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Home My WebLink About13572 (827) i•� ��8�� .. _ � � �� CITY OF DIAMOND BAx S C P 101001 DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES w 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 , �RES$ ��-�AM� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION _ � PERMIT�� "�J`�LP/ �I{� � ADDRESS I�D {A�LL��I VIS�� DATE NUMBE �� u �� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER V O � ADDRESS ZONING SETBACKS Z CITY ZIP TEL. � FRONT RW ❑ g APPLICANT �� TEL.' REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR �l SIDE ❑ o ADDRESS ROPOSED USE 7� � O�G��'Biv1M�121'l� CITY 1 � ZIP�`_'_7�b�EL. p o ARC NG/ Ig DESIGNER � � ADDRE S S�g L �� NO.DWEL. NO. NO. UNITS STORIES BEDROOMS � CITY �/� ZIP qAol� TEL. ��'8�.� y DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREr1/VALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFlRM UNDER pENALTV OF PE0.NRY THAT I AM EXEMPT FROM THE CONTMCTORS LI- G8fe9B/CBfpOA W CENSEUWFORTHEFOILOWINOREASON(SEC.7031.SBUSINESSMIDPROFESSIONSCODE:ANYCITYOR� (n U COUNTYN?11CHREWIRESAPERMRTOCONSTRUCT.ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck w 7URE,VRqR TO ITS ISSUANCE,ALSO RE�UIRES THE APVLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PUiiSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CHAPTER 0(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PRO- � POOVSP3 �� FESSIDNS CODE)OR TFIAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR 7HE ALLEGED EXEMP- � TION.ANYVIOI.ATIONOFSECTION7o31.58YANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root � ACML VEN/�11V OF NOT MORE TWW FNE HUNDRED DOLURS(i500).�: � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMFLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfTIrtl8fCl81 � � MIILL DO THE WORIC,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.7ou,BUSI� J � NESS ANO PROFESSIONS CODE:THE CON7MCTORS L�CENSE LAW DOES NO7 APPLV 70 AN OWNER OF � PROPEHTYNM1100UILDSORIMPROVESTHEHEON.ANDNMOOOESSUCHWORKHIMSELFORHERSELFOR m � THROUGHHISOHHEROWNEMPLOVEES,PROVIDED7HATSUGiIMPROVEMENTSAHENOTINTENDEDOR 0 OFFEREDFORSALEIF,IiOWEVERTMEBUIIDINGORIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE• �TION,THE OWNER�BUILDER NALL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF S/�LF.j. - � W ❑I,AS OYMER OF THE PROPERfY,AM E%CLUSIVELY CONTMCTING W17H LiCENSED CONTRACTOfiS , Q TO CONSTRUCT TME PHQIECT(SEC.7oM,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70R5 LI- VaIUB[IOfI ADJ.AREA W CENSEUWOOESNOTAPPLYTOANOVMEROFAPROPER7YMMOBUILDSORIMPROVESTHEREON,AND � WFIOCONTMCTSFORSUCHPR0.IECTSWIhIACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG �UANTITY DESCfiIPTION FEE Y TORS LICENSE UW.). � ❑1 AM E%EMPT UNDER SEC. B.8 P.C.FOH THIS REASON Q 3 � � ¢ DATE OWNER F' Z U W � LICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIRM UNOER PEN�LN OF PERIURY TMAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINO WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS IN FULL FORC D EFFECT. 1 /// m , 0 UCENSE CUSS LIC.NO.�� j � - / J V DATE CONTRACTOR a ' W . � W RKER 'COMPENSATION DEC ARATION Q tn �' V N I HEREBY AFFIfUI UNDER PENALiV OF PERIURY ONE OF THE FOLLOWING DECLARATIO� Z , � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70 SELF-INSURE FOR WORKERS' � COAIPENSATION,AS PROVIDED BY SECTION 37000F 7HE UBOR CODE.FOR THE 7ERFORMANCE W OF THE WORK FOR NM1IICH THIS PERMIT IS ISSUEO. � , 0 w _I HAVE AND VALL AWMAIN WORKERS'COMPENSA710N INSURANCE,AS REQUIRED BY SEC710N / Q 370o OF 7HE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �1�A I U ISSUE�.MV WORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBEH ARE: CONSTRUCTION jCARRIER PLAN REVIEW t' )�`.