HomeMy WebLinkAbout12325 � _ CITY OF DIAMOND BAB
DEPARTMENT OF COMMiJNITY&DEYELOPMENT SERVICES
21660 E.Copley Drive Suiu 190
�, (909)860-3193 Fax(9U9)8G1-3117 PRESS
"�'�.� $UILDIIVG PERMIT APPLICATION FIRMLY
� JOBSITE , s �� I�rf Q� DATE CA710N '�b� NUMB R v v N�
o ADDRESS
� ISSUE TYPE p�
APN LOT TRACT DATE CONST. GROUP
� OWNER
" AD O � � � ZONING SETBACKS
� CITY 6 21P TEL ' R�RT RW ❑❑
APPLICAN TE 51DE/SIQE STREET RW ❑
CON7RA 31DE ❑
ADDR
g CITY ZIP TEL - � PROPOSED USE
8 ARCWENG/
� DESlGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
CITY ZIP TEL.
u� DESCRIPTION SQ.Fl: FACTOR PSF ADJ.AREANALUATION
¢ OWNER•BUILDER pECLARATION SFFVADOIREM
O
1 NEREBV AFFlRM UNDER PENALTY OF PEIW RY TMAT 1 AA1 E%EMPT FROM 7NE COHTRIICTOIiS LI-� O8�g�0�rt
CENSEWVPOFl7NEPOLLOWWOREASdV(SEC.7Uet.68U51NESSAHOPROFE5510NSODDE:ANVCITVOR� (A
OOUMYMIFIICHREOUFESAPERMITTOCONS7qUCT,ALTERMdPROVE.DEMOIJSH,OHREPAIRANY9'IRUG W pB���k
RlRE,PRpR TO IT9 ISSUANCE,ALSO REOl11flES h1E APPIMANT FOR SUGI PERMI7 M FILE A&pIiED�
i7ATEMEM TUT ME OR SME IB LICENSED WIRSUANT TO TME PiqVISIONS OF Tl1E CWJTRACfOliS�F
CENSE lAW{fx1MiEF Y(COMMENCNO N7TH SECTION 7000�OF DIVISpN]OF TXE BUSINESS ANO PRO-, � PooYSpa
FESSpNSO00qORiMATHEOR8HE19IXEMPT7MEREFROMMDTHEBASI3FO1tTHEILLLE0EDE7fEA1V-� (�
TqN.ANYVIOL�TIONOFSEC710N7o91.6BYANYAPPl1CIlNTFORAPERMITSU9JECT9T11EAPPLICANTTD. +Z {�9_Rpp�
� A CIVIL PEWLLTY OF NOT MOi1E 7}IAN FNE FIUTANED OOLLARS(t5o0�J: � :� � : J
O4�^OWNEROF7NEPipPERTY,ORYVEMPIOVEESNATHWAGEBASTHEIRSOLECOMP�NSATqN,; O C0111T8fC181
MALLDO7HE WORK AND THE 6TRUCTURE IB NOT INTEN�fO OR OFFERED iOH SALE(9EC.7aiu,6USF, J
NESE AND►ROFESSpNS CODE:THE CONTRACTOq9 LICENSE 1.AW DOES NOT APPI,V TO AN OWNEfl OF =
� iRDPE1RYMfHOBUILOSORMPROVESTTEREON,AN�W110DOESSUCHWORKMIMSELFORHERSELFQq.
� TWi0U0HWSOit1iEROWNEMPIAYEES,PROVI�ED7NATSUGTICdPROYEMEHTSMEND7INTENDEDOR� �
OFFERm WRSALE R FIDN'EVER,7HEBUILDINOOR IW�ROVE►tENT IS SOID 1MTHIN ONE YFiVt OFCO/PI.E-.
