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Home My WebLink About16873 (669) ------�?�..--- ci�oF n�orr�a�x EXPI6�ED � DEPARTMENT OF COMIvfUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive �1 (909)860-3195 Fax(909)861-3117 �UN 1 S Z��[. PRESS ��'%��" BUILDING PERMIT APPLICATION FIRMLY Q ADDRESS��3I ��?�/D/Gp �! • � APPLICATIOv�' PERMIT I-� P/C o DATE 1 .Gb' �r NUMBER # ' � ISSUE TYPE OCC APN LOT T ACT . � � DATE CONST. GROUP p OWNER �e / r _% o ADDRESS a ' ZONING SETBACKS Z CITY P,yl�TEL�O ��✓ FRONT RW O REAR - � APPLICANT TEL. � Z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR SIDE ❑ o CD;RESS ZIP TEL. PROPOSED USE `�i -d�'� �I.2,P.d� oARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRM UNDER PENAL7Y OF PERIURY THAT I AM EXEMPT FHOM THE CONTRACTORS LI- GyfflJO/C2fpOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BU51NES5ANOPROFE&SIONSCODE:ANYCITVOR (n U CAUN7VWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W TURE,PRIOR TO ITS ISSUANCE.ALSO FE4UIRE5 7HE APPLICANT FOR SUCH PERMI7 TO FIIE A SIGNED w Patio/Deck STA7EMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRAC70RS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB � FESSIONSCADE)ORTHATHEORSHEISEXEMP7THEREFROMANDTHEBASISFORTHEALLEGEDExEMP- (� U TION.ANVVIOLATIONOFSECTION7031.SBVANYAPPLICANTFORAPERMI75U&IECTSTHEAPPLICAN770 Z Re-Root A CIVIL PENAL7Y OF NO7 MORE THAN FIVE HUNDRED DOLLARS(5500).): ❑I,ASOWNEfiOFTHEPROPERTV,ORMVEMPLOVEESWI7H.WAGESASTHEIRSOLECOMPEN5A710N, � Z WILL DO 7HE WORK,AND THE STRUCTUFE IS NOT INTENOED OR OFFERED FOR SALE(SEC.7odt,BU51- J COmmBfCial � � NESS AND PFOFESSIONS CODE:7HE CANTRACTOFiS I.ICENSE LAW DOES NOT APPLY 70 AN OWNE{i OF � PROPERTV NTiO BUILDS OR IMPROVES THEREON,AND MMO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGM HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m � OFFEREDf-0RSALE.IF,HOWEVERTMEBUILDINGOHIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOH 7HE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPER7Y,AMEXCLUSIVELYCONTRACTINGWITHUCENSEDCONTRACTORS � TO CANSTRUC7 THE PR0.IECT(SEC.70a�,BUSINESS AND PROFESSIONS CADE:7HE CON7RACTORS LI- VelllBllOf1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOAtJOYMEROFAPflOPERTYWHOBUILD50RIMPROVESTHEREON,AND � WHOCON7RACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUAN7TO7HECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). �� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q U � DATE ��`�7��DI OWNE � Z w � LICENSED CONTRA RS CLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERJURv THAT I AM LICENSED UNDEF PFOVISIONS OF CHAPTER � d B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z 'X MY LICENSE IS IN FULL FORCE AND EFFECT. m- � LICENSE CLASS LIC.NO. j � J V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTY OF PERJURV ONE OF 7HE FOLLOWING DECLARATIONS: Z _ Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' _ Q CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE w Q OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED. � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOl11HED BV SECTION Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMI7IS ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION J j CARRIER PLAN REVIEW \ Z POIICY NUMBER ELECTRIC O.V Q � (IHISSECIqNNE�NO7BE00MFLEfFDOFTiEPERMfTISFORONEHUPDREDDOLLPAS(f100)ORLESS). PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL (,'} SHAIL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ? SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR \ CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE J � SMIP p DATE: ' APPLICANT: J WAFiNING FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECTANEMPLOVERTOCRIMINALPENAL7IESANOCIVILFINESUPTOONEHUNDREDTHOl1SAND ENERGYPERMIT DOLLARS(5100,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN � J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � � Q a� CONSTRUCTION LENDING AGENCY PR6ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTFUCTION IENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ. . Z W � LENDER'S NAME � LENDEF'SADDHESS � � TOTAL FEES 4 .S O � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE I FORMATION IS CORRECT. �'� w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND T S RELATING TO BUIIDING � CONS7RUCTION,AND HEREBV AUTHORI REPRESEN7ATIVES UN7V TO ENTER UPON THE � ABOVE-MENTIONE P P RTV FO P ION PU POSE Z COMMENTS o " J I I m FER EE N RINT - Q � � SIG UREOFPERMITTEE DATE = RECPT.N0. PAID BY VALIDATION ~ WHITE—De artment Co YEILOW—Finance Co PINK—Assessor Co GOLDENR06—File Co GREEN—A licant's Co P PY. PY� PY. PY, PP PY -� � {. :�, ,. :, .• :.: .,ra :...6.'_,.:' •..., . . i � �- •�r•�r.•�..l. �+�49:c ,:7:_n�.w�. . . ... . .. . . . . _ . . . . .. ... . �� I��7 �� 0�1��u G�G� f��[i�[�D O��C�JOa DQ� OU� a a � D�` °� �G�'` 4 a�7L�`tr� << �[� �o �� SET BACK I —� FLOOf�JQIS7 � --- ---.- ----- , _._ _.____. � ---------- FTGSIFORMSlSTEEL ; ! FHA REQMTS � _. ._ _ __......_ - ------ --...__...._._.- ---- ELECTRIC GROUND � UNDE� FLOOR DUCT j - ---. . -- , GROUND PLUMBING ____ UNDER FLOOR CUMpU1T _ __ ___-- --..._____. �_--- _ ----..._..__.._._ SLAB GRADE FIREPLACE FOUNDATION _ TEMP POWER ; __ y FiREPLACE BOND BEAM -- -- _ _.._ ..._._ W,4TER SERVICE ! MID HT. BOND BEAM � __ ROOF SHEATHING 8 FT. BdND BEAM __ � , FRAMING/VENTIUATION ,__ FINAL BOND BEAM � - --- ------ - -.. _...___._---.. ROOF COVER PRE-GRADING � ' ROUGH HEATWG SENCHING ROUGH ELECTRIC ROUGH GRADING ' -- ---- — ROUGH PLUMBING � � FINISH uRADING _ - ---- --------- SHOWERlTUB TEST I ' POOL ELECTRIC —_ ----- ..— ____�_ EXT. LATH/SIDING PUOL FENCItJG i WALL INSULATION POQL FINAL _. __. -- - �_.__..____.� CEILING IIVSULATION OFF SITE IMPS. DRYWALL NAILihlG DEDICATIONS SEWER FINAL EM11G. SEPTIC TANK LANDSCAPE/IRRlG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINA�ZONI►VG FINAL CONST. I �lRE DEPT. FINAL FINAL HEATING ; HEALTH DEPT. FINAL FIPJAL ELECTRIC ! DEV. FEES PAID FINAL PLUMBING � ENERGY � � � �— _ � //�� /\(�� I ��V/U .},/�..—IVJC� I COIUIItl1�1 V�� SEPTIC TA�lK SIZE SEEP PIT/U SIZE � �� ------ �