HomeMy WebLinkAbout13443 (17) � �
��_ CITY OF DIAMOND BA� ��[} �
� DEPARTMENT OF COMMUNITY&DBVELOPMENT SERVICES
21660 E.Copley Lkive Suite]90
(909)860-3193 Pex(909)861-3117 � PRESS
�'��'��� BUII.DING PERMTT APPLICATION FIRMLY
� JOBSITE APPLICATION PERMIT 2 P/C
o AODRESS DATE NUMBER I✓ 3 �►
� APN LOT C7 DATE �J�I�-1 CONST. GRO�
p OWNER
eADD �S ZONING SETBACKS
CI ,r� ZI TEL FRONT qW ❑
� APPLICANT TE HEAR ❑
SIDFJSI6E STREET RW ❑
CON7RACT R SI�E ❑
� ADDR PROPOSED USE L
� CITY ZI TEL.
8 ARCFUENG/ _
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CfTY ZIP TEL.
v� DESCNIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFWADDAiEM
O
� I MENEBY AFFlRM UNDER PENALTY OF PEiWRY TFY1T I AM EXEMPT FIqM THE WMfRACTORS LI• Gef�gO/Ca1�OK
CBISEUWFORTXEFOILOWINGREA60N(SEC.7q71.6BU51NE53M1DPHOFES510N5C0�E:ANYpTVOH (n
COUNNMMIClIREOUIRESAPERMRTOCONSTRUCT,KTEH,IMPpOVE,UEMOLISH,ORREPNRANY3TMIC- W pellD/D6CI(
TURE,PRIOR TO RS F59UANCE,11LS0 REOUI0.E81ME MPLICANT PoR SUCH►ERMIT TO FllE A BIONED
STATFYENT TIU7 HE OR SHE IS LICEI�LSED PURSUANT TO THE PRDVISIONS OF THE CONTMCTOq9 lb
� CEN6E IJ�W(CIIAPTER 0(COMMENC�NG NATH SECTqN 7000)OF DIVISIDN'OF THE BU31NES9 M1D Mp- � PooUSpa �
FE5910N5 COOq ORTUiHE OR SME 19IXEMPTMEREFROM M!D TXE BA81S FOR Tl1El1LlE0ED E%ElAP•
TION.ANYVIOlAT10NOFBECTION7U97.6BYAM'APPLICANTFOqAPEfiMITSUBJECT9THEAPPLIGNfTO Z Re-Roo1
F AGVIL PE W�LTI OF NOT NOiIE TMN FIVE MUNDNEO OOLLARS(i5ao)):
O ❑4hSOY7NEROFTNEVROPEHT'GaRMY@APLOYEE6WIiHWAOE5A5THEIFl50LECOMPENSATION, O COTTBfCIflI �
Z YALLOD 7HE WWIK MA TIIE S7RUCTURE IS NOT IMENDE�OR OFFEHEO FOR SALE(9EC.70��,8U51- J
NESS AND�NOFESSIONS COOE:THE CONTMCTORS LICENSE U'M DOES NOT APPLY TO AN OWNER OF
� PROPERTYWSiOBlAD50RWPROVES7HENEON,MJOYMODOES6UCf/YVORKHIMSELFOPHERSELFOR �
a TWpUGHHISORFEROWNEI+IPLOYEES,PROVIDEDTHATBUCHIMPROVEMEN7SARENOTMRENDE00R m
�jOFFEREUfOHlAI.EIF,NDYY�/EiL7NEBUlDINGORNAPROVEMENTIS501DWfR11NONEYEAROFCOMPLE
� TIDN,TFIE OWNER�IIILDER WILL NAVE 1HE 6UMEN OF VNOVIN�THAT NE ON SHE DID NOi BWID OP
MIPROVE FOR h1E PURPOSE OF SI1LE1.
