HomeMy WebLinkAbout17199 (23) � � CITY OF DIAMOND IIAR EXPI RED
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� .��� 21825 E.Copley Drive
(909)860-3195 Faac(9D9)861-3117 J U N 19 2002 PR ESS
BUILDING PERMIT APPLICATION FIRMLY
¢ qp R'Ess1�6� presado dr•, ��Q b r APPLICATION I�1���' NUMB R � ( q/C
DATE �
c� ISSUE TYPE OCC
APN� LOT TRACT DATE CONST. GROUP
p OWNER
4" ADD ESS_ � ZONING SETBACKS
ociTv � ziPq��b�. TEL ���� FEART RW ❑❑
a APPLICANT TEL. SIDElSIDE STREET FiW ❑
� CONTRACTO S G O 1� SIDE p
2
ADDRESS 0 PROPOSED USE �'�LU,/ D�- � �4�e R
� CITY ZIP��� TE � ����
� ARCH1ENG/ ��� ��,�,��
� A D ESS NO.DWEL. NO. r NO.
� CITY ZIP TEL. UNITS STORIES BEDROOMS
� DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER OECLARATION SFR/ADD/REM
O
p 1 NEREBY AFFIRM UNDER iENALTY OF PERA1flY TNAT I MI EXEMGT FROM 1HE CONTMCTORS U• Gdfd92lC8fpOf�
W CENSEUWFORTMEFOILOWIN(1REASON(SEC.70]7.6BUSINESSANDPROFESSIONSCODE:�NYqTYOR (n
U �JM'/WHIp1RE�UIRE5A7ERMITTOCONSTRUCT,ALiERIMPROVE,�EMOlISH,ORHEPNRllNYSTRUG W PdtiO/DeCk
Z TURE.CRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APCIICANT FON SUGM GEFA/IT TO FILE A SIGNED
W STATEMENT iHAT HE OR SME IS LICENSEO PUFSUANi TO TME PROVISIONS OF THE CONTRACTOflS U• W
� CENSE UW(CMAPTER Y(C0IAMENCINa WITN SECTION 7000)OF�IVISION]OF THE BUSINE55 AND PRO• u' PooVSpa
FESSqNS COOE)ORhUTHE OR SHE IS E%EA17T iNEREFpqAANO TNE BASIS FOii TME ILLEGEO EXE4P• �
� TION.ANVVqU1TKKJOFSECTION70�1.68VANVAPPLICANTFOFAGERAlITSU&IECTSTHEAPPLICANTTO Z Re-Root
A CML FENALTV OF NOT MORE 7FW1 FIV[HUNDRED DOlURS(f5oo�.):
� ❑L�30YMEROFTMEPROPERTY.OftAIYEMPIOVEESNITHWAGE5A5THEIR50lECOMPENSATqN, � COfl1f11BfCIdI
Z WILL DD THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FON SALE�SEG 70N.BlAib J
NESS AND PROFESSIONS CO�E:TME CONTMCTOHS UCENSE UW DOES NO7 APPLY TO AN OWNER OF
� iROPERTYYR10BU1LOSORIMPROVESTMEREON,MIDVlHODOESSUCHWORKHIMSEIFORHERSEIFOR �
fL THROUGHHISDRHEROWNEMPLOYEES.PROVIDEDTMATSUCHWPROYEIAENTSARENOTINTENOEDOR m
� OFFEREOiORSALEIF,/10WEVE0.1ME0U1LDINGOHUAPROVEMEM.ISSOLOWITHINONEYEAROFCOMPLE•
Z TION,THE O'M�ER�BUILDER WILL HAVE THE BURDEN OF PROVW6 THAT HE OF SHE DI�NOT BUILO Ofl
_ �MPROVEFORTNEPUNPOSEOFSALEG
❑I,AS OWN[R OF ME PHOPERTY.AM EXCLUSNELY CONTMCT�NG WITH LICENSED CONTMCTORS
� TO CONSTRUCT THE iROJECT(SEC.TG�,BUSINESS/W�PROFESSIONS CODE:THE CONTMCTOFIS LI� VdIU8l10f1 AQI.ARE11
W CENSEUM�DOESNOTMPLYTOANOYJNEROFAiPOPERTYMltiOBUILD50HiMPROVESTHEREON,AND
� M?1000N7MCTSFOq5Up1PR0.JECT5WITMACONTMCTOR�S)LICENSEDWRSUANTTOTMECONTRAC- QUANT�TY DESCRIPTION FEE
Y TORSUCENSEUW.).
