-JG � 1 __
SHO:"JER/TUB TEST I I I PCOL ELECTRIC
EXT. LATH,'SIDIPJG � � I � POOL FE(•JCIPJu � ;
�"JALL INSUU1TIOfJ � i � I POOL FI�!/1L _� I _ �
CEILIPdG IfJSULATION � O'=F SITE IP:f�S. � I
DRl'1PlALL NAILING � I DEDICATIO'JS
5EIPJER � � FIfJAL ENG. �
SEPTIC TANK � • � LAPJDSCF,PElIRRIG. �
SEEP PIT/L.L. ' � OfJ SITE 1�,1PS. �
G�,S AIR TEST _ _�_ I � FINAL 7_O"JI�•1G l
FINAL CONST. �Q I I I FIaE D�PT. FIPd/1L �
FINAL H�ATIP:G � �_l HEl, i r1 DE?T. FIfJAL �
FINAL ELECTRIC � � DEV. FEES PAID —�
FINC�L PLUPABING I � E�J�RGY � � �
- --i— �--- _.
I I '1.1`�__"'JW_r.I,-....___."__-_"'""_".'_" 1 ' ,
� cor,nr,�ENYs y �
SEPTIC TAPdK SIZE
SEEP PIT/U SIZE
._.�_ 'i r -----,
�
tl��
`, . , -
�y .
