HomeMy WebLinkAbout16968 (1111) C1TY OF DIAM0:�1D BAR ���
�� DEPARTMENT OF COIvIIvIUNITY&DEVELOPMENT SERVICES % �
� 21825 E.Capley Drive � � .
a\�� '�`� (909)860.3195 Fax(909)861-3117 � ��- PRESS
BUILDING PERMIT APPLICATION FIRM
N JOBSITE Q I,`�]L /' �C �`/, � ! ,� ' I„
o ADDRESS Z$3V W [e�(�QV DATECATION [)' PERMIT P/C
�G �_NUMBER �J M�
� APN LOT � TRA T �ZRS� �SSUE TYPE CC
T�— DATE CONST. GROUP
p OWNER��er►NMa D�l'L�' �-5���..LG
o ADDRESS �344� i�rZRI'�NC,E w�. ZONING SETF3ACKS
z CITI'1 e7LRAAIC.E ZIP�i['so� TEL.31�SYO'��9p FRONT RW ❑
� APPLICANT TEL. fiEAR p
� SIDE/SIDE STREET RW ❑
� CONTRACTOR �- �S' ELELTI�l� SIDE p
ADDRESS_/n23 5[o'T G't; �
o CITY SftatblwlC � ZIP��t7T3_ TELZlC-4R0'3`j PROPOSEDUSE
o ARCWENG/
�z DESIGNER NO.OWEL. NO. NO.
= CrDTMDRESS Z�P TEL. UNITS STORIES BEDROOMS
N
cn DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUIIDER DECLARATION SFRlADOlREM
O
1 HEREBY AFFIRM UNDER FENALTY OF PERAIRY THAT I AM E%EMPT FROM THE LOHTMCTORS LI• G3f2g0/C21pOR
�W CENSEUwFORTFIEfOLLOWINCHEASON(SEC.7o]t.5Bu51NE55ANDVROFE55qNSCOOE:ANYCITYOR (n
U COUNTYNT/1CHqE0URE5A7EHMITiOCONSTPUC7,ALTEit11APROVE.DCAlOL�SM,ORREPtiHANYSTRUG w
w NRE.VRIOR TO RS ISSUANCE,AL50 REOUIRES THE AV7LICMtT FOR SUCM VERMIT TO FILE�SIGNED w Falio/peck
STATEMEHT THAT HE OR SHE IS LICENSEO PURSUAM TO TXE PROViSIONS OF THE CONTRACTORS LI•
� CENSE UW(pUPTER C(C01.1MENCINa WITH SECTION 7000)OC DINSqN]OF THE BUSiNE5511N0 PRO- � POOIISp3
0 FESSi01:5CODE)ORTwITXEORSHEISEXEMPTTXERCFROAIAYDTM'ceA5i5FORTNEALIEGEDEXEMP- (�
V T10N.11NV1/IOIATKKJOFSECTION7071.SBYANY�op�i�(TFOHAPERMITSU&lECTSTHEAPPLICANTTO Z FlB•R001
A CML 7ENALTY OF HOT MORE T/UN FNE MUNDRED OOLURS(iSOC�.)'
ZOLASOWNEROFTMEVROPEflTY,ORM'IE�v�pYEESWITHWAGC5A5MFIFl50LECOMPENSATpN, 0 COrt1rtlEfCl31
1MLL DO THE WOiU(,AND THE STRUCTURE IS NO7INTENDED OR OFfERE�FOR SAIE(SEC.70��.BUSI• J
N NE55�1ND PROFESSIONS COOE:TME CON7RAC70f15 LICENSE UW OOES NOT APVLY TO AN OWNER OF
7R07ERTYWFqBU1LD50RIMPROVESTHEREON.ANDNMODOESSUCMWORKNIMSELFORHEHSELFOR �
2 TNROUGNMISORHEROVME4PLOVEES,VROVIOEDTMATSUCNII/PROVEl1ENT5MENOTINTENDEDOR m
Q OFFEREDFORSKEIF,HOWCV[RTM[BViDWGORMPROVEIAEMlSSpDYnTHINONEYEAROFCOMPLE-
Z TION,TH[OWNER-BUILDER WILL HAVE THE BURDCN OF PROV:NO THAT HE OR SNE DiD NOT BUiID OR
� IAIPROVE FOR THE PURPOSE OF SALE�.
