HomeMy WebLinkAbout13570 (824)� ������� �'
� �� CITY OF DIAMOND BAB S E P 1 O ������ `
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 2002
21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-311'I PRESS
�� ������'�� BUII.DING PERMIT APPLICATION __ FIRMLY
o� OBSITE ��Z� Va1��`f �l�c-� D*� . DATEICATiON/ y_� � �1 NUMBEW ` S�O # - �
ADDRESS "I (O
$ ISSUE TYPE OCC
� APN LOT TR DATE CONST. GROUP
°C OWNER �
O
o ADDRESS ZONING SEfBACKS
Z CITY -IP TEL. FRONT RW �
APPLI � NT TEL. REAR ❑
SIDE/SIDE STREET RW ❑
� ,CONTRACTOR � C�D SIDE ❑
Q ADDRESS '- PROPOSED USE � I
� CITY ZIP I� TEL. �
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
N
I O OWNER-BUILDER DECLARATION SFR/ADD/REM
0 I HEREBY AFFlRM UNDER PENAL7Y OF PERNRV THAT I AM E%EMPT FROM THE COMMCTORS LI- � Garage/Carport
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7037.58USINESSANDPROFESSIONSCOOE:ANYCI7YOR
U COUNTNWHIq1HEWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OFiREPAIRANYSTRUC- W Patio/Deck
�Z TURE.�RIOR TO ITS ISSUNJCE,A4S0 REWIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMEM THAT HE OR SHE IS LICENSED PURSUMIT TO THE PROVISIONS OF T1E CONTRACTORS LI�
� CENSE UW(CHAVTER Y(COMMENCINO WITH SECTION 7oao)OF DIVISION 3 OF THE BUSINESS AND PRO- LL' POOVSpB
fESSIONS COOE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR 7HE ALLEGED EXEMP-
TION.ANYVIOUTIONOFSECTION7o31.58VAHYAPPUCANTFORAPERMITSU&IECTSTHEAPPUCAHTTO Z Re-Root
ACML PENAL7V OF NOT MORE THAN FNE HUNDRED OOLURS(i500).):
❑I.ASOMMEROFTHEPROPERTV,ORMVEMPLOVEESWffHWAGE5AST4EIRSOLECOMPENSATION, � �
Z Commercial �
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/a,BUSI- J
NESS ANO PROFESSIONS CODE:THE CONTMCTORS�ICENSE LAW DOES NOT APPLY TO AN OWNER OF
� VROPEHTVWFIOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR �
[C TMHOUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q ,OFFEREDFOHSKEIF,HOWEVER7NEBUILDINGORIMPROVEMENTISSOLDWITHINONEYFAROFCOMPLE-
Z 'TION,THE OMMERAUILDER WILL HAVE h1E BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
7 IMPROVE FOR THE PURPOSE OF SALE).
❑I,tiS ONMEROF THE PROPEHTV,AM El(CIUSIVELY CONTRACTINO WITH LICENSED CONTRACTOqS
� TO CONSTRUCT THE PHQIECT(SEC.7W4,BUSINESS AND PROFESSIONS CODE:hIE CONTMCTORS LI- VflIU9llOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLY TOAN OWNER OFA PROPERTY MMO BUILDS OR IIAPROVE^u 7HEREON,AND .
� WFqCONTiUCTSFORSUCHVRO.lEC7SWITHACONTMC70R(S)LICENSE�PURSUANTTOTHECONTRAG QUANTITY DESCRIPTION F E
� TORS LICENSE UW.).
0 O I AM EXEMPT UNOER SEC. B.8 P.C.FOR THIS PEASON �
3
� OATE OWNER
Z
� LICENSED CONTRACTORS DECLARATION
� I HEREBYAFFIRM UNDER PENPLTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
� 0(COMMENCINO WI7H SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CADE,M10
X MY UCENSE IS IH FULL FORCE ANO EFFECT.
�u � �
� LICENSE C '6 �� LIC.NO.
V DATE CONTRACTOR
- W
� WORK RS'COMPENSATION ECLARATION ��`�f� ��
� � U ' ��}
� I HEREBY AFFIRM UN�ER PENALTY OF PERJURV ONE OF THE WLLOWING DECLARATI S: i �
u� Z � �"J�
� _I MAVE AND WILL MAINTAIN A CE(iTIFICATE OF CONSENT TO SELF•INSUHE FOR WORKERS' 2 ' �� ' '
COMPENSATION,AS PROVIDED BV SECTION 37uo OF 7HE LABOR fADE,FOR THE FERFORMANCE U
Q OF 7HE WORK FOR YMICH THIS PERMIT IS ISSUED. �
�
W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSUMNCE,AS REOUIRED BV SECTION
� 37000F THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WOPK FOR WHICH 7HI5 PEHMIT IS �/
ISSUEU.MYWORNERS'COMPENSATIONINSU CE HRIERANDPOLICYNUMBERME: CONSTRUCTION
� CARRIER � PLAN REVIEW � ��
� POLICYNUMBER_���,� ELECTRIC
Q
(iHISSECfqNNE�NOTBE00A�LETIDOFiHEPERMTISFDRONEF0.11�DREDDOLLNiS�f100)ORLE�,S} PLUMBING
F /p.'�i�r`
w MECHANICAL �1'�N���'�t D �
Z I CEHTIFV THAT IN TNE PEHFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISS D,I �
� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO T E
� WORKEAS'COMPENSATION UWS OF CALIFORNIA,AND AGREE 7HAT IF I SHOULD B OME INSPECTION FEE
SUBJECT TO THE WOHKERS'COMPENSATION PROVISIONS OF SECTION Oo OF LABOR �
�j COD I SH FORTHWITH COMPLV WITH E PROVISIONS. ISSUANCE y t-, `t�i1- ��(p7�
• � SMIP �Ai � �9 IJJ ��7 t V v
p OATE: APPLICAtlT: .
