HomeMy WebLinkAbout17400 _
r�[� � . . y . . . . . _.'
V
� CITY OF DIANCOND BAR
�� DEPARTMENT OF COMMLTNITY 8c DEVELOPMENT SERVICES �
� 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 . PRES$
�-�TM'� BUII.DING PERMTT APPLICATION ` FIRMLY
� JOBSITE /' c 1— c✓J�� � _ APPLICATION /' PERMIT P/C Q�
0 4DRESS_ L 3 '7'� �r L• P�e�.-�Il L�.� ! IXLE�P.7'�1.� DATE l 2 b NUMBER �O # L/�-' �'
$ . ISSUE TYPE OCC
APN LOT TRACT DATE � �v CONST. GROUP
p OWNER 21N p
p ADDRESS D ZONING SEfBACKS �
w CITY • ZIP �'7pIi7Q TEL. Z 2 7 FRONT RW ❑
� APPLICANT '}'tC��l� TE . 'L 6 '� REAR ❑
� SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE ❑
� ADDRESS PROPOSED USE
CITY ZIP TEL
o ARCH/ENG/
� DESIGNER NO.DWEL. _ NO. NO.
ADDRESS UNITS STORI ES BEDROOMS
� CITY ZIP TEL.
�
u� DESCRIPTION - SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q ONMER-BUILDER DECLARATION SFR/ADD/REM
O
1 HER�Y AFFlRAI UNDER VENALTY OF PERNRV THAT I MI EXEMPT FAOM THE COMRACTORS LI- G8f8QB/C9f�OR
W COJSELAWFORTHEFOILOWPIOREA.90N(SEC.7031.6BUSWESSANDPHOFESSIONSCODE:ANVCf7YOR (n
C.) COUHfYNR11G1qEqAqE3APERMRTOCONSIAUCT,ALTERIMPROVE,DEMOl1SH.OHREPAIRANYSTRUG W
Z 7URE.PRIOR TO ITS 133UANCE.AL30 REWIRES 7HE MPIICMfT FOR SUCH PERMIT TO FlLE A SIONED w P0t10/DBd(
� STATEMENf 7HAT HE OR SHE IS LICENSED PURSUAHT 70 THE PROVISIONS OF THE CON7RAC70R5 ll� � �
C CQ15E LAW(CFiAPTER G(COMMENC7N0 W17H SECTION 70ao)OF DIVISqN 3 OF TME BUSINESS AND PRO- PooUSpe •
�E FESSqNS CODE)ORTHAT HE OR SHE 19 E%EMPT 7HEREFROM AND 7HE BASIS FOR THE ALLEOED EXEMP• (�
V TION.ANV VIOLATION OF SECTION 7a91.6 BV ANV APPLICANT FOR A PERMIT 5U&IECTS THE APPLICANT TO Z Re-Roof
� A CML VENALTV OF NOT MORE THMI FIVE HUNDRED DOLLAHS(tboo).):
� OI,ASOWNEROF7HEPROPERTY,ORMYEMPLOVEESWITHWA6ESASTHEIRSOLECOMPENSA710N, 0 COff1ff18fC18I -�
WILL DO THE WORI(AND 7HE S7RUCTURE IS ND7 INTENDED OR OFFERED FOR S/LLE(SEC.7aI,BUSI� J
� NESS AND PROFESSIONS CODE THE CONTRACTOHS LICENSE UW DOES NOT APPLV TO AN OWNER OF � � �
PiqPERTY W/10 BU0.AS OR IMPROVES TIEREON.AND NT/O DOES SUq1 M/ORK HIMSELF OR HERSELF OR
2 THROUOM MIS OR HER ONN EMPLOYEES,PROVIDW TNAT SUG/IAIPROVEAIENTS AAE NOT INTENDED OR m
W OFFBiWFOR3ALEIF,HOWEVERIMEBUiDINOORIMPROVEMENTISSOLDWfTMNONEVEAROFCOMPLE- �
� �•TION,7HE OWNER�UIIDER WILL HAVE 7HE BURDFN OF PROVIN�THAT HE OR SHE DID NOT BUILD.OR �
'.�j IYPROVE FOR THE PUHPOSE OF SAL�. �
w OI,A40NT/EROFTHEPROPEHfY,AME%CLUSIVELVCONTMCTINOWfiHLICENSEDCOMRAC70RS �
[� TO CONSTRUCT 7ME PRO,IECT(SEC.7oH,BUSINESS M1D PROFESSIONS CODE:THE CON7RACTORS LI- VHIUBtiOn ADJ.AREA
LL1 CEN9E UW DOES NOTMPLY 70AN OWNEH OFA PROPEHTV WFIO BU4DS OR W PROVE9 TMEREON,M!D
I � WFqCONTRACTBf-0RSUGI7RO.IECTSWI7HACOHTAACTOR(SjLICENSmPURSUAMTOTHECONTAAG pUANTITY DESCRIPTION FEE �
� roRs uco�se uw.�. I
❑I AM E7(EM77 UNDER SEC. B.a P.C.FOR THIS REASON �
� 3 �
� � .