� O4�D�NNEROFTIEPROPEHTY,AMEXCLUSNELYCONiRACTINOVY17F1UCEN5E�COHfRIICTORS
TO LONSTiR1Cf TV/E PR6IECT(8EG}041,BUSINE53 MID CROFESSIONS CODE:7NE CONTRIICTOR4 U� VBIUfilldt ADJ.AREA
CENSE UW DOES NOTAPPLV TOMI OVINER OFA PqOPERTY WIiO BUH.,DS OR IMPROVESTHE(1EON,AND
NM1100ONTAAc.`TBWRBUp7PRQ1ECTSWITMIICONTR�CTOR19)UCENSEDPUi15uANT707HECON7RAG QUANTITY DESCRIPTION �E
� 70RSUCENSEUW.� J .
O I AM F]�AIPf UNDER BEC. B.8 P.C.FOR TNI5 RFASON Q
Q �� �� • G�s
� OATE OWNER �
� LICENSED CONTRACTORS OECLARATION W .
� I NEAEBYAFFIIIM UI�IDER PENALiY OF PEFWf1Y 7MAT I AM 1,ICENSED UNDEH PHOV�SIONS OF GHAPTEH �
� •�Cq1YENCWOWITH9ECT1ON7000�OF01VISIDN70FTHE6U51NE5SANDDROFESSIONSCODE,ANU Z
X MY 110ENSE IS N FULL FOR D EFFECT. � m
LL �
� LICENSEy�ss LIC.NO.� �
� a►� .�3 �,'�l'� cor�macroa a
w
� WORKERS'COMPENSATION DECLARATION —�
N1 NENEBYAFFINIA UN�ER PENALN OF PERIURY ONE OFTHE PDLLOWINO DECLARA�IONS: Z
� �_IMAVEANDWILIWINTAINACEHTIFIGTEOFCONSEMTOSELF•INSUREFORWpRNERS' _
� GOAAPQISATION.ISFROVIOW9YSECTION97000FTHELABORCODE,FORTHEPERFDRMANCE W
Q OF T}1E MIONK FOR WHICH 71N5 PERMIT IS ISSUED. �
�I HAVE AND YVILL MAIIYLUN WORKER3'COMPENSATION INSURPNCE.AS HE�UIRED BY SECTION
O a7000FTHElABOPCODEFORTHEPERFOflMANCEOFTNEWORKFOflWHICHiHISPERM1T15
� ISSUm.MY WOIkYl1��lri CyOM�PEN.SA7qN INSU CECARRIER^ANO POLICY NUMBEN�RE: CONSTRUCTION
+J CMRIER ����A ��� fJ PLAIV REVIEW
� ro�ICY NUMBER ^��T L,ECTRIC �L 4 /
Q (IIlS8CC11oNNEEDW0i8EO01.KEiIDOFTVEVERAQfBFOHaIEHIIPDRm0011A0.SR��1�LFss? PLUMBING 'y
Z 1 CERTIFY TlU71NTHE PERFORMANCE OF iHE N'ORK FON WHICH THIS VERMIT IS ISSl1ED.1 MECHANiCAL �j k'�`R
SNAL�NOT EMPLOY ANY PEH60N IN ANY MANNER SO AS TO BECOME SUBJECT T�THE
(n WOR(ERS'COMPEN9ATpNLAWSOFG�IIFORNIA,IWD�GREETMJITIFISNOUIDBECOME �NSPECTIONFEE
SU&IECT TO THE WORKEHS'COMPENSATqN Pp01fl510N5 OF SECTION 9700 OF THE U60F
cooE.�sw�u.wmr+Nnrr�couP�v vn sE PArnnswr+s. �1�...� SUANC ��A����,,t;'„�'�7�'' q ��
p oa�:I�(_t� APPLICA����` i�-N�-- SMIP rr "'` i I f�
T--
� WApNINa:FA0.VRETOSECUREYYORKERS'COMPENSA7pNCOVEMOEISUNLAWFlIL,ANO3HALlBE ENERGYP/C�� • ti T * �
LL 9UBJECTANEMPLOYERiDCRIMINALPENhLTIESMIDCNILF�NESUPTOONEHUNOREDTNDUSAND ENERGYPERMIT ��'"r^"' �-� �
OOLLARS�f10o,000),IN AOdT10N TO TNE CAST OF COMPENSATION.DAAIAGES AS PNOVIDEO FOR IN
� SECTION770eQFTiEU1BOROODE.INTERE3T,AN�ATfORNEYSFEE3. RETENTIONFEE: � � 1'
OCANSTRUCTION LENDING AGENCY PRE-ALT FEE�
� IFiEREBYAFFIRMl1NDEHPENKTYOFPERNRYTHATTHEREISACONSTRUCTIDNLENUINOM3ENCY
z FOR TNE VEqFORMANCE OF iHE WORK POR WHICH 7FIIS PEqM1TIS ISSUEO(SEC.3oB1,CIY.C.�.
W
� LENOER'SNAME
� 4ENDERSADDRESS ,�,�.y
� 10ERTIFYTHATIHAVEREMiHISMPUCATIONMIDSTATETTMi1HEABOVENFORMATIONISCOqRECT. TOTAL FEES � (-�V%(
� IMiREETO001dPLVWIiHALLCITYMIDCOUNlYO(iDINlWCESANDS7ATElAWSREUTINGTOBUILOING .
� CONSTRUCTION,AND NEREBV AURqqIZE qEPRESEMATNE50F THIS COUNTI TO EMER UVON THE
ABOVHAENTONED PAOPERT'FON INSPE ION PURPOSES. '(AMM[NTS
0
J
� EE IP�lNry/_ �/`I�/'/ � .
CSG�t f
y 810NA OF PEHMRTEE ��T
� iiECPT.NO. PAtD BY VAIIDATION
WHITE-0epenment Copy.YELLOW-�inence Copy.PINK—Aateseor Copy,GOLDENROD—File Copy,GREEN—Applicent's Cqry
„ ! �. CITY OF DIAMONQ BAR .
� INSPECTION RECOFiD �
• t R � • i ' @ 0 . . � .
SET BACK � FLOOR JOIST � �. ' ,
FTGSIFORMS/STEEL� FHA REQMTS., . • -
ELECTRfG GROUND _ ' ' � UNpER FLQOR'DUCT, � � - . -
. _ _ �};-_-.--�
GROUND PLUMBING UNDER FLOOR CQ�IDUIT �
SLAB GRADE FIREPLACE FC)UNDATION � - c-�' -_----
r•. � �
TEMP POWER FIREPLACE�ONq B�AM
WA7ER SERVICE MID HT.BOND�F-11M - ..�� : - � ', t. �”
ROOF 9HEATHING �" ' ` -- - ' �_ ----- S FC BOND B�RM . . . �� • . , t --
FRAMINGNENTILIATION FINAL BON[7�BEAl1/l' r
ROOF CUVER PRE-GRADING
ROUGH HERTING BENCHING �
ROUGH E�ECTRIC �A�l, ROUGH GRADING
ROUGH PLUMBING � FINISH GRADING
SH�WEFUTUB TEST POOL ELECTRIC
EXl". LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILING 1NSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATfONS !
SEWER FINAL ENG. !
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. I ; QN SITE IMPS.
AS L�IR TEST �e-•� ..,� -.FINAL ZONING
FKJAL CC7NSi': ' - - '�`� , I FIRE DEPT. FINA�
FINAI.HEATfNG � � , -' ��' HEALTH DEPT. FINAL ; �
FINAI�EL'ECTRIC . p� ' ` ' DEV. FEES PAID � j
FINA�PLUMBING ENERGY ' ! . �
. �
I � k .
I _ � Q t �-- ,_______
COt�tt�Jf�NTS
_ .
� � . �: ;_i , , _
, . _. . -
,,
. . . . , . ,
, ..
,., �_ , . , .
...--- -�-=-�-_-�--- --....---
� �:� , . ,:`'_ . -----_:�.._., -
SEPTIC TANK SIZE
SEEP PIT/U SIZE � - -
� �I� --- ----------�----
,,y ,
. _ . .� " . . �� •t . �; , , , . �
. , • ',` • , ti . ,ti. _
, i �