HomeMy WebLinkAbout16894 (19) [
` "__ �
crr5r oF n�oNn B�x EXPlRED
-�� DEPARTMENT OF COMMUNITY&DEVELOPMEN7'SERVICES
t. 21825 E.Copley Drive J UN 18 1002
(909)860.3195 Fax(909)861-3117 PRE$$
`'-:�� BUILDINGPERIVIITAPPLICATION FIRMLY
��,) S' �� APPLICATION PERMIT I _ C,� P/C
o DD ESS ' ^ �L v�� � ��C' DATE______��NUMBER �v � a
c� ISSUE TYPE OCC
� APN LOT TRACT DATE CONST. GROUP
p OWNER I�Z
"" ADDRESS_��'I� ZONING SETBACKS
c
Z CITY ZIP TEL FRONT RW ❑
g APPLICANT TEL. REAR ❑
SIDEISIDE STREET RW ❑
� CONTRACTOR d/V'll ,�¢•.: ��A��} SIDE ❑
� ADORESS ,jj ��(' � ��'� .
� CIN '✓n IP� TEL.��- '��
PROPOSED USE �
w ARCH/ENG/ 7.0 �4� .r�
W ADDRESS NO.OWEL �'— NO. NO.
� CITY ZIP TEL. UNRS STORIES BEDROOMS
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
�
Q OWNER-BUILDER DECLARATION SFR/ADO/REM
O
p I NEREBV AFFl11M UNUER FENAIiY OF PEfWHY T11AT I AA1 EXEMPi FROM T11E CONTMCTORS Lb Ga�9g0/Ce�pOK
W CENSEUWFORTHEFOILOWMdpEASON(SEC.7o]1bBUSWE55M1DDROFE5510N4CODEANYCIT'OR (n
U COUNTYMMIp1REWIRESAVERM�TTOCONSTRUCi,ALTEiIMPROVE,OEMOLISH,ORREPA�RANYSTRUG W PBSfO/DBCk �
� TURE,PRIOR TO RS ISSUMICE.ALSO RE�UIPES THE Av7LICANT FOR S11G1 FERAIIT TO FILE A SIGNE� W
� STATEMENT TUT HE OR SHE IS UCENSED PUf35UANT TO THE PHOYISIONS OF hIE COMMCTORS U-
� CENSE UW(tlUPTEH 0(CdA1AENCWO WITH SECiION 7D00)OF DINSqN 7 OF THE BUSIHE55 M1D PRO• V"' P��Pa
fE5510N5 COD�OR T/UT HE OR SHE t3 EXEMPT 1HENEFpOM t11D THE BA515 FOR THE ALLEGED EXEMP-
VTION.ANYVIOUTKKiOFSECfKKl7071.SBYANYAPPLICANfFOR�PERMITSUBJECTSTME�PPLICANTTO Z Re•Roo1
� A CML VENALTY OF NOT MORE THAN FNE HUNDRED DOIWiS(S5o0)):
� ❑I,ASOWNEROFTHEPROPER7Y,ORMVEMPLO�'EESWITHWAGESASTMEIq50LECOAIPENSATqN, � Commareial �
Z YALL 00 THE WORK AND THE STRUCTURE IS NOT INTENOED OR OFFEAED FOR SALE(SEC.70u,BU51• _I
NE55 AND VROiE5510N5 CODE:7ME LONTMCTOflS IiCEN3E Uw DOES NOT APVLY TO AN OWNER OF
� ORO�EFTVNM1IOBU1�.OSORIMPROVESTHEREON.AND�MMODOESSUCNWOHKHIMSELFORMERSELFOR m
Q THROUGNNISORHERWJNEMPLOYEES,PROVIDEDTiAi5UC111MPROVEMENTSMENOTINTENDEDOR •
QOFFEHE�FORS/LEIF,HOWEVER7MEBUlDINGORINPROVEMEMLS..OL�WITMNONEYEAROFCOMVLE�
Z 7qN,iHE OWNEii�BU1LDER WILL HAVE THE BUiWEN OF PqOVWO TMAT HE OR SHE DID NOT BUItD OR
= E1PilOVEFOR7HER/RPOSEOFSALE�.
O 1,AS OWNER OFTHE PHOPERT!AM FXClUSNELY COMMCTINO W17M UCENSEO CONTIUCTORS
Q N CONSTRUCT THE PNOIEGT(SEG)a�,BUSINESS AND PROFESSIONS CODE:TNE COHTMCTORS LI� V81USt�Of1 ADJ.AREA
W CENSEUWDOESNOiAPttVTO/�NOVlNEROFAOpOVERTYM/lq6UILOSORIIADROVESTMEREON.AN�
� YhqCOMMCTSFORSUCH7NQ1ECT5WITHACONTMCTOR(5)UCENSEOPURSUMlTTOTMECONTRAC• QUANTITY DES IPTION FEE
� 700.S UCENSE I.�W).
p O I MI EXEMP7 UNDER SEC. B.i P.C.FOR THIS RE�SON �
� �
u" DATE OWNER V
Z �y
� LICENSED CONTRACTORS DECLARATION W
� IHEREBYAFFIRMUNDERPENALTVOFPERIURY7HllT1AMLICENSEOUNDERVidOVI5lON50FCHA0TER Ur
p_, i�COMMENCWQN7TMSECTIDN70ao70FDM510N70FTHEBUSINESS�NDPHOFE5S10N9CODE,AND Z
X MY IICENSE IS k1 FUIL FORCEAND EFFECT.