w ENERGY P/C T'1''V Y�r, c��n an;-?�?.i i'+ sC A�
J WARNINO:FAILUR TO SE RE WORKERS'CA ENSATION COVERAGE IS UNUWFUL,AND SH E �—,. ,. � ....�....�..-, --
� SU&IECT AN EMPLOYER T CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PEAMIT A TfY 3lYAT�/'oy C.?�ll'�e C.'•A�-�i'��ryJ Y
DOLLARS(i100,000),IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN �...,._,.�u�.,� .,_,-,..... .....-—
¢ SECTqNJ7oeOFT1EUIBORCODE.INTEREST,ANDA7TORNEI^SFEES. RETENTIONFEE: �
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER VENA�TV OF PERJURY THAT 7HERE IS�CONSTRUCTION LENDING AGENCV O
� FOR THE FERFORMANCE OF THE WORK PoR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.).
Z �
W
� LENDER'S NAME
F- LENDER'SADDRESS
�
� I CERTIFV 7HA71 HAVE READ THIS APPLICATION AND S7ATE THAT THE ABOVE INFORMATION IS CAHRECT. TOTAL FE ES � .
w 1 AGHEE TO CAMPLV WI7H ALL CITV Ml�COUNTY ORDINANCES AND STATE UWS REUTING TO BUILD�NG
� CONSTRUCTION,AND HEREBV AUh10RIZE REPRESENTATIVES OF hil5 CWNTV 70 ENTER UPON THE
Z /�BOVE�MENTIONED GROPER7Y FOR INSPEC710N PURPOSES. COMMENTS
� s
J
� I
m PERMI7TE AME( INT) �
Q
� �
� NATU E OF ITTEE DA7E
� RECPT.NO. PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
. . . . , . . . - , .. . " • . , , _ ..i.t � ,.r...� .,
���ll �� �G1J�U0HA�0�'!I� �P�U� • ••
� �II�CI����s�9�lltl �IGV.iU.Mif'A�
��� '• � -.�. s, ...
F ;:; � ... . .��.� ., ' �� �� ' •. � ���y�- .��
. . � a,.
. ���'J�r15 Q �< � � .��' �V'UUA '�� ����� UIJiJ�JIYLc����, '._���k �iJLti1 '�°s d, �?�}� o �'s
SET BAGK . ! FLOOR J�IST .� • • '
_ ; _.— , :.._ ----- —
�__..---_.__..
FTGSJFORMS/STEEL � ! FHA REC�M7S ' ' ___� _
ELECTRIC GRCUND UNDER FLQOR QUCT • .
GROUND PLUMBING UNDER FLO.OR CU�i��11T_______ � � �
-- ----- - _,.. . .
� FIRERLACE FOUNDATION {— �� i
SLAB GRADE � � � � • __�
TEMP POWER � "i � FIREPLACE BONt�BEAM � '� ' �� _��
WATER SERVICE � MIQ HT. BOND BEAM ' ` �- ,
ROOF SHEATHING 8 FT. BOND BEAM - I •
FRAMlNGNENTILIATION� riNAL BO(�D BEAM '
ROOF COVF_R - -- -PRE-GRADIN,C�n-� .. - —
4�OUGH NEATING � BENCHING
ROUGH ELECTFiIC ��� ROUGH GRADING
ROUC7H PLU(VISING + FINISN URRDING ;
SHO�`JER;TUB TEST POOL ELECTRIC �
cX"f. LAThilSIDING • POOL FENCiNG i
WALL lNSUTATION POOL FINAL �
�CEILlNG I(��ULATION � OFF SITE IMPB. � ' �
�DRY'NAL.�(VAILING DEDIGATIONS �
SEV�IER FINAL ENG. • �
>-- ----
� c3Ef'Ti�rANK LANDSGAFE/IRRlG.
j StFP p�;;L.L. ON SITE IMPS.
4_."'�°--- - FfNAL'ZOMNG � �__�
f ��.,;,��ib�i�5T ,
i'r=it�1;`,' �;I�NST. " .`:';>FIRE DEPT, FINAL
t__.__....'_.___ _.
� F=1��i�._ �-IEATING HEALTH DEPT. FINAL
r� i :":!_�LECTRIC DEV. FEES P.AID
i
"._P�UMBING � ENERGI'
. -- ----r--------
,
_ .
i
o p e� _ i
�.. _...---�- - �- , � ���-�, � ;::�a - •----- —�------
_� 1•: � • -
r i����;������ . ---- -^r — �--- —
,
r -
S'� �.. ,-- -
�a_..���'_: ����.,� �?— � ���?-_ �'�"--------__ _ ��
,�-- �-�-- � _ ----
�- - — - — -----__
. ._ ,;
,.. — . _____._�---- -
�--�
SEPTIC TAI�K SIZF�-
SFEP f'IT/U SIZE —
� �=�� � � � — —
�� � � � -- — —
. ' �•� � �� , . ` .
------ ----
� � .
. . ,
� �•�
�
,
� „, ; ; • , �4 �
