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HomeMy WebLinkAbout16720 _�� CITY OF DIAMOND�AR � � . DEPARTMENT OF COIvIIv1UNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS "�� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE .��1�,5� � ���p �J APPLICATION r„ � , NUMB R�`��M� o� / o ADDRESS �� v��'�(-���r7�� �R. DATE �v � � p ISSUE TYPE OCC APN � L.j �TRACT DATE CONST. GROUP p OWNER N �i 4 L.c21A , DE.T�i o ADDRESS Z 3._ � ZONING SETBACKS SCITY ZIP TEL REAR RW p APPUCANT L TEL. � 51DE/SIDESTREET RW O � CONTRACTOR O G SIDE ❑ ADDRESS � CITY ZIP TEL PROPOSED USE �a tJ-�' 2Z� oARCH/ENG/ z� DESIGNER ��LT /� NO.DWEL NO. NO. � ADDRESS � UNITS STORIES BEDROOMS � CIN__T�/.�?�/Z/o ZIP 2 TEL D D cn DESCRIPTION S4.F7. FACTOR PSF ADJ.AREANALl1ATION p� OWNER-BUILDER DECLARATION SFR/ADDIREAA 'LE� O p I HEHEBY AFFIRM UNDER PENALTY OF PERAIRV THAT I AM EXEAIPT FROM THE CONTRACTORS U• G0fe98/C9fp0fl (1J CENSEUWFORTHEFOILOWIN6REASON(SEG7071.6BUS�NESSAN07ROFESSqNSCODE:ANVCITYOR (n CJ COUNTYWHICHREaUIRESAVEHMRTOCONSTRUCT,ALTER�PROVE.DEIAOLI5V/.ORRE7A1qAN`/STRUC. w � TUI7E,VRIOR TO RS ISSUANCE,ALSO REIX11RE5 TME APVLICANf fOR SUCH DERAIIT TO FILE A SIGNED W Patio/Deck • STATEMENT T/AT HE OR SNE IS LICENSED WRSUANT TO TNE VROVISIONS OF TNE CANTMCTOR$U- � CENSE UW(p1APTEP G(COA�MENqN6 WITH SECTION 7D00)OF DIVISION�OF THE BUSME55 AND PRO� LL' POOUSP3 �� FESSIONS[DD�OATFIATHEORSHEISEXEMPTTHEREFROMANOTHEBASISfORTHEALLEGEDE%EMP• (� � TpN.ANYVIOLATIONOFSEGTiON70�1.68VANYAPPLICANTfOR�PERMITSU&lECTSTHEMPLICANiTD Z Re•Roo1 A GML f ENALTY OF NOT MOqE T W W FIVE NUNDRED DOIURS(f5001 k � O�ASOWNEROFTHEPROPERiY,ORMYEMV�OYEESWITMWAGE5A5THEIfl50LECOMPENSATIDN, O (',pmT0fCI3I Z WILL DO THE WDRI(,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEL.7W/,BU51• J N NESSAND DROFESSIONS CDOE:THE CONTMCTORS LICENSE UW DOES NOTAVPLY TO/N OWNEP OF � PROPERTY NT10 BUIlDS OR IMPROVES TNEREON.AND WFIO�OES SUp1 WORK HIMSELF OH HERSELF Oq � THROUGHHISORHEROKTlEMPLOYEES,PROVIOEDTHATSIKHMvppyEAlENTS�RENOTMENDEUOq m w OFFFREDFORSALEIF,NOWEVEi�THEBUIIDINCORIMP{iOVEYENTI550IDK7iHINONEYEAROFCOIAP�E� � TION,iME OWNER-BURDEF WILL HAVE 7ME BURDEN OF FROVINO THAT HE OR SHE O�D NOT BVltp pq IMCf WVE FOR THE PURPOSE