�yJ ❑1i150NRlEROFTH[PR07ERTV,AME%ClU51VELYCONiRNCTPlGW:TMLICENSEOCONTRACTORS
Q TO CONSTRUCT THE PROJECT(SEG 701�.BUSINE55 AND PROFESSIONS CODE:TME CONTMCTOAS U- VaIl18li0f1 A0.1.ApEA
W CENSEUWDOESNOTAPPLYT011NOYMEHOFAPROVER'YM7MOBUIlD50RIMPROVESTNEREON.AND
� MAfOCANTRACiSFORSUGIVRO.lECiSWITHACONTRACTOR�S)LICENSEDPUFSJ/MTOTMECON7MG QUANTITY DESCFIIPTION FEE
Y TO0.SLICENSEIAw�.
� OIM1E%EMPTUNOERSEC. 8.8V.C.iORTHiSRFA50N Q �
}O V
u.. ¢
DA7E ONMER U
Z
� LICENSED CONTFiACTORS DECLARATION W _ .
IHEAEBYAFFIRAIUNDERPENAIT'OFPERIURYTH�TIAMLICENSEDUNOERPROV15iON50FCHAPTER �
� i�COMMENCWQN7TH5ECTION7o00�OFDNi510N70FTHEBW^INESS/�NOPROFESSIONSCOOC,AVD Z
X W LIGENSE i5 N FULL FORCE AND EiFEGT. m ,
LU '/t'
0 LICENSECU S G� UC.NO. T�7`.I'ZZ 1 ^ j ,
�j DQE C CONTMCTOR�yL.�G�Y/L a
W _1
� WORKERS'COMPENSATION DECLARATION I�3 t'O� U
�
� I HEREBYAiFIRM UNDER VENALTV OF GERJUM ONE OF THE FOILOVlING�ECURATqN,,. Z
� �IHAVEAKJY1iLLMA:MAMACEHTIfICATEOFWNSENTTOSELF�INSUREFORN9RKEfiS' $
COIAPENSATION,ASPR�VIDEDBYSECTION]�ooOFTMEIADORGOOE.FORTMEPERFOHMANCE W
OF TH[WORK FOR NM111CH THIS PERMiT IS ISSUED. �
W
�I HAVE AND W:LL MAINTAIN WORKERS'CdAPFNSATqN INSVRANCE.AS REWIqfD BV SELTICN
4 ]TODOFTMEUBORCODE,FO(iTMEPERFpRMiV10EOFTHEWORKFORVlMIp1THISVEM�IT15
ISSUED.MVWORN.{EP.S�a}�PENSATIO�NSURANC CARRIENAN�POIICYNUM�ERARE: CONSTRUCTION
jCARRIER ��K`G rV"� � PLAN REVIEYd —�'
� VOIICYNUlABER���l O t��/n'7 E�ECTRtC _ � `7�—
� (M55ECfiGJNEmNOTBE00M'LEfEDOFIYEPEA.�f6fd10NEMft7RE�DOIWlS(i�OolOplE553 PLUMBING
Z ICERTIFYTMATPITHEPERFONdiVlCEOF7N[N'ORNFORWHIpITHISFERAUT5155UE�.l MECHANICNL
(J SMALLNOTEVPLOVANVPERSONWANVMANNERSOA5T08ECCMESl10JEC1TOTNE
N WORKERS'CWAPENSATqNUWSOFCAL1iOtiNIA,MIDAGREETMATIFIS�+IXILDBECOME IUSPECTIONFEE -
S SU&IECTTOTHE WORKERS'CONPENSATqN PRON510NS OF SECTION�70oOF iHE UBOf1
CODE,I SMALL FORTT1WrtMCOMPLY W17H h105E PRON510NS. �SSUANCE
� SMIP
p DATE: APPLICAM:
� WARNINO:FAILURETOSECUREWORKERS'CO�APENSAiIONCOVERAGEISVNUWRIL,MIDSLULLBE ENERGYP/C
� SUOJECTANEMPLOYERTOCRIM:t�ULPENALTIESMIDCIVRFWESUPTOONEMUN'�REDTHOIISAND ENERGVPERMIT
DOIUfLS p10o,000).N 11DOITIONTO THE COSTOF COMPENSATqN,DAM�GES AS PRO`ADED FOR IN
� SECTION]70A OF TME UBOR CODE.NTEREST,M10 ATfORNEYS FEES. ��ENTION FEE:
� CONSTRUCTION LENDING AGENCY PR[-ALT FEE:
O
� IHEREBYAFFIFiMUNOERVENALT'OFPERJURYTHA7TH[R[ISACONSTRUCTIONLENDINO�GENCY '
FOR TME PERFORMANCE OF TN[YlORK fOR WMIGH TMIS PENMIT IS ISSUED(SCC.7oB�.GIV.CJ.