� ❑IAIA E7(EAIPT UNDER SFC. 8.6 V.C.FOR THIS PEASON U
�
� �
DATE OWN[ii U
W
� UCENSED CONTRACTORS DECLARATION W
IMEREBYAFFIRMUNDENPENALTYOFVERJURYTHATIAMUCENSEDUNDER�ROVISIONSOFCHAPTER �
d 9�COMMENCWONI7HSECTION7o0o)OFDMSION70FTHEBUSINESSANDPROFESS�ONSCA�E,M1O Z
MY UCENSE IS IN Ml FORCEAND EFFECT.
0 I�CENSE CLA55$L�i�1 C�i�"LIC.NO. �O�Z� � .
�
V DATE_�11�2 r/l� "-" �CONTMCTOR G C O]�O� C GJ�.
w {/"J—l7 ..{
� WORKERS'COMPENSATION DECLARAT�ON .YnG' a
N U
� IHEREBYAFFIRMUNDEHPENALTYOFPE0.IUMONEOFTHEFOLLOWINGDECIAMTqNS�. Z
Q
� _IHAVEMIDWILIMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUPEFORWORKERS' _
� COAIPENSATqN,AS VROYlOED BY 5EC710N 7t0o Of TME UBOR CODE,FOfl THE GERFpqMANCE �U
OF 1HE WORK FOR NMICH TiIS PERMIi IS ISSUED. �
O
1 NAVE AND WILL MAINTAIN WOFKERS'COAICENSATqN MSUfiANCE.AS RE W IREO BV SECTIDN O
Q 77000FTHELABORWUE,iORTHEPERFORMAN OFTNEWOFNFORWHICHTMISVERMITI$ '
ISSUED.MY� RS' MP�RANC�CARRiERAND POLICY NUMBERARE: CONSTRUCTION
¢
� CARRIEH e PLAN REVIEW
� POIICVNUMBER�(.�(�,�,,.(}�.�G�_{� ELECTRIC
¢. ( � � `�/ 7 �r
� (iF�SSECfqNPEmNOT8E2�RETEDOFTE7EFiMT6i0iiON[HIf�L%iED uasp+m�oaiess� PLUMBING
Z ICERTIFYTMATINTHEPERFORMaNr�OFTHEWOfiKFORWHi �� PEFMI ISISS�ED,1 MECHANICAL -------
(,'} SMPLLNOTEMPLOY/WYP ��wAN � ERSOA TOB�_OM „!BJEG TOTHE � �� /,i:.:.�� � � �I .�_�
� WORNERS'COMPENSATIONUWSOFGLLIFOH��+.,/JJD GH TH�1�.FISMOu�BECOME INSfECTIONFE�'� � -
S SUBJECTTOMEWORKERS'CAMPEy.SATIONPR 'nSK S SEC7 :N770o TMEUeo ISSUANCE �
GODE.I SHALL FORTM4ITM LOMPLY+1�tTH THOS 'RO il YS.
� �—��_ �I � SMIP '
DATE: APPLIC T
WW�RNING:FAILURETOSECUREWORKERS' PENSATIONfAYERA � .UwFUl,A6 �1ALLBE ENERGYP/C �
' �y SUBJECTANE4PLOVERiOCRIMWALPENQTIESAKDCMLFMESUPTOONEHUNDREO '�JSAND ENERGYPERMITrr�-- � �
OOILAiLSIS1ao.Dao),p1ADDITONTOTHECOSTOFCOMPEN5AT10N.pAMAGE5A5VROV10C FORIN I �
� SEMION77oeOFTHEUBORCODE,NTERESiANDATTORNEY5FEE5. RETENTIONFEE"-'�'-'� -�' ^
pw., CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
Q IHEREBVAFFIRMUN�ERVENALTYOFVERJUR�'THpTTHEREISACONSTRUC7iONLEN�INaACENCY
0- iOR iME PEAFORMANCE OF iME WORN FOR WMICH THIS CERMIT IS ISSUED(SEC.3097,CIV CJ.
Z
W
� LENDERSNAME
� IENDER'SADDRESS
w ICERTIFYTMATIHMEREADTHISAPVLICA710NANDST�TET�uTTMEABOVEwFORM�TqniSCARRECL TOTAL FEES , 1 a+�
p� IACREETOCAMPLYN7TMALLCITYANDCOUNTYORD'N0.VCESANOSTATEUWSREUTINGi09VILDING
� CONSTRUCTION.ANO HEREBV AUTFIOFIZE REVRCSENTATIVES OF TNIS CWNTV 10 ENTER UPON THE
Z OVE-MENTKKlED PROVER FOR MSP CTION PURPOS[S. COMMCNTS
�
J
_
OE�TTEE Nu E(71 Nn . I O ��'U I
�
(A SIGN :UH P �Mi EE DATE
� RECPT.NO. . _PAID BY � VAUDATION
WHITE aDarment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
.,f. I:`�'1 i n1'J'�. ♦� . a.��• � . .n . � ..� � . ..� .. ' � ..�.`vf�f'f i ...�;.�;Cl 4 .. �.�J"� � � !'1.•f i� �� , �. �^1'I, � r .+�.'��..� . � ,.. -� � � .. ..
CIfY O� DI�,�k�10f��D F3I-�R .
INSi=EC i IOP� RECO�D
II< �- �.� rl.�ia �)��r�-; ►�- r�t�-1:.1,_I.�A.1� ,��h��� t.�� /4F � 4��1�.� . ��._ v,.y.�``':. .
i � e�I � '1 L1 � '. 1 y '^�C I � • �,' C �' I� ` .�i. E� C'1�
�C�'���� ./� . ��� J v ` � .��� c°"� N,..�,.�{
..__....�..�..__._"'---.'----_.__.---_ '.._...---.. ...v.........--'__-___...----`---,...__�__.__....�_.,- -�-"---_�..__._._._ ' ..-
SET BACK � I I FLOOR JQIST j --I------___�_____..__��_---�._._�:
FTGS/FORP�IS!STEEL � I � FNA REQMTS
ELECTRIC GROUND ( UPdDER FLOOR DUCT � - � '
GROUND PLUMBING I UNDER FLOQR CUP�IDUIT � •�� :� �; '
SLAB GRADE FIREP�AG�E Ft�UNdATION � •� '� ' ` ' '
TEMP POWER FIREPLACE EOP�D� BEAM�
WATER SERVICE �_ � I MID HT. QO�.b BEAPJt• � �
ROOF SHEATHING � o�J�� _���11 8 FT. BO�JD;SE�Fh ', ; . � � ; ��,;
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC I ROUGH GRADING
ROUGH PLUMBING FINISH GRADIPJG
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FIrJAL ENG.
SEPTIC TANK LAN�SCAPE/IRRIG.
SEEP PITlL.L. ' ON SITE Ih1PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINA�
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
�
i
— -- — -��M7 f �:1� Gj[;r - y • + . , ---
..- , �; . , - -.-
COPJIMENTS �"" .�
; .
��
SEPTIC TANK SIZE
SEEP PIT/U SIZE
���
,���� �
� ,,
_......—.'-'-_'._~�-`-'---.._..._� . ' ' . .