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_���_ CITY OF DIAMOND BAE
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � �
.� 21660 E.Copley Drive Suite 190 � °
(909)860-3195 Fax(909)861-3117 PRES$
��`��'� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE + ^ APPLICATION `�� PERMIT �1��/C{'� .� 2
o ADDRESS �S� � ��'t �i- � � � �� DATE "� � NUMBER # ��c� v
c� ISSUE - TYPE OCC
APN LOT TRACT DATE ' CONST. GROUP
p OWNER A� S � F..f� G-T U L�.
� ADDRESS _7 fi �,�.�`? ZONING SETBACKS '
� CITY�2 ZIP TEL. FRONT RW f7
APPLICANT .� ��"'' � TEL.S Z� '-3� � REAR ❑
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a� CONTRACTOR ��-���n ('h1.�C-"��.tGG1 G^��%J SIDE ❑
ADDRESS ` ' " r% •; � iG� ' a
� CITY �I n-.l_[+e.%?� ZIP C'- " TEL. " .ROPOSED USE • �� � � � ty
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� DESIGNER NO.DWEL. NO. NO.
n. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER•BUILDER DECLARATION SFR/ADD/REM
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p 1 HEREBY AFFIRM UNDER PENALTV OF PERNRY THAT I MI EXEMPT FROM THE CONTRACTORS LI- GBfe J0/CelPOft •
W CENSEIAWFORTHEFOLLOWINOREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:ANYCITYOR
U COUNTYWHICMREQUIRESAPERMfiTOCONSTRUCT,ALTER,IM7ROVE,DEMOl1SH,ORREPAIRANVSTAUC- W patio/Deck � �)
w TURE,VRIOR TO ITS ISSUANCE,�LSO REOUIRES THE AP7LICANT FOR SUCH PERMIT TO FILE A SIGNED W u L�
� STATEMENT THAT ME OR SHE IS LICENSED PURSUAN7 70 THE PROVISIONS OF hIE CONTMCTORS LI-
� GENSE UW(CHAPTER 0(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- V" POOVSPe
FESSIONS OODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALIEGED EXEMP-
TION.ANVVqLATIONOFSECT,lON7031.5BYANVAPPLICANTFORAPERMI75U&IECTSTHEAPPIICANT70 Z Re-Rooi
� ACML PENALTY OF NOT MORE hIAN FIVE HUNDRED DOLURS(f5oo).):
� ❑I,ASOVMEROFTHEPROPERTV,ORMYEMPLOVEESWIiHWAGESASTHEIRSOLECAMPENSATION, � Commercial . -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70t1,BU51- J
NESS AND PROFESSIONS CODE:THE CANTMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF
� PROPEiRVVAlOBUILDSORIMPROVESTHEREON,ANDMMODOESSUCHWORKHIMSELFORHERSELFOR �
._Q 7HHOU(i!1 HIS OR MER OWN E�IPIOYEES,PROVIDED THAT SUd1 IMPROVEMEMS ARE NOT INTENDED OR m
QOFFEREDFORSALEIF,FIOWEVERIHEBUIIDINOORIMPROVEMENTI550LDWITHINONEYEAROFCOMP�E-
Z �'TION,THE OWNER-BURDER NALL HAVE THE BUHDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS ONMER OF THE PROPEHTY,M1 E%ClUS1VELY CAMRACTINO WITH LICENSED CON7RACTORS
Q TO CONSTRUCT THE PR0.IECT(SECJOH,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTORS LI- V81U8f1Of1 G ADJ.AREA .
W CENSEUWDOESNOTAPPLV70ANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� N?iOCONTMCTSfORSUCHPR0.JECT5WITiACONTRACTOR(S)LICENSEDPURSUMfTTOh1E00NTRAG pUANTITY DESCRIPTION FEE -
� TORS UCENSE UW.).
� ❑I AM EXEMPT UNDER SEC. B.\P.C.FOq 7HI5 REASON �
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� DATE OWNER � �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENAL7Y OF PE0.IURV 7NA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� D(COMMEHCINO WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
X MY LICENSE IS IN FULL FORCE AND EFFECT. •
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� UCENSE CIASS '/ �� LIC.NO.v � •� � J . '
V DATE CONTRACTOR - / a
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r� WORKERS'COMPENSATION DECLARATION � '
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� I HEREBV AF UNDER PENALTY OF PERIURV ONE OF THE FOIIOWING DECURATIONS: Z , . .