Z
w
� LENDER'S WV.1E
F-� IENDERSADDRE55
W ICERTIFYiHATIMAVEREADTMISAPPLILATIONANDSTATETIUTTHCABOVEWFOfWA710N15CORRECi. TOTAL FEES ���
� IAGREETOCOM7LYWI7HALLCRYANDCOUNTVOHD:NANCESANDSiATEUwSRELATINGTOBUILDING
� CONSTRUCTION.ANDHERCBVI1U7Y10RIZEREPRESENTATIVESOFTH�SCOVNTYTOENTERUPONTME
Z ABOVE�MENTIONED OROPERTY FOR IN57ECTION vURPO5E5. COMMENTS
� �
� � C1 w� L , 3►-o o ka s
�
m PERMITf AME(PRINT) �
� '�'�.Gd tiJ�2 g �b �—
� Si IUf.OFPERMITTEE OATE �
� AECPT.�O. _ _PAID OY VALIDATION
WHI7E—Department Copy.YELLOW—Finance CoDY•PINK—Assessor CoDY.GOLDENROa—File Copy.GFiEEN—ApDlicanCs Copy
�� .. i ...._. .......-.�,v ..��.•:� .... � .. , i.'T': . .� " .•."^rt.•. . . . . ��.a.. .r—.���+� .. r � • �. r-.� � • � ...�. .....�.. .. . _.. ..... .
....,.... . ...� �
. . , ,.. ...�...........�.�. �•'•r±• . .
�� 1 ''� �t' �1�-:��;iC'Tti� t's��r,
������L=�.�kVi\� [:t�lr�3::L� .
Ie���S:��c`fl�]►�; -__.,iJ��;' = I►`k�`iC�= f'ca:�._.._-_...__-li F=i��_:C:�li'1i.-____.__.�_�,�`i�= -.__.__``��=1'��c�rejc{ __.....
. ` � ... ----- . . .. .. . ................:.. . .... ---. ....-- ...._. .. ... --- - --. .. . ..-- ---------. .._..._..._._. .._..--�------..__..._
-••----.. ...__ .-� - -- - �
5ET BACf�- - •, I I � FLOOR JU'.1. , i ' • �--------- -
FTGS!rOR"�1S;STEEL �-- - ---�-- ---• -----j i Fi�1A REQ':�TS -- --. ----�--- � -
ELECTRIC GR�U�JD � i T i ; U�����R FLOOR DUC I� � ! I
GROUPJD PLU�11BING --�-- - � --- - -�I : UPJD�R FLOOR COi•'.UUIT ' --_ • - -
SLAB GRADE I � I ; FIR�F'LF�C�FUl'Ji•.D!'.Th�N ' I � '
----i -- --- --- - - I ------
TE�AP POWER j_; FIREPL:,CE E3�?JD �EA�.1 �
' - -------- -- ....--- - --
I
LVATEFi SERVIi,E � _-- ' ----- -- ' I C"�D HT. �?OP:� B�nt." ----- � .---G ----- -
ROOF SHEATHING I I ' i & FT. GO'�D 6EA^.� (___ __ I
+------ �-r----- --- —
FRAP.IING,NENTILIATION I _�___ I FINAL�O�JD �EP.P:" � _ �
ROOF COVER I � _� FR�--GRF,DItJG I I
ROUGH HEATIPJG I I __� B�iJC'.HIhJG ___�. �
ROUGH ELECTRIC I I __�_i �`JUu^f�GRADii•Ju _ I
ROUGH PLUt:�BI��G j � I I FIPJISFi GRADIPd;:; �
-- 1 --- ----�-1-------- ----- - ---
SHOVJER.rfU3 TEST � _ I _ _I_I�'���f�_EGTRIC __ __ I _
EXT. L/�TH;SIDING I � POOL FE?dClfJa_ _ � __
�'JALL INSULF:TIO�J � -- - --- ---� I F'O�L F=1��AL j
CEILIPJG INSULF�TIOPJ � I � OFF SITE If�."PS. �__ _
DRY1�'JI,LL�dt;ILI�JG �_ � � DEn1�nTI0�JS �__ _
SEbb'ER I 1 I �ir;AL EfJG. �__
SEPTIC TP,NIC ; � LAPJDSCