HomeMy WebLinkAbout15593 (23) I ---��� DEPARTMENIT OF COMMUNITY�DEVELOPMENT SERVICES E�P�RED
21660 E.Copley Drive Suite 190
w (909)860-3193 Faz(909)861-3117 ��� 1710D1 PRESS
�����»�� BUII.DING PERMTT APPLICATION FIRMLY
o DDRESS�/��- P�/'" I�f��"F�L� � 'L APPLICATIO � PERMIT e� P/C
DATE NUMBER� #
c� ISSUE � r-if 1 TYPE OCC
APN LOT TRACT DATE «V CONST. GROUP
p OWNER �T A�ilI"H
" ADDRESS � M ZONING SEBACKS
g ciTv ��/���n /ln 2ZIP TEL. -� 1 FRONT RW ❑
APPLICANT TEL. REAR ❑
SIDE/SIDE STREET RW O
� CONTRACTOR L JLl ' � �N�T 4C'1 °'�'� SIDE O
ADDRESS ' " "" '"
� cirr �ArQw S��Z / ZIP�� TEL � �- _1z PROPOSED US _ �X 1,�57�"' GJ��, i C �
o ARCWENG� � � .� �
aDESIGNER NO.DWEL. N
ADDRESS UNITS T�il BEDR��'
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALTY OF PERri1RV THAT I AM EXEMPT FROM iHE CON7MCTORS LI- Gafe JB/C9fpOfi
W CENSEUWFORTHEFOILOWINO{iEASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCI7YOR (n
� COUMYWHICHREOUIflESAPERMRTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVS7AUC- W Pat10/DBCk
NRE,PHIOH TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CONTRAC70RS ll�
� CENSE UW(CHAP7EF Y(COMMENCINO WITH SECTION 7000)OF DIVISION�OF THE BUSINESS AND PRO- � PooVSpa �
FESSpNS CODE)OR 7HAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANVVIOLATIONOFSECTION7031.5BVANVAPPLICANTFORAPEHMITSUBJECTSTHEAPPLICANTTO Z pe-Raot
� A CIVIL PENALTV OF NOT MORE THAN FNE HUNORED DOLURS(t500).):
� ❑I,tiSONT1EROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESlSTHEIRSOLECOMPENSATION, � COrtIR18tCi81 � �
WILL DO THE WORK,AND THE STRUCNRE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7041,BUSI� J
NE55 AND PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NO7 APPLY TO AN OWNER OF
N PROPERTYMRIOBURDSOR�MPROVESTMEREON,ANDNh10DOESSUCHWORKHIMSELFORHERSELFOR �
(t hIROUl3H HIS OR HER OWN EMPLOYEES,VROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q ,OFFEREDPDRSALEIF,HOWEVER7MEBUILDINOORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE-
Z TpN,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I.ASONMEflOFTHEPROPEHf`/.AME%CLUSIVELVCONTMCTINOWI7HLICENSEDCONTMCTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7oal,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VelU3flOf1 ADJ.AREA
� CENSE UW DOES NOTAPPLY TO AN ONMER OF A PROPER7V WHO BUILDS OR IAIPROVES THEREON,AND
tN1000NTMCTSFORSUCHPROJECTSWITHA00NTRACTOR(S)LICENSEDPURSUAHTTOhIECONT{UG �UA �ITY DESCRIPTION FEE �
� TORS LICENSE UW.).
❑I AM E%EMPT UNDER SEC. B.d P.C.FOR THIS REASON Q
3 c�
� ¢
DATE OWNER F'
Z w
F LICENSED CONTRACTORS DECLARATION W
� 1 HEREOV AFFIRM UNDER PENALN OF PERIURY THAT I AM LICENSED UNDER PROVISIONS Of CHAP7ER Ur
d Y(COAIMENCINO NRiH SECTION 7000)OF DIVISION 9 OF 7HE BUSINESS AND PROFESSIONS CADE,AND Z
MV LICENSE IS IN NLL FORCE AND E EC7.
