HomeMy WebLinkAbout17131 �
J� CITY OF D]AMOND BAR
� � DEPARTMENT OF COMMUNTIY&DEVELOPMENT SERVICES
�. ��� 21825 E.Copky Ilrive
(909)860-3195 Fax(909)861-3117 PRESS
��'%:�' BUILDINGPERMITAPPLICATION FIRMLY
� JOBSRE I (� DATE CATION �i 1��� ( NUMB R/?!3! #�O O� "�
o ADDRESS
� APN _ L,QC TRACT ISSUE TYPE OCC
DATE CONST. GROUP
p OWNER
o App � ZONING SETBACKS
Z CITY ZIP TEL. FRONT RW ❑
g APPLICANT ' � TEL. - S DE/SIDE STREET RW O
� CONTRACT R _ i SIDE ❑
� ADD E PROPOSED USE
� CIN ZIP TEL
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO. C
n. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
y DESCRIPTION S4.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD�AEM
O
p 1 HEREBY AFFIRM UN�ER PENILLTY OF FERNRY iMAT I AM EXEMPT FROM THE CONTMCTORS LI• G8fag0lC8fpOR
W CENSEUWFORTHEFOLLOWINOREASON(SEC.70.71.68USMESSAN�VROFESSIONSCOOE:MlYCIT'OR (n
U COUNTYWHICHREWIRESACERMITTOCONSTAULT,/�LTER.IMPROYE.DEMOUSN,OHREPAIRANYSTRUP W Pa�iO/DBGk
w TURE.VRIOR TO rt5 ISSUANCE,AL50 i1E�WRES 7HE A7PLIGUfT FOR SUCH PENMIT TO FILE A SiGNED W
� STATEAIENT THAT HE OR SHE IS UCENSED GURSUANT TO TME VRONSIONS OF THE CONTRACTOFiS LI•
� GFNSE UW(pUPTER Y�COIAMENCW O WITH SECTKKJ 7000)OF UIVISION 70F iHE BUSINESS M!D FRO- V"' PooVSpa
FESSIONSCODEJOFITHATHEDRSHEISEXEMPT7HEREFROMANDTHEBASISFORhIEALLEGEDE%EMP- C7
V T10N.AN'/VqIATqNOF5ECT10N707t.68YANYAPPUCANTFOflAGERMRSUBJECiSTHEMPLICANTTO Z Re•Root
A pVIL VENAITY OF NOT MORE TH/�N FIVE HUNOREO DOlLARS(f5oo)J:
ZOI,ASOMMEROFTHEPROPERTY.ORMVEMPLOYEESWITNWAGESAS7NEIflSOLECOMFENSATION, � COrtIR18fCIaI �
W�LI 00 THE WONIC,AND THE STRUCiUNE IS NOT INTENDEO OR OFFERED FOR SALE ISEC.70�1,BU51- J
N NE55 AND VROFESSIONS CODE:iHE CONTRACTOFS UCENSE UW DOES NOT APPLY TO AN OWNER OF
PROPERTYWHOBURDSORIMPROVESTHEREON.MIDWHODOESSUCHWORKMiMSELFORHERSELFOR = �P
[[ THqOUGHH150RHEROY�'NEIN7LDYEES,OROVI�E�THATSL1CHtlADROVEMEN7S�RENOTMIENOE�OR m
� OGiEREDFOqS1LLE1F,HOWEVERTME&Jd.DiNGORIIAPROVEAIENTIS50lDWiTHINONEYE�ROFCO6IP�E•
TION,THE OV/NER-BUIIDEN WILL HAVE THE BURDEN OF PROVINO THAT HE OR SIIE DID NOT BU�LD OR
= WPROVE FOR THE PURPOSE OF S/LLE). V
w �4ASOWNEROFiHEPROPERTV,AME%ClU51VELYCONTRACTWOWITHLICENSEDCONTMCTORS
Q TO CONSiRUCT TME VROJECT(SEG 7aa/,BUSINE55 AND PROFESS�ONS LODE:iHE CON7MCTORS LI• V21U8fi0� ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEflOFAPROPEHTYWHOBURA50FIMPROVESTMEflEOKANO
� WFIOCONfMCTSFORSUCHVHO.IECTSWITIACONTMCTOR(S�IICENSEDPURSUANT701HECONiMG OUANTIN DESCRIPTION FEE
Y TOpS LICENSE UW).
� OIAMf%EMPTUNOERSEC. B.BP.GFORTHISREASON U
�
U.. �
DATE OWNER V
W
� UCENSED CONTRACTORS DECLARATION w
� I HEREBY 11FFIfUA UNDER PENAITY OF FERJURY THAT IAA1 LICENSED UNOER PHOVISIONS OF CHAPTER �
d, Y(COMAIENCWOWITMSECTION700D)OFDIVISION70FTHEBUSINESSANDPROFESSi0NSC00E.AND Z
X MY LICENSE IS IN FII�FOR AN� m
LL' UCENSE SS V ��� LIC.NO. � ��'���( J
V GATE�� �--CONTRACTOR. ttfJC�t Y� d .
W ��
� WORKERS'COMPENSATION DECLAHATION a �
� IHCREBVAFFIRAIUNDERPENALTVOFiER.M11RYONEOF7HEFOLLOWINGOECIARATqNS: U
y Z
Q
� �IHAVEAND1NlLMAiNT�INACEfi�iFICATEOFCONSENTTOSElF�MSUREFORWORKERS' _
�� , COM7ENSATION,ASPROVIDEDBYSECTHJN77oaOFTMELA80RCODE,FORIHEPFRFOHMNICE w
r OFTHE WORK iOR WHICH THIS PEIiMIT IS ISSUEU. �
�
W 1 HAVE AND WILL MAINT�IN WORKERS'COMPENSATION INSUMNCE,AS REOUIRED 8Y SECTION
O 7ov OF TME LABOR E,FOR TME PERFORM/WCE OF THE WORK FOR WMiCH TNIS PERMiT IS I � �� 6
' ISSUED.MY�S MPE SATION INS 4CE CARRIER ANO POLICY NUM9ER ME: CONSTRUCTION
� GRRIER `m� • P�nN aeview •l
� POLICYNUMBER� �� ELECTFiIC
d
� (iFGSECiIONNE�NOTBE00MiFfEDOFT4EPEFlMT6FORONEFUt%iEDDOIl/1LS(tt0oI0i1LE55) PLUMBING . , -�T '��i��
w �j,�-�ti .
Z 1 CERTIFY THAT W THE GERFOWAMNCE OP THE WORI(FOR WHIp1 THIS PERMi715I55UED.l MECHANICAL
C7 SHALLNOTEMPLOYAM'VERSONIN�NYMANNERSOASTOBECOM[SUBJECTTOTHE
� WORKERS'COMPENSATIONUWSOFCALIFORNI0.�NO�GREETHA7IFISFIOULDBEfAME INSPECTIONFEE �
S SU&IECTTO ME WORKERS'COMPENSATqN PHOVISIONS OF SECTION]700 Of iHE UBOR t /`
CODE,I SHitLL FORTMWITH COMPLV WI7N T/10SE PROVISiONS. ISSUANCE I 7�.�
� SMIP �
p DATE: APPLIGANT:
� ENERGY P/C T�� • -----
WARNINO:FAILUNETO SECl1RE WORKERS'CdAPENSATqN COVEMGE IS UNUWFUL.AND SHALL BE _, .___._..
�y SV6IECTAN E4PLOVER TO CRIMINAL FENALTIES AND GVIL GINES UP TOONE NUNDNE�THOUSMID ENEROY PERMIT `
OOlURS(5100,000),IN ADOITION TO THE COST OF COMPENSATION.DA6UGE5 AS FROViOED FOR IN
� SECTION�70eOFTHELABORCODE,INTEREST,ANDATTORNEYSFEES. RETENTIONFEE: � ' O�
a CONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: ��
� 1 HEREBV AFiIRAI UNDER PENILTV OF PERNRY THAT THERE IS ACONSTHUCTION LENDINC AGENLY �� �
� FOR THE PERFORM/WCE OF THE WORN FOR WHICH TMIS DERMIT IS ISSUEO(SEC.9oY7,CIV.C.).
Z ^ �
W
� lEN0ER5fUME
H LENOERSAODRE55 ^/ Q
� ICERTIFYTIUTIHAVERE/�TNISAPPLIGTIONANDSTATETMATTHEABOVEINFORIAAiIONISCARRECT. TOTAL FEES ��N " �/'�/./O
W IAGREE TO COIAPLV WITH.LLL CRY AND COUNTY ORDINANCES IND SiATE LAWS REUiINO TO BUILDII:6 1 � ` r'� ` ����
� CONSTRUCTION.IINO NEREBYAUTFqR12E REPRESENTATIVES OF iN15 COUHTV TO EMERUPON ME
ZvE-IAENTKKJED PROPERTV accraa wavoses. COMMENTS �'\J `J �
\
_ .p17'��' -
m TE N M
¢ � on 3�-15�1 �
�
� 51 . UREOf PERMITTEE � OATE �q
� RECPT.NO. __ PAID BY _ �Jy VALIDATION
WMITE—DeDartment Copy,YELLOW—fhance Copy,PINK—Assessor Copy,GOLDENROD—Fite Copy,GREEN—ApplicanYs Copy
� ... , , . . .. �'C. '`1:' 'l� ]. . ,. :f � .. 1 4., . . .�� . .�. ...r..�r.C' .. ti�i�� 1,. , . .. -��� .. . . -- � . � . � � . . ..
, . . . . .'�.. ' ��.��
CIT� OF DiAf�OPrlD 6Af�
If1S��C�(Of�! #�ECUr3D
.__._.�.____
�1►��-�G��c;ii�Ce:�i!p �.) tt:= I��E-y�l�,c�����i �l��.E-�1:a�¢''�!(al►`I �� �c= �y�:�:�l�tc rc�.�� '
---- ------—- ---__ . -__ __ ___.__�r.---- ----._..�_.__._.--------._ .._.�.�__ _.._
SET BACK ' , I I FLOOR JOIST ' _;i_... ._____ ._�I.._.__�._..._____
FTGS/FORMS,�STEEL �/p -vE�.�.f� FHAREQMTS ��
ELECTRIC GROUND UNOER FLOOR DUCT ( ; j '
GROUND PLUPIIBING UNDER FLOOR CUi�IDUIT i �
SLAB GRADE FIREPLAGE FOUNDATION ' � •
TEMP POWER I FIREPLACE BOND BEAM ' ,
WATEFi SERVICE MID HT. BOND'BEAhJI � � :I `
ROOF SHEATHING . ' � •� B FT. 6rJND BEAM ' � '
FRAMINGN�NTIUATION —������ ' FINAL BOND BEAM I
ROOF COVER PRE-GRADI�dG
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERli'UB TEST - POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILING INSULATION OFF SITE IDAPS.
DRYWALL NAILING DEDICATIONS �
SEWER FINAL ENG. � '
SEPTIC TANK • •� � LANDSCAPFJIRRIG.
SEEP PITlL.L. � OPJ SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. ��� FIRE DEPT. FINAL
FINAL HEATING � HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
. ej�;.fu £:1`.�.tCiC ' I .
COMMENTS
� .
', �
SEPTIC TANK SIZE
SEEP PIT/U SIZE
I�.� -
�
���p� � �.�
� t .
--------- -��----�__�_9 ' . , � , .