TqN,1NE OMMEN�WIDER M7LL NAVE 7HE BURDEN OF PR01fINO TNAT ME OR SHE DID NOT BULLb OR
61DROVE W0.TIE Pt1RPOSE OF BALE} �
y� ❑LASOMMEROFtMEVHOPER7Y,AME%CLUSIVELYCONTRACTMONrtfNLICENSEOCONTMCTOpS!
(� TD CWISTRUCT TME PI�.IECT(9EC.7aI,BUSINE59 AND PROFE391ON3 CODE TNE CONTFiACTORS�ll" Y911JitI0f1 ADJ.AREA
It1 CEN6ELAWDOE8NDTAPPLYTOANOWNEROFAPHOPER7YNAfOBUNDSORNAPFqVESTHEREON,AND�
Z WHOODNTMCT8PDR8UCHPROJECfSM11Tf�CONTMCTOR(9�LICEN9EOPUH9UMITM7HECONTMG� QUAN7ITY �ESCRIPTION FEE
� 10R3lJCENSE I.AW.). � .; �
❑1 AA1 EI�GPT UNDER SEG 8.i P.C.FOR THI6 REASON �
U
u' OATE ONMER � .
�` W
LICENSED CONTRACTORS DECLARATION W
2 I NEREBY AFFIRM UNDER PENAL7Y OF PE0.IUIIY TNAT 1 AM LICENSEO UNOEq PqOVISiONS OF CHAPTER,
� �(COMM£NCYKi WfiH 8EC710N 7000)OF DMSION e OF THE BUSINESS AND PROFESSIONS CODE.AND z /
MY UCENSE{3 N FUl FORCE AND EFFECT. m
� UCENSE CLASS�� LIC.NO. �jJ
�j DATE ".►� CONTRACTOR a
= WORKERS'COMPENSATION DECLAqAT10N ; �
yIMEREBYAFFlRM UNOER PENKTY OF PE0.IURY ONE OF 1HE FOLLOWWO DECUMTqNS: ... Z
� _IWWEANDWILLMANTAINACEffTIFICATEOFCONSENTTOBELF•INSUREFOHWORKERS' _
COMPEN511TpN,A9 VRONDED BY SECTION J700 OF TNE LAHOR WDE.FOR iHE PERFORMANCE U
Q OF 7HE WORK FOR YIM1IICH 1HIS PEIiAAR I8136UED. �
�I HAVE ANO WILL MAIMAIN WORKERS'ODMPENSATpN NSUMNCE,AS REOUIRED BY BECTqN
Q J7a00FTNElA90RODDE,POHTTIEPEHPDRMANCEOF7HEWORKFONWHIpiTXISPERMRl9
� ISSUED.AIYWORKrE8,S'�PEN5A IN9LIRANCECMi A�wovoucvrn�t,�aenurE: CONSTRUCTION
� GRq1ER l G \s—• ���L�-� S^'� PLAN REVIEW
� POLICY NIAABEH � ` r—s—T tf2" �n�L E �C
(n�sEc.'non�raTeE�rFnaFnEaEawrsro�a�wron�oouu�sRiala+�ss1 LUMBING �
8 ICERTIFY7{UTN7HEVERFORMANCEOFTHEWOHKFORWHN%ITHIS7ERIAITISISSUED.1 ME FL4NICAL
(� 9HALL NOi fMPLOY ANY OEIiSqJ IM ANY YANNER SO AS M BECOME SUBJECT TO THE
y VYONKENS'COAIPENSAiqN LhWS OF CAI.IFORNIA,AND AGREE TFU71F I SHOULO BECOME I ION FEE
6UBJECT TO THE NFOf�KEI45'COMPENSATION PROVISIONS OF SECTION 7100 OF T11E U1BOR
s c�,i sH�u w rn caav�r wm+ r aNs.� ISSUAN � r
O _
p OATE: APPLICAM: SMIP
� WARNINO:FAILURE TO SECURE VODRKERS'COMPENSATION MOE IS UNIAVYFIA,AND SFULL BE ENERGY P/C
ry 81AJECTANEMPLOYERTOCRIMINALPENALTIE8ANDCIVILFINEBUPTOONENUNDREDiXOUSAND ENERGYPERMIT
DOLLMS(il OD,000),W ADDITON TO lY1E COST OF CAMPENSATION,OAMAOES AS PROVIOED FOR N
� SECTIOIi 970C OF i11E UBOR COOE,NTEREST,ANO ATTORNEI"5 FEES. RETENTION FEE:
OCONSTRUCTION LENDINQ AGENCY PkE•AlT FEE:
� IMEREBYAFFiWUNOERVENRLTYOFPEfLURYTHATTHEREISACONSTRVCT10NLENDINf3AOENCY
PDR Tl1E PERPORMANCE OF ME WpiK FOR WNICH THIS VERMITI9ISSUEO(SEG 9097.CIV.G).