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' 2
COMPEHSA710N,AS PROVIDED BV SECTION 37000F 7HE LABOR CODE,FOR 7HE PERFORMANCE U
Q OF THE W9RK FOR WHICH THIS PERMI7 IS ISSUED. �
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w I HAVE AND WILL AWNTAIN WORKERS'COMPENSATIOH INSUMNCE.AS REOUIRED BY SECTION
Q 37000F THE LABOR CODE,FOR THE PERFORMMICE OF THE WOHK WR WHICH THIS PERMIT IS O
� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: � CONSTRUCTION � �
� S� C}-� ''!_ �—V 1-� � � PLANREVIEW �
CARRIER �
� POLICV NUMBER r� � {�+ �2 4�j '-' D �� ELECTRIC
0 (Ri65ECT10NNE�NOTAE00MRETmOFTHEPEFANT6FORONEHINdJFiED00LLARS(5�00)ORLESS} PLUMBING
w MECHANICAL _�� �P�
Z 1 CERTIFY 7NAT IN THE PERFORMMICE OF THE M/ORK FOR WHICH THIS PERMIT IS ISSUED,I
(,'} SHALL NOT EMPLOY ANV PERSON IN ANY MPNNER 50 AS TO BECAME SU&IEC7 TO THE
� WORKERS'COMPENSATIONLAWSOFC AGREETHATIFISHWLDBECOME INSPECTIONFEE
SU&IECT TO THE WORKERS'COMP A710N ROVISIO FSECTION 3700 OF THE LABOR
CODE,I SHALL FORTHWITH COMPLV WITH TH�E PROVISIONS.
ISSUANCE
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p DATE:����"4XPPLICANT: �) ������ SMIP � .
w ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNIAWFUL,AND SHALL BE ��1
� SUBJECTANEMPLOYER70CRIMINALPENAL7IESANDCIVILFINESUPTOONEHUNDRED7HOUSANO ENERGYPERMIT L i �
} DOLLARS(f7oo,000�,IN ADDI710N TO THE COS70F COMPENSATION,�AMAGES AS PROVIDED FOR IN B ^/
� SEC710N 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � �/ �
� CONSTRUCTION IENDING AGENCY PRE•ALT FEE:
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� I HEfiEBV AFFIRM UNDER PENALTV OF PE0.IURV THAT THERE IS ACANSTRUC710N LENDING AGENCY � (�� �
FOR THE PERFORMANCE OF THE WORK FOR WMICH 7HIS PERMIT IS ISSUED(SEC.90a7,CIV.C.).
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� LENDER'S NAME � �
F- LENDER'SADDRESS
� I CERTIFY 7HAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COHRECT. TOTAL FE ES " /
w I AGREE TO COMPLV WITH ALL CITY M1D CAUN7V ORDINANCES AND STATE LAWS RELA7ING TO BUILDING � n
� CONSTRUCTION,AND HEREBV AUTHORIZE REGRESENTA71VE5 OF THIS CAUNTV 70 ENTER UPON THE � ���J � I � � � �
ZABOVE•MEN710NED PROPEH FO INSPECTION PURPOSES. COMMENTS ��V �
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m ERMI7TEE NAME(PRI
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�' DATE L t
— RECPT.NO. 1 PAID BY VALIDATION
�'VYHITE—Department Copy,YELLOW—Finence Copy,PINK—Asseuor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy
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SET BACK '' D ' FLOOR JOIST
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FTGS/FORMS/STEEL d(�,�` FNA REQMTS. __
ELECTRIC GROUND , UNDER FLOOR DUCT
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GROUND PLUMBING ' ' UNDER FLOOR GC1t�IDUIT___j___
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SLAB GRADE FIREPLACE FOUNDATI�N
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TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE �iID HT. BOND BEAM � �
ROOF SHEATHING � 8 Ff. BONd BEAM �
FRAMINGNENTILIATION r— _ FINAL BOND BEAM _______
ROOF COVFR PRE-GRADING
ROUGH HEATING BENCHING �
RQl1GH.ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING .
SHOWEf�/TUB TESt - PQOL EI�ECTRIC
EXT. LATH/SIOING POOL FENCWG ` �
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CEIUNG INSULATION ' QFF SITE{MPS.
DRYWAL.L NAILING ' DEDICATIONS •
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SEPTIC TANK LANDSGAPE/IRRlG. A �
SEEP PIT/L.�. ON SITE fMPS. �
GaS AIFi'i"EST � FINAL ZONING
FINf�L C�h1ST. FIRE DEPT. FIiVAL
F1i�AL HEATING � HE,4LTH QEPT. FlNAL
�I�f�L ELECTRIC � � DEV. FEES PAID � �
; i= •!.".L PLUMBING ENERGY
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