ZZ DATE OWNER � - . .
� W
LICENSED CONTRACTORS DECLAAATION -�
� W
I HER�YAFFWM UNOER PENALTY OF PE0.IURV THAT I AM LICENSED UNDEH PROVISIONS OF CHMTER �
a a(COMMENCINO WI7N SECTION 7000)OF OMSION 3 OF 7HE BUSINESS N1D PROFESSIONS CODE,AND Z
x W LICENSE IS Pl FULL FOfiCE AND EFFECT. m
� UCENSE CUSS LIC.NO. � j �
� '� DATE CONTRACTOR a .
� WORKERS'COMPENSATION DECLAAATION . �
� 1 HEREBV AFFlRAI UNDER PENALTY OF PERIURY ONE OF THE FOLLOWINO DECLAMTIONS: Z
� _I HAVE AND WILL MAMTAIN A CERTIFICA7E OF CONSEM TO SELF-INSURE FOR WORKERS' a ' � �
2
Q COMPENSATION,AS PROVIDED BV SECTON 37ao OF THE UBOR CODE,FOR THE PEHFORMANCE 'U.
O OF TiE WOPo(FOR WHlqi THIS PERYI7IS ISSUED. �
_t HAVEAND WILLMAPlTAIN WORI(ER9'COMPENSA710N INSUWWCE,AS REOUIREO BV SECTqN A
Q 37000F THE UBOR CODE,FOR THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS O
ISSUEO.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE CONSTRUCTION
jc�aPoeR PLAN REVIEW •
� aa�crwnaeEa ELECTRIC �
QQ (nissEciqHt�w7eEaoA4�E7mOFnEVERr.TiSPoHONEFIUI�D(i�OouJ�RS(t�ro)oaLEss1 PLUMBING _ •• . '�.� •
Z I CERTIFV TTiAT IN THE PERFORMANCE OF THE WORK f-0R WHICH THIS PERMIT IS ISSUED,I MECHANICAL L-I �}S• ����)
C� . SH�LL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&lEC7 TO THE � . .
(/) WORKERS'COMPENSATqNUWSOFCALIFOfWItiANDAOREETHATIFISHOULDBECOME INSPECTIONFEE
. `- SUBJECT TO THE WOPo(ERS'COMPENSATION PROVI510N5 OF SECTION 3700 OF THE IABOR
S CODE,I SHALL FOftTM41TH CAMPLV WIT1 THOSE PROVI510NS. ISSUANCE ��
� SMIP � ��.� V �•�
p DATE: � APPLICANt
w � ENERGY P/C �
� WARNINO:FAILURE TO SECURE WORNERS'COMPENSATION COVERAGE IS UNLAWFUL,M1D SHALL BE .
� SU&IECTAN EMPLOVER TO CRIMRJAL PENALTIES AND CML FINES UP TO ONE HUNDRED h10USAND ENERGY PERMIT
OOLURS(i100,000),W ADDI710N TO THE COST OF COMPENSATION,OAAUOES AS PROVIDED FOR IN �/ /^
� SECTION 37oB OF 7HE UBOR CODE,INTEREST,AND ATTORNEY'S FEES. � RETENTON FEE: � ) �Q /,J
d CONSTRUCTION LENDING AGENCY PqE-ALT FEE: ' �
O .
� I HEREBV AFFIRM UNDER PENkN OF PERIURV TFUT NERE IS A CONSTRUCnON LENDINO AOENCY �
w
WH THE PERFORMANCE OF 7HE WORK FOR WHICH THIS VERMIT IS ISSUED(SEC.30D7,qV.C.�. , ,
� LENDERSNMIE . . . .. '�'A���• . . ,.