m
0 LICENS CLA S � LIC.NO. �Z L"� �� �—' �
J
V DATE � �� CONTRACTO I
W ��d
� WORKERS'COMPENS ON DE RA Q
= U
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE F THE FOL E —
�
� _I NAVE AND WILI AWNTAIN A CERTIFICATE OF 70 SELF-INSURE FOR WORKER 2
COMPENSATION,AS PROVIDED BY SECTION 370o Of TH U
Q OF THE WORK FOR NMICM THIS PERMIT IS ISSUE�. W
0
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED B CTION /l �
Q 3700 OF THE LABOR COOE,FOR THE PEHFORMANCE OF THE WORN FOR WHICH PERMIT I ��/�
ISSUED.MY WOflKERS'j'AMPENSATION INSl1RANCE CARRIER AND P UCV NUM �ARE: �RUCTION -� [
¢ �//�
� CARRIER ' "+ � ��! � P EVIEW
ZPOLICY NUMBEH � L V E CTRI �
Q
� (fFCSSEcfqNME�w78EOa.�LE7moF7HEPERARSFnRa+Elax�IXiED0a1AAs LEss} BING n\'R��T1�
W '}��i�:.i�
Z I CERTIFY THAT IN hiE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL u
(} SFULL NOT EMPLOV ANV PERSON IN M!Y MANNER 50 AS TO BECAME SUBJECT TO THE
� WORKERS'CAMPENSATION LAWS OF CALIFORNIA,AND AGREE TMAT IF I SHOULD BECOME INSPECTION FEE
SUBJECT TO THE M10RKEfl5'COMPENSATION 7ROVISIONS OF SECTION 37000F THE LABOR � ��(�U
�= ISSUANCE n �, � -
CAD,1 SHAL�.FORTHWI7H COMPIV WI7H THOSE PROVISIONS._
� �� � �.� SMIP 5ti.r G.., °- `�„hm RAIt e
DATE: �' APPLICANT: �. �
w lE�lviv'•_ .rv
ENERGY P/C nTTV f?l' � n nY:F.1 i
J WARNIN :FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE �,,,.� - >� ��J�Z-
�—y SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT *�T�YI T1T1`V� �
OOLURS(S10o.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN v��a_
J SECTION 37o80F THE LABOF CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
Q
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
CL 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THA7 THERE IS ACONSTRUCTION LENDING AGENCY
d FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30V7,CIV.C.). �
Z
W
� LENDER'S NAME
F_ IENDER'SADDRE55
� I CER7IFY THAT I HAVE READ 7HIS APPLICA710N AND STATE THA77HE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �S .���
w I AGREE 70 COMPLV WITH/�LL CITY AND COUNTY ORDINANCES AND S7A7E LAWS REUTING TO BUILDING
� CANS7RUCTION,AND HEREBV AUTHORRE REPRESEN7A71VE5 OF THIS COUNTV TO ENTER UPON THE
ZABOVE�MENTIONED PROPEHTV FOR INSPEC710N PURPOSES. COMMENTS
� l,.� ��J �. � � l% �.
m PERM T7EE NAME(PRINn A
�„ _ � �/ �Z S � �/ �-'
� SIG E OF PE ITTEE DATE
= RECPT.NO. PAID B VALIDATION
~ WHITE--0epertment Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy, EEN—Applicant's Copy
. � . . ..,..� �;.�,y:,�.• '.-., ... .-•:1 ,.^ :.� ... � �Y. . .....,r�..., y .. . . Y! .�,...r.. . r. v v. � . � . e, .. ..,.. .. . .
' „ ' � . , '�:1�;
V�� Y �� ��011�M,�i .LLY LLd'4'N� f�
�����V���� ������
�C u�lOa DG� Oa�° o � OGI�'��i�lO�J� DGJ� � (.��'o 0 0
SET BACK • i FLOOR JOIST � , - •
� . .
FTGS/FORMS/STEEL � FHA RE�MTS � '
ELECTRIC GROUND UNDER F�OOR DUCT , .j
-- -- --..._..___..._
GROUND PLUMBING UNDER FLOOR CU�I�UIT
__ . . .
_._........_..__._
SLAB GRADE FIREPCAGE•FC)l�h3DATION r: : ��,� ;�,
— --...._.._..---
�TEMP POWER FIREP�ACE BOND BEAM
WATER SERVICE MID HT. BOND BEAivI�'� '.; , . � ,`�' ,� .
ROOF SH�ATHING L� �t b �� ,' '� 8 �(. B`Ot�l�R,B.E'A�1'_i . ' '� - -. i �': �,. .,: • -----,
" 1�,-- . - .
FRAMIN�NENTILIATI'd'iV '` ' " FINAI B�ND BEAM
ROOF COVF_R � � PRE-GRADING
ROUGH FiEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILlNG INSULATION �FF SITE 1MPS. �
DRYWAL.L NAILING DEDfGATIONS
SEW�R FINAL ENG. -- ---_____�
SEPTIC TANK - LANDSCAf�E/IRRIG. --_ ______.__.--
SEEP PIT/L.L. � . ON SITE If1APS. .
GAS AIR TEST FINAL ZONlNG
FIN�L CONST. FIRE DEPT. FINAL
FIP�RL NEATING HEALTH DEPT. FINAL
�=EN�1L ELECTRIC DEV. FEES PAID
' t- •Y(�L PLUMBING ENERGY
----- -T—
��--.._ C���a �`�,.�o� . � �.�
,
�_.. . _ . --- - , . -
_1 f, t
� CUMNiEN�f'S '�� , �
� �- �. . � �y ,
, , � — � � , � ! ., __.---
1 �
i
SEPTIC TANK SIZE
SEEP PIT/U SIZE _� ---�- . ------
� , _.-- -_— - __..-----
F` ° - ` • _ –___.__
� �
, , � . � � . . �
c� . `� , ' ; . , . , l