m
0 LICENSECLAS � LIC.NO. � � ,� j
� J
V DATE _CONTfi0.CTOR� � n-
W
�, �WOFiKERS' OMPENSATIONDECLAHAT N ¢
� U
� INEREBVAFFIRMUNDERGENALTYOFPE0.NHYON60FTHEfOLLOWWGDECLAMTqNS:
y Z
� �_IMAYEANOMALLAUINTAINACERTIfICATEOFCONSEMTOSELF-INSUREfORWORKERS' 2
� COMPENSATION,ASPHOVIDEDBVSECTION77ooOfTNELAeOfi[ODEFORTHEVERFORA/ANCE U
�Q OFTNEN/ORKFORWNICHTMISiERMITISI55UED. —�- �
�
W _IXAVEM7�MALL6MMTAINWORKERS'COMPENSATIONINSURIWCE,ASREWIREOBVEECTION /'��\ l
Q 970o OF hfE UIBOR CODE.FOR THE PERFORMANCE Of THE W'ORK FOR WNiCH THIS VERMR IS � iS' 1 �U
ISSl1E0.MV WORKERS'COMPENSATION INSUNANCE CMRIE MID PoIICY NUMBEA�E: CONSTRUCTION e �v
� CARR�ER PLAN REV�EW
� POLICW NUMBER_r y • ELECTRIC
I
� (iH155EC1�oNNE�wiBE oFT+EPEaM7sR7Ra:EFIUI�D�Eo�atMsls+rolailESSJ. PLUMBING
Z ICEqTIFYTHATINTHEPERFORMMICEOFTHEWORKFORVMICHTHISPEM1IT615SUE0,1 MECHANICAL �"'=
(J SHALLNOTE�PLOVANY7EPSONINANYAIANNERSOASTOBECOMESUBJEGTiOTHE /�`."'. �y7
((� WORKENS'COMPENSATIONUWSOFCA�IFORNIA,ANDAGREE�NTGISHOULCBECOME INSPECTIONFE
SUBlECT OiHEWORKERS'C01.1PENS�TqNPHO�n5lON50F5ECT10NJ7000FTMEU80R ' UU
O E,1 S ALL FORTMnTH COMPLY WITH THOSE PqOV15iON5. ISSUANCE �C
J
p DATE: ��PPLICANT: ' SMIP
W ENERGY P/C
� WANiINQi.L �E OSECUREWORKEflS'COMPENSAT COVEMCEISUNLAWFUI,ANDSHALLBE R
� SUBJECT F4PLOYERTOCHIMW�LPENATIESANDCNIIFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMI �-/ I
OOLURS(5100.000).N�DDITION YO THE C09TOF COMPENSATqN,DAMACES AS PROVIDED FOR M --
J SECTIDN07oeOFTMELABORCODE.NTEREST.ANU�7TDNNEV'SFEES. RETENTIONFEE: �~� �y-t� �-"` ��:I
2
a CONSTRUCTION LENDING AGENCY pRE-ALT FEE-
O
� IHEPEBVAFFIRAIUNDERPENALTVOFCERJURVTMATTMEREISACANSTRUCTIONLENOWGAGENCY
dZ FO(i TME PERFORMANCE OF Th1E WORK FOR WHIp1 THIS PENMIT IS ISSUE�(SEC.1o97,CIV.C.�. �
W
� LENDER'S NMIE
� IENDER'SADDRESS
Q ICERTIFVTHATIMAVENEADTHISAPPLICAiIONANDSTATETMATTME�BOVEINFOfUlAT10NI5CARRECT. TOTAL FEES ' �
W IACREETOCOI�PIVWRNALLCRYANDCOUNTVOPDMANCESANDSTATEUWSRELATWOTOBUtDIN6
� CONSTRUCTION,ANOMEREBY�UfNORIZEREPRESENTA7NE50FTNISCWNTVTOEMERUPONTHE � � //�� /�
Z �BOVE-MEMIONEDOROPEHTVfOAINSVECTIONVU�O ES. COMMENTS �Le_(.J� � /� � �� •
p � V
� _�_
[n � ,�
Q
�
� SICNATUREO cRMIT1EE DATE
� RECPT.NO. PAID BY AUDATION
WHITE-0epartment Copy,YELLOW—Finanee Copy,PINK—AssessaCopy,GOLDENRO�File Copy,GFEEN—ApplicanCs Copy
, , .. . . . . . , . . . . . �..� . �� ., . .. , i� , . . . � . . . �, � � . -.. .... .
a CITY OF DIAtJ�OND BAR .
���� ; � IfJSPEC i ION RECORD
iC�������1��� � ��'��=- ����������� °;f:�1������i�o�.�� ..���c�': .�r���.���!i��l� ,
SET BACK ' � .. ' FLOOR JOIST �~�� I + ' i-=--`
FTGSlFORMSISTEEL FHA RE�MTS
ELECTRIC GflOUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT �
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER I FIREPLACE BOND BEAM
WATER SERVICE I � MID HT. BOND BEAM �
ROOF SHEATH�NG � 8 FT. BOND BEAM , �
FRAMINGNENTILIATION � � FINAL BOND BEAM
ROOF COVER PRE-GRADING
R�UGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBIPJG ( FINISH GRADING
SH�WER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION PO�L FINAL
CEILING INSULATION OFF SITE IMPS.
DRYINALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING '
FINAL CONST. � FIRE DEPT. FINAL
FINAL HEATING � � HEALTH DEPT. FINAL
FINAL ELECTRIC � � DEV. FEES PAID
FINAL PLUMBING I I ENERGY
�c�����(� ,-����2 c;;
�_ -
COMMENTS
SEPTIG TANK 51ZE
SEEP PIT/U SIZE
€�p
����� �� .
- ..�. '� -�' , � , :