� IENDERSADDRESS r�
� I CERTIFY TMAT I HAVE RE}D THIS MPIJCATION AND STATE THATTiE ABOVE INFORMATION IS CORRECT. TOTAL FE ES � r . { /�,'1 I.�3�
w I AOfiEE TO COMPLV N7TH ALL CfTV AND COUNTY ORDINANCES AND STATE LAWS REUTINO TO BUILDINO ,V� V�
� CONSTRUCTION,AND HEREBV AUTF1bRIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � ��_` I ' � . '
Z ABOVE�MENiIOHED VROPERTY FOR INSPECTION PURPOSES. COMMENTS L � � '� '
� S �;�a � �3�-c o r e.,o s��to � �.
� .-,
m PERMfTTEE NM1E(PRIIfT) ' / 1 t•'.;
�n � �� ��� /2 O � .
� 516NATUREOF PERMfTTEE DATE RECPT.NO. PAID BY VALIDAl10N �
~ WHITE-0epanment Copy,YELLOW--F'Nenoe Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
ci�rv o� ���►�o�� �,�o� .
� Bft�ISP�CI"10� ��COIF��
, .. ,
> ,, ,. .� . �.
, � Q .��' AC -3 S � � � -� ����.I���sr,��n gt i F'?�' 6�Mrs.��:. 7 - .�ri:�� ,� ,.. ,.c(�
,: �" ° 0 .-.r t� �„ ,, � �, ',�,��lS'`vJ� o
SET BACK � ; :� ; . FLOOR J�IST
_F'fGS/FORMS/STEEL � ' ' FHA REQMTS �
'E•LECT.RIC GROUND � UNDER FLOOR DUCT �
GROUND PLUMBING UNDER FLOOR CUMDUIT �
SLAB GRADE ��(-fl Z FIREPLAGE FOUNDATION
TEMP POWER FIREPL'ACE'BOND BEAM � ' `
WATER SERVICE � MIQ HT. BOND BEAM
ROOF SHEATHING ' �2--0` 8 FT. 60ND BEAM
FRAMINGNENTILIAl'ION L FINAL BOND BEAM
ROOF COVF_R PRE-GRADING
ROUGH HEATING' BENCHtNG
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUNIBING FINlSH GRADING
SHOWER/TUB TEST ' � ' POOL ELECTRIC
EXT. LATH/SIDINCa POOi.FENCING
WALL INSULATION � POOL FINAL �
CEILWG.IfVSULATION , OFF SITE IMPS, � ��
DRYWALL NAIUNG �EDICATIONS �
SEWER � FlNAL ENG. -
SEPTIC TAPlK LANDSCAPE/iRRIG. ,
SEEP PIT/L.�. . �^' �' ON SITE IMPS.
GAS AIR TEST F1NAL ZONING .
FINAL CONST. _. � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRiC DEV. FEES PAID �
Fii�AL PLUMBING ENERGY
�-- � . _ �= " a t3 � ��'�� -----
, . .. � ,�,�.
� . . _ . -- - -- - — -- - - -- - _ _ - . -------_ __ —
� Ci�(VIMENTS
�. _ /
,-D_`�/��..s�r�'�%�2,�a����.
/ �C'L i'�(%"C :'`fiL / �� � � r� }ij;� -
, .L:i,r/3�G� �'� ! 7 �,, � ��,.�_...__. ,_.,.
�c� , � G�� 6�.� ,.�-� 0�02�
, . � dt � �-��
% ��-z I S 7 � 2 �v ,�� — o [� ---
� , �., � _ _____
� '"3�' _�_ .�G-R L�vr� oic.. .SHF�-r s-Z
i / /� ___._�—
- � u o7. �•'� �C/t%lJ�ri U1.41 J �/S V' /� sd .Cy%.vl�,:� Lt/d6� �G�s i i� �.� /�� ---
S P IC TANK SIZE �j���S ��,� g ��2 ��,�, � �,� ���/��.
SEEP PIT/U SIZE S
s �� `!� c�,c��'�� ?.�,v sno.2,_�.
'��� r � �, ,,:r' �-y-Z��Z. �7/���—��"/'-�L���
� � fi ;*��.+
`��s � ��� �
',�� �� ��y �'. . .
� -�,,. � ' ; ....
h � �F�i
3
n
`��'� �: m i r 'v` `����7s4 .
-t' - �.,-�C:
a'l�ia`��, �tf.a '3' . a � t�„°������ , . �
`� �`�' �, L tf,y,4
' •�_ ��I{'k �;4� 1Cry �Z��, �A�.rf'8t�,5��k�j � _ �
E� dL S '�v .;,�,;'�_ _ _ . � .
r�,t� �f��'.: C a's;��{�!'v. , - f �� ' . . _.�- —
� �