OF SALE} �y,� 04�OMR'7EROFiHEPRDVEflTY,AME%CLUSIYELYCONTMLTINGWITHIICENSEDCONTMLTORS [= TO CONSiRUC'T TME 7flO.lECT(SEC.70a�.BUSINESS AND 7flOFE5510N5 CODE:TNE GONTRACTORS U• V0W2IIOf1 ADJ.AREA W CENSEUWDOESNO7APPLYTOIWOYMEHOFAPR07ERTYWFIDBUILDSORMPROVESTNEREON,ANO � WF�OCONTMCTSFORSUCFI7ROJECTSWITHACONTMCTOR(S�UCENSEDPURSUANTTOTHECONTMG ouarmTv ESCRIPTON �E � TORSLICENSEIAW). 0 O I IM E)CE/APT UNDER SEC. B.a P.0.fOR THIS REASON ¢ � U . l� ¢ DATE OWNER V Z W ¢ LICENSED CONTRACTORS DECLARATION W [[ INEREBYAGFIRAIUNDERGENALTVOFPE0.RIRYTNAiIAMLICEN5E0UNDERPROV15lONSOFCHAPTER � p_, •�COMMENC�NO WIM SECTqN 7000�OF�NI51ON]OFTME BUSMESS AND VROFESSIONS COOE,AND Z X MVLICENSEISNFULLfORCEANDEFFECT. m LLI � LICENSECUSS UC.NO. j V DATE CONTHACTOR � W � WORKERS'COMPENSATION DECLARAT�ON a � IXEREBVAFFlRMUNDERPENALTYOFPE0.NRVONEOFTHEFOLLOW�NQ�ECUM710N5: Z . � �IMAVEANDWILLMAINT�INACEHTIFiCATEOFCONSENTTOSELFdNSUREFORVARNERS' _ COMPENSATION,ASVROVIOEDBYSECTION]7000FTHELABORLODE,FORTHEPERFORMANCE W Q OF THE WORK iOR WHltl/THIS VERMiT IS ISSUED. � _I HAVE AND WILL MA�NTAIN WORKEHS'COMPENSATION INSURANCE,AS REGUIHED BY SELTION /� � Q J7oo OF TNE LABOR COOE,FOR TME PERFOqMANCE OF iME WORK FOH WHiLN THIS VERMIT IS 1 ISSUED.MV WORNERSCOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION ¢ � .CARRIER PLAN REVIEW � � . Z aa�cvNuueEa ELECTRIC ¢ � (M6sEci�oNNEmwreEaA4lErmoFn+EVEPowisiOaOkEMM7REDDa1/3�R��%oRlE55} PLUMBING Z ICEFTIFYTHATINTHEPERFOFIAANCEOFTHEWOHKFORWHiCNiHiSPEWdITI5155UE�.1 MECHANICAL i' - - (7 SMALLNOTEG7LOVANV7ERSONWANVAIANNERSOAST09ECOMESUBJEC7TOTHE '",/�� y WORNERS'LdAPENSATqNUN50FCALIFORNI,�1WD11GREETMATIFISMWIABECOAIE INSPECTIONFEE , `---,%� S SUBJECTTOTHEWORKERS'CAIAPENSATqNPROV1510N50F5ECTqN�7000FTNELABOR CODE,I SHAIL FORTIM7M COMP�Y WITI TMOSE PROYISIONS. �SSUANCE � � p DATE: APPLICAN7: SMIP � WARNIN6:fA0.URETOSECUREM/ORKFRS'COIAPENSATqNCOVEMGEISUNLAY/FUL,ANDSHALLBE ENERGYP/C � � SVBJECTANFIAPLOVERTOCRIMWAIPENALTIESANDGVIlFMESUPTOONEFIl1NDRE0hIWSMlO ENERGYPERMIT } DOLURSp100,000),INADORIONTOTHECOSTOFCOMPENSATqN,DAMAGE5A5PROVIDEDFOHW ��____ _ J� SEC7�ON 770e OFME LABOR CODE,IN7ERES7,/wDM70RNEY5 FEES. RETENTION FEE: a CONSTRUCT�ON LENDING AGENCY PRE-ALT FEE: O � I HFREBVAFFIPAI UNOER PENALTV OF PERJUiiY 7HAT iMERE IS A CONSTPUCTION IENDINC AGENCV FOR THE PERFORMANCE OF TME WORK FORNMICII TMIS PEHMIT IS ISSVED(SEC.7097,CIV.C.