HomeMy WebLinkAbout15632 (22) CITY OF DIAMOND BAB �
-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suitc 190
(909)860-3195 Fax(909)861-3117 PRE$$
�'�', BUQ:DING PERMIT APPLICATION • • FIRMLY
� JOBSITE f1 c APPLICATION �Y PERMIT f (�,��.� P/C ,�,q_ �l
� ADDRESS �ZV `��� �b DATE ��� NUMBER -�1:/ _�`fV ��
� ISSUE TYPE ' OCC I
.- APN LOT TRACT DATE CONST. GROUP
p OWNER Nk. SllMP�$�t�0
o ADDRESS �Z k ZONING SETBACKS
Z CITY A lA_�_ ZIP TEL. CD�Z"'��� FRONT RW ❑
g APPLICANT TEL. � REAR ❑
� SIDE/SIDE STREET RW ❑
CONTRACTOR E�J1" SIDE ❑
p� ADDRESS PROPOSED USE Z S E Q�c �
� CfTY ZIP \ TEL — —I
o AHCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
N CITY ZIP TEL. i
�n DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION �
Q ONMER-BUILDER DECLARATION SFR/ADD/REM
O
� r�xs�Euw�wat�iiE�anNOR�i��sEc.7m�BUSWES3EANDPVROE�ar�s�En�nrc�oR Garage/Ceryort
COUHTVNMIpIREOUIHESAPERMRTOCONSTRUCT,ALTERIMPROV�DEAIOLISH,ORREPNRMIYSTRUC- �
7URE,VFi1DR TO ITS ISSUANCE,/�LSO REWIRES 7HE APPLICANT FOR SUCH PERMIT TO FlLE A SIONED w Pe�b/DBCk
� STATEMQ7T THAT HE OR SHE IS LICENSED PURSUMIT 70 THE PROVISIONS OF THE CONTRACTORS LI� �
� CENSE lAW�CHAP7ER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PH0. POOVSpB
FE3510NSCODE)ORTHATHEORSHEISIXEMP77HEREFROMANDTHEBASISf-0RTHEALLEQEDE%EMP- C7
TION.ANVVqLATIONOFSECTION7o31.6BVANVAPPLICAHTFORAPERMRSU&IECTSTHEMPLICANTTO Z �Re-Rooi
� ACML PENALTY OF NOT MDRE THAN FNE HUNORED DOILARS(f60o�J:
� ❑I,ASONRIEROFTHEPROPER7V,ORMVEMPLOYEE9WI7HWAGESASTHEIRSOLECOMPENSATION, � �mmerciel . � � � �
WMl DO 7HE NKMK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa1,BUSF J
� NE55 AHD VROFE5910N3 COOE 7HE COHTAAC70R5 LICENSE LAW DOES NOT MPLV 70 AN OWNER OF ? '
PROPEHTY NM1/D BUIDS OR IMPROVES THERC-0N,AND Nk10 DOES SUCH WORN HIIASELF OR HEiiSELF OR
� THiqUGHHISORHEROWNEAIPLOYEES,PROVIOmTHATSUp114PROVEMENTSMENOTINTEFIDEDOR m
OFFER�FFOAN SALE.�F,HOWEVER 71�E BULDINO OR IMPROVEMBiT IS SOLD WITHIN ONE VEAR OF COAIPLE-
Z �'TION,iHE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILD OR
� IMPROVEFORTIEWRPQ4EOFSALE} �
W ❑I,A90MMEROFTHEPROVERTY,AMIXCLUSIVELYCOHTMCTWOWITILICENSEACONTMCTOR9 �
STO CpISTNUCT THE PRQIECT(SEC.)OM,BU91NE59 AND PROFESSIONS CODE:7YIE CONTRACTOR9 LI- V8IU0fIOf1 ADJ.AREA
CENSE UW DOE9 NOTMPLY TO AN OWNER OF A PROPER7Y WFiO BUILDS OR W PROVES THEREON,AND �
� NM1IOCOHTMCT6FORSUCMFHOJECTSWIhIACONfRACTOR(SjLICENSmPURSUANTTOTHECOHTRAG pUANTITY DESCRIPTION FEE -
� 70RS LICENSE UW.).
. � ❑I AM D(EMPT UNDER SEC. B.L 7.C.FOR THIS REASON � Z TL, �
3 � � -
DATE OWNER U
� J �
LICENSED CONTRACTORS DECLARATION W s s
� 1 HEREBY AFFIAM UHDER PENALT/OF VERfURV 71/AT 1 AM LICENSED UNDER PROVISIONS OF GIAPTER �
2[ Y(COAIMENCWO WfTM SECTION 7000)OF DMSION�OF THE BUSINES$AND PFOFESSIONS CODE,AND Z
�X MY UCENSE IS W FULL FORCE AND EFFEC7. m
�� UCENSE CLA S LIC.NO. j .
� DATE O CONTRACTOR d
= WORKERS'COMPENSATION DECLARATION �� �I �
� I HEREBY AFFIRM UNDER PENALTY OF VERAIRV ONE OF THE FOLLOWIN(i DECLARAT�S I Z
� O _I MAVE AND WILL MAMTNN A CERTIFlCATE OF CONSENT TO SELFINSURE FOR WORKERS' a
2
Q COMPOlSATqH,AS PqOVIDED BY SECTION�7000F THE IABOR CODE,FOR THE PERFORMANCE U
Q �F THE WOHK FOR WHlq/THIS PERMIT IS ISSUED. � �
�
_1 HAVE AND WILL MAINTAW WOR!(ER5 COMPENSATION INSURANCE,AS FEWIRED BY SECTION F {�
Q 9700 UF hIE LABOR CODE,FOR THE PERWRMANCE OF THE WORK FOR WHICH THIS PERMI7IS �
� SSUED.MY WORKERS'COAIPEN9ATION INSUa�/ `CAARIER AND POLICV NUMBER ARE: CONSTRUCTION (
] CARRIER � ' V� PLAN REVIEW - O
0 POLICY NUTABER Z
Z ELECTRIC
Q
Q (nissEcna+r+�no7eEaor.aEr�oFnEa�.�rsFoaa+er�uo� (t�ao)oa PLUMBING (Jy/F 7 Tj'
Z I CER7IFY THAT IH THE PERFORMMICE OF THE N�ORI(FOH WHIp1 THIS PERMIT IS ISSUED.I MECHANICAL I I-H\ I�I I rl
(,�}� SHALL NOT EMPLOY ANV PERSON M ANY MANNER SO AS TO BECOME SU&lEC7 70 THE �""^�'
(/j YYORKERS'COAIPENSATION I.AWS OF CALIFOfWIti AND AGREE TMAT IF I SHOULD BECOM INSPECTION FEE
S SU ECT TO THE WORKERS'COMPENSATION PROVISION OF S CT ON 77000F THE UB R �
E.i wrm�nicoMP�rwi os aaov� or+s. ISSUANCE v n �
O �
p DATE: APPLICANT: �SMIP �I V � U
J WMNINO:FAILURETOSEWREWORKERS'COMPENSATIONCOVERAOEISUNUWFUI.ANDSMALLB ENERGYP/C �T�T`W dl�S�,iA p!rl�A�T'9 Ea A'!�
� SUBIECTMIEMPLOVERTOCRIMWALPENAL7IESANDCM�FINESUPTOONEHUNDRED7MOUS ENERGYPERMIT RT TI TYAlf7 AAT7\�Alf!L7Tf,r
r DOLLAF75(iloo,o00�,IN PDDITION TO THE COST OF COMPENSA710N,DMIAOES AS PROVIDED FOfi 1 _� � � .�.� y.� ..,y �
� SECTION 370!OF THE LABOR COOE.INTEREST,AND ATTORNEV'9 FEES.
� p� � � RETENTION FEE: ` �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIUfiY THAT THERE IS A CONSTRUCTION LENDWG AOE CV j� � �L ,� . , - ' � � � ' �
Z FOR iHE PERFORMMICE OF THE WORK f-0R N?11CH THIS PERAl1T IS ISSUED(SEC.70G7,CIV.C.j. —�7�� , �
W �
QT LENDER'S NMIE �� � �
i
H LENDER'SADDRESS
� I CERTIFY 7HAT I HAVE READ THIS MPLICATqN NID STATE hUT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES , 2���./�
� I A6REE TO COMP�V WITH ALL CITV AND COUNTY ORDINANCES MID STATE LAWS RELATINO TO BU0.DIN0 , lY
� CONSTRUCTqN,AND HEREBY AUTHORRE REPRESENTATNES OF THIS COUNTV TO ENTER N THE � �
Z ABOVE�MENTIONED PROPERTY FOR INSPECTpN PURPOSES. /� � �'� „i.f� � . . .
Q // " COMMENTS�� `'.��
J 1 J
� �
m PE NAME(P NT) � . .
Q
�
� si TUHEOF aumE ��� RECPT.NO. PAID BY VAUDATION
� � WHITE-0epe ent Copy,YELLOW�Inence Copy,PINK—Assesaor Copy,GOLpENRO�File Copy,GREEN—Applk�nYs Copy . �
C11'Y OF 1�6e4��6!!D ��►F�
fNS��tCI"806l� �E��B�3D ' �
, � . ._ . _
_ � � w{ ,'.,� � � �� o '� v �;,,�,,,t.z :-'� p Q :'r: ��- °; [y i. �` -' �lv'Jll � ; .i�',
, R � ,.., ,
._ , � . . . _ . . ��• -,. _ � .. . . `
SET BACK • � n • ,. FLOOR JOIST _�
FTGS/FORMS/STEEL • '�-.�• � FHA RE�MTS � -
ELECTRIC GROUND UNDER FLOOR DUCT
GROUNQ PLUMBING UNDER FLOOR CU�IDUIT � � '
SLAB GRADE FIREPLAEE'FOUNDATION � ' '
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BQND�BEAM� '
ROOF SHEATHING - � � � 8 FT. BqND.BEAM„ ' ' ' � ' ' .
FRAMIN ENTILIATION Z.�'t - � FlNAL BOND BEAIVI
CC>VER PRE-GRADING
ROUGH HEATlNG BENCHING
ROUGH EIECTAIC ROUGH GRAdING
ROUGH PLUNIBING FINISH GRADING
SNOWER/TUB TEST POOL ELECTRIC
EXl". LATH/SIDING POOL FENCING
WALL IfdSULATION POOL FINAL
CEILING lNSULATION OFF SITE IMPS.
DRYWALL NAILING QEDiCATIONS
SEWEa FINAL ENG.
SEPTIC TANK LANCSCAPE/IRRIG.
SEEP PIT/LL. ON SITE IMPS.
GAS AIR TEST FlNAL ZONING
FINAL CONS7 Z_ � �� FlRE DEPT. FINAL
FINAI HE T1NG � _: � HEALZH DEPT. FINAL
FINAL ELECTRIC � � • � DEV. FEES PAID
FWAL PLUMBING � ' � - ENERGY . .
� �7 .. O �O :s�; �>` ___
i•.�-l'�.1�_, ',�:� �` ��t t � _`
CUMiViENTS � ., � _ 1 _ '
� - /
� . .
, — --------
I , ` . �
_,+ � . , , �i
� . ,
SEPTIC TANK S1ZE '�
SEEP PIT/U SfZE ' ---
�*a�� '� �'u.4^� �3a�.g'�
RI . � �o
,���� ��,����� ��TM�+ .� •
� ���#�. ,�� ��
?x`°u�'''r`1F _� ��^7�''+ r,.._y'� a���
�� �� � � � ��.,� V
z
� �
�,���� ����� �.�._� �
�� � '�' ` .
, ��� ..�-?��: � � q:��° � , ,
.�'c'��''4'� ��� � ��'"'�`,a� .. � ' ��
��� ,�e,�� � _.z� �:���� � , �, ' �` `. \ ' � � �
. � � . _ �� ,
i