HomeMy WebLinkAbout15801 (23) _ � CITY OF DIAMOND BAB
— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 F�(909)861-3117 PRESS
-'A�' BUILDING PERMTT APPLICATION FIR
� JOBSITE � APPLICATION ` U� PERMIT �y��f� P/C
o ADDRESS � DATE I �i NUMBER �.'�/`-' ri
� APN LOT T ACT DA EE ► t yl ev TMPE OCC
CONST. GROUP
p OWNER
� ADDRESS ZONING SETBACKS
Z CITY IP TEL' REART RW p
g APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS PROPOSED USE �
� CITY ZIP TEL.
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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0 I HEREBV AFFlRY UNDEH PENALT/OF PERNRY THA7 I AM EXEMPT FROM THE CONTRACTORS LI- G8f39B/CBfpOR
W CENSEUWPoRTHEFOLLOWINOREASON(SEC.7o31.58USINESSANDPROFESSIONSCADE:ANYCITYOR (n
U COUHTYWHIdiREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8fi0/DBCk
� TURE.PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w
STATEMENT THAT HE OH SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI�
� CENSE UW(CHAVTER 0(COMMENCINO Wlhi SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- � PooVSpa
FESSIONSCODE)ORTTIATHEOPSHEISEJ(EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
TIOH.ANYVqlAT10NOFSECTION7031.58YANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAHTTO Z Re-Root
� A CML VENALT/OF NOT MORE THAN FNE HUNDRED DOLUHS(i5a0).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrtIR1BfCl81 - -'
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/1,BUSI- J
N NESS AND PROFESSIONS CODE:THE CON7RAC70R5 UCENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERN N?i0 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q T1IROUGH HIS OR HER OMM EMPLOYEES,PROVIDED 7HAT SUq1 IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDPoRSALEIF,HOH�EVERTMEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE-
Z �`TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W OI,ASOWNEROFiHEPflOPEHTV,AMEXCLUSNELYCONTMCTINOWfTHLICENSEDCOMRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTOFS LI- VelUOflOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOVINEROFAPROPERTYWFiOBU1LDSORIMPROVESTHEREON,AND
� NM1pCONTMCTSFORSUCHPRQIECTSWITHACOHfMCTOR(S)UCENSEDPURSUAHTTOTHECONTMG QUANTITY DESCRIPTION FEE �
� TORS LJCENSE UW.).
� ❑I AA1 EXEMPT UNDER SEC. B .F EASON Q
3 �
� �
DATE_ ONMER V
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� LICENSED CONTRACTORS DECLARATIO W
� I HEREBYAFFIRM UNDER PENhLTY OF PERIURV THAT I AM LICENSED UNDEP PROVISIONS OF CHAPTER �
� Y(COMMENCINO N7TH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�� MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS IIC.NO. � j
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q
N I HEREBY AFFIRAI UNOER PENALTV OF PE0.IURY ONE OF THE FOLLOWING DECLAM710N5: �
C� Q
� _1 MAVE ANO WILL MAINTAIN A CEfiTIFICATE OF CANSENT TO SELF-INSURE FOR NbRKEHS' _
COAIPENSATION,AS PROVIDED BV SECTION 37ao OF THE UBOR CODE,FOR TNE PERf-0RMANCE U
� OF T1F WORK FOR WHIGi TMIS PERMIT IS ISSUED. �
0
W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIHED BV SECTION
Q 9700 OF THE UBOR WDE,FOR THE PERFORMMICE OF THE WORK FOR WHICH 7HI5 PERMI715
ISSUED.AIY WORKEAS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ME: CONSTRUCTION
,___j c�wAiER PLAN REVIEW
� POIICY HUMBER ELECTRIC �
0 (iVCSSE(.'f10NNE�NOTBE001.G'lEfmOFhEPERMfISFORONEFAN�DREDDClLP175(5�00)OF1LE55} PLUMBING
Z I CER7IFY 7HAT IN THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
�} SHALL NOT EMPLOY ANY PERSON IN M1Y MANNER 50 AS TO BECOME SU&JECT TO THE
Uj WORKERS'COMPENSATIONUWSOFCALIFORNIA,AIJDAGREETHATIFISHOULDBECOME INSPECTIONFEE
SUBJECT TO THE WOqKERS'COMPENSATION PfiOVISIONS OF SECTION 3700 OF THE IABOR �` /1/l
�j WOE,I SHALL FOH7HY/ITH COMPLV WIT/7HOSE PROVISIONS. �SSUANCE _ l Jv
� SMIP
p DATE: APPLICANT. ,
� ENERGY P/C
J WARNING:F/ULURE TO SECURE WORKERS'COMPENSA710N COVERAGE IS UNUWFUL,AND SHALL BE
� SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(i100,000),IN ADOITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN �
J SECTION 370E OF THE IABOR CODE,IN7EREST,PND ATTORNEV'S FEES. � RETENTION FEE:
Q
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEPEBY AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3oY7.CIV.C.).
Z
W
� LENDER'S NMIE � �
H LENDER'S ADDRE55
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CAHRECT. TOTAL FE ES � �5�5 U
w I AGHEE TO COM7LV N7TH ALL CITV AND COUNTY ORDINANCES AND S7A7E UWS REUTING TO BUILDING �
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA71VE5 OF THIS COUNTY 70 ENTER UPON THE �
Z ABOVE-ME IONED PROPERN FOR INSP rioN auavosEs. COMMENTS �
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m VEqM177 7
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� SIGN ITTEE �ATE � � ' .
= RECPT.NO. PAID BY VALIDATION
~ WHITE-0epaAment Copy,YELLOW—Finance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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SET BACK i � FLOOR JOIST _
FTGS/FORMS/STEEL FHA RE(�MTS �
--- --- -- —... _..-- ----- --...._------
ELECTRIC GROUND UNDER FLOOR DUCT
ROUND PLUMBING � 11NDER FLQOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE 80ND BEAM
WATER SERVICE MID HT. BOND BEAM `
ROOF SHEATHING_ � __ 8 FT. BOND BEAM ___
FRAMINGNENTILIATION � FINAL BOND BEAM
ROOF COVF_R PRE—GRADING
ROUGH HEATING � BENCHING
ROUGH ELECTRIC 1 v ROUGH GRADING ______ _
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL E�ECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATI�N POOL FINAL
CEILING INSULATlON � OFF SITE IMPS. � ___
DRYWAL.L NAILING DEDICATIONS �
SEWER FINAL tNG. � � T '
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. O�1 SITE IMPS.
GAS AIR TEST FINAL ZONING
�INAL C(�NSi. FlRE DEPT...FENAL
FINAL HEATING NEALTN DEPT. FINAL
�iN�L ELELTRIC � DEV. FEES GAID ^
F?NAL PLUMBING ENERGY
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