�. � � LENDERS NA1AE � IENOEH'SADDRE55 ) � ICERTIFYTNATIHAVEREADTHISAP�LICATIONANDSIATETNATTHEABOVEWFORMATIONISCORRECT. TOTAL FEES ��� D� 'I]� � W IAGREETOCOMPLVWITHALLGTY/VIDCAUNTYOFDINANCESANDSTATEUWSREU1TINaTOBUILDING � l� � CONSTRUCTIDN,NIOHEREBV�VTI/OFREREPRESENTATIVESOFTHISCWNTVTOENTERUPONTNE Z ABOVE�MENTqNED VROFERTY FOR INSPECTqN PURPOSES. COMMENTS � �c c.�— �.s T�S�kg � PERMI7TEE NAME(PN u�i 8 O/ � SiONATURE O DA � RECPT.h0. PA1D BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy p.,•,�b�^,.'.:P.i!'r'Irr. ;�'1- . ._;a�_. , � ... . -.. ..._v ,. ..., , e � .� , �.. �- �•r:',-„ ; .,, •• r-. ..- ° � i. • ., ��, 4 �• ..,i .ex.. t , ,.� .. . ,. �ITY fa� �l��f���t�'D F3/'�R lr�lS���C i fOf�? �'�CGiTE� il►��7:a�i:iCr��RG i�,1';9�[,� ..._.��rE=�.a-i�;'e'��.q T i�'¢:It.a�;�,��1f�1►": ey.wc'= '1�����=+c�p'oj:� i __--_----=-____.____�. .. .: - - -� _ _ ---------�- -... _--- . �..----._ .._ .__.__.,__.. ... .._ ----,. .- -------- -� - —_._..__._�� ---- SET BACK �_ � FLOORJ015� ..' . . � . , •-- - FTGS/FORMSISTEEL i � FHA REQMTS � , . • =2$=��'. � .� - - ELECTRIC GROUND I�'�/ �! � ' � UNDcR FLOORDUCT• . . � , ., , , • . GFiOUND PLUMBING �,�"'" �� i Ut��DER FLOOR CUP,�DUIT •� � I� � � SLAB GRADE I FIREPL.ACE FOUNDATION • I TEP.4P PO4VER I FIREF�LAGE BO�1D E3EAM WATER SERVICE MID HT. BOND�EAP�4 ' �' � � '� I � ROOF SHEATHING • II FT. BOfJD BEAM I FRAMING/VENTILIATION FINAL E30ND BEAM ROOF COVER PRE-GRADING ^ ' � �. : • ROUGH HEATING BENCFi ��IG� ' � '� ', • � ' ' ' ' ' ' ROUGH ELEC7RIC ROUGH GRADING ROUGH PLUMBING � FINISH GRADING SNOWER/TU8 TEST POOL ELECTRIC EXT. LATHlSIDING POOL FENCING WALL INSULATION POOL FINAL I CEILING ItJSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATI�NS SEWER FINAL ENG. SEPTIC TANK � LANDSCAPE/IRRIG. SEEP PIT/L.L. ' CN SITE IDAPS. GAS AIR TEST FINAL ZONI�dG FINALCONST. �j � �� re� �IRE DEPT. FINAL FINAL HEATI�dG �• HEALTH DEPT. FINAL FiNAL ELECTRIC DEV. FEES PAID � FINAL PLUMBING ENERGY i5. ��T� 0�.���ir�.� COP�IMENTS SEPTIC TANK SIZE SEEP PIT/U 51ZE ;�v� �� � �;���f ��i . :� , I ` � � ,� , .