�' .. r�O �-t++.�..u.s� Z POLICYNUMBER ELECTRIC Q � (fFO6sECfqNNE�Noi6EODMPLE7IDOF7}EPEw.(isinRa+EHIx�DaEODoli�as(S1ro)oaLEss). PWM8ING k!�p�/ w MECHANICA iL1�..1 T � �� '�C�QQ� Z I CERTIFY THAT IN hIE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 ,� � (J SHALL HOT EMPLOV ANY PEPSON IN ANV MANNER SOAS TO BECAME SU&IECT TO THE ) �r'e� Uj WORKERS'CAMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE 1( Y�T.�T.�n � ...� S SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00 HELABOR }j �v `' �'b�b4J)1�f,S�/-1Ii CAD,I S FO TH COMPLV WI7H THOS O . ISSUANCE "'��^ ��1'�T� � � � �t . ';F+¢-'� Y p DATE: Z APPLICANT: SMIP � � ' � w ENERGY P/C � J WARNIN .FAILUR O SE RE WORKERS' MP SA710N COVERAGE I UWFUL,AND SHALL BE � SU&IE AN EMP OVER 70 CNIMINAL PENAL7IES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT � DOLLARS(f100,000),IN/�DDI710N TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN xI � J SECTqN 3708 OF 1HE LA80R CODE.INTEREST,AND ATTORNEI"5 FEES. RETENTION FEE:1 2 a CONSTRUCTION LENDING AGENCY PpE-{y►ly/f/EE: � 1 HEREBV AFFIRM UNOER PENALN OF PERIURV THA7 THERE IS A CONSTRUCTION LENDING AGENCV ��,V v FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.30i7,CIV.C.). Z W � LENDER'S NAME 1— LENDER'SADDRESS � 1 CERTIFY THAT I NAVE READ TH{5 APPLICATION AND STATE THAT THE ABOVE INFO{iMAT10N IS CORRECT. TOTAL E ES , ` 1 � 1 AGflEE TO COMPLY WITH ALL CITV AND COUNTV ORDINMICES AND STATE IAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBV AUTiORIZE REPFESUEiN�TATIVE$E.S�OF 7HI5 COUNtt TO ENTER UPON THE ZABOVE-MENTIONED PROPERN FOR INSPECTION P�r� / / � COMMENTS � _ � G, � � m N` � SIONA7URE ITTEE ATE � RECPT.N0. PAID BY VALIDATION WHITE—DepaRment Copy.YELLOW--Finence Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �L . , s � C15fol OF �IAi�iOG�D �� ! , :�.� � ' 19�S9�f��U�Df�I IA��Q�ff��D - _�.__ . � .. , . �� _��-�� ,_,� o � „,: '� r�� o �� v° �� . �il�J° �lJ U LILJIN °`:�� p'�, . a (� p . °�� . --�� . . . o , , ,,_ SFT BACK � � �' I ; FLOOR JOIS7 _ . _ � ____—, rTGS;FORMS/STEEL ' � � - . ; FHA REC�MTS �' 'J'; „`�':'� '"� ,.�� ,. " --____ _ -- -__ ------ ----- --------. �LECTRIC GROUND � UNDER FLOOR DUCl" _,_ ._ � � ..=-., . - ----- GROUND PLUt�IBING � UNDER FLQU.R-GU�IG�UIT ,'. .�_ �:" .'�`` � �-`�,." _ . .. . � - ., , ,...... -�---�.+-----�' -��:,:^� _ .--.---..._.---- SLA[3 GRADE Ft �P�{L -�.:Ft7i1 jX'ATION ,�.*�,.� ::;:;�:•.'� T�MP POWER _ . ; FIREPL�IG�''B�Uf�D'=��AM '..�-4"'�'�_.:k4�'t, 'N,:: :.z;:;=; ----- VV�ITER SEFiVICE � MID,HT. BQND BEP,M ___ __ _____ _ _____ �ROtIF SHEATHING,..�.�. ..,-._ .. i=;';� _ ,; - S FT. BOND BEAM . --r---- . F��iUfiiVCa/VE�ITILIAI�ION � FINAL BOND BEAM � � j �OQFCC3VFR PRE-GRADINC��- � . F :1, ,;' e";�=�:y'., � RC�UGHHEATING � �. 't.—r�� -�r--�•a-,..,�� ,�,�;�- BEN }�t �.!!.�- :.:` !�5 _ i ,� � ROUGH E�EC i RIC r, . . ROUGF�GRADING -- ---_---- .��.-�--_-- ;� RC?UGH PLUiVIBING ''j _ ' ��.,� FlNISH GRADING __ � SF��`WERITUB TEST �OOL ELECTRIC _ � �X?'. LATH/SIDING POOL FENCING �VvFiLL IiVSULATI(�N POOL FINAL _ ___ C.Ll1_Ii�G 1NSU�ATION �. QFF SITE 1MPS. � ..,,, , -- --_. �..._.�-- � DRYI(V/�l..L AIAlLING ' � ' __� DEDICATIONS � SEN�lER . FINAL ENG. f --_ __.._._.�___. ' SE�'?'IC�1'ANK • LANDSCAPE/IRRlG. ' �'��:? P!TlL.L . � �. � .:,t. ON SITE IMPS. .� ---_ _.._.�__--.-- �--_�_—_� -.— � �z;::A!R TES?' FiNAL ZOtViUG � t �Ri�l,�,t C�!�IST . I FIRE bEPT. FINAL _____�__.__._____ __.�----.-----_-- � r;:.I,�L�-IEATING 7 2,0 P • � HEALTH DEPT. �INAL p--_. — --- -- - _.-fi�!�,L�LEC'TRIC i DEV. 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