�
� LENDER'SNAME
� LENDERSADORESS
� ICERTIFYiHATIFIAYEREADiHISAPPLICA710NANOSTATETMATTHEIIBOVENFORMATIONISGORFECL TOTAL FEES ��t
d IASiHEETOCOMPLYWRMALLGiYANOCOUHTYOfIDINMICE31WO6TATEUWSRELATINOTOBURDINO
� CONSTRUCfION,MONEREBYAlJIi10R2ENEPRESENTATIVESOFTHISCOUN7YTOEN'fERUPONTHE
ABOVEAAENfqNE�PROPEHTY IN3PECTIONPUHPOSES. COMMENTS
�,�, . V�
4 PERMRT [OPoNI)
� ��
� 6qNANNEO RMITT � ��
� RECPT.NO. PAID BY YAL1DA710N
WHITE—Oepanment Copy,YELLOYV—Flnanoa Copy,PINK—Aesessa Copy,OOLDENROD—Fila Copy,6FEEN—AppliceM'e Cqpy
ci�r oF oi�r�or�� �aR
' I�rE�PECTION RECdRD �
• � e � s - • • e . . f .
SET BACK � , �• � . FLUOR J41ST ,•.. '
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT -
GROUND PLUMBING tJNDER FLO�R COPIDUIT '
SLAB GRADE FIFiEPLAC�FOUNDATI�N- � • ' � - • .
TEMP POWER FIREPLA�CE�BOND BEAM ' " � -- " "
WATER SERViCE MID HT. BOND BEAM - .
ROOF SHEATHING 8 FT. ROND BEAM --� -�
FRAMIIJGNENTILIATiON FINAL BOND BEAM
ROOF COVEFi PRE-GRADING
ROUGH HEATING � BENCHING
ROUGH ELECTRIC ROUGH GRA�ING
ROUGH PLUMBIRIG FINISH GRADING
SHOWER�i"UB TEST POOL ELECTRIC
EXT.LATH/SIDING � POOL FENCING
WALL INSULATIpN i POOL FINAL
CEILING iNSULATION i OFF SITE IMPS.
DRYWALL NRILING j DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK . � LANDSCAPE/IRRIG.
SEEP PIT/L..L. i ON S.ITE IMPS.
GAS AIR T T � FINAL ZONlNG
FINAL CON�T. ��..�1 ^���� I � FIEiE DEPT. FINAL --- _
FINAL HEATfNG � HEALTN DEPT. FINAL i
FiNAL ELECTRIC ! I �DEV. FEES PAID �
FINAL PLUMBING ' ; � I ENERGY �
i�--�----�-i--�;-i- � -1
i � � i �
� w ' .._� . -.._.'""" """' " ' .
'L�e�i � � (��
COMMENTS l�-��-Q� C�?��r �ra�v �� 1C �L� fi�1�tL�e� .�4�' �
. �
, . �— `_
� _._ _. . .., '
SEPTIC TANK SIZE
SEEP PIT/U SIZE
ii '������� ,
, .
. .�..:--
�
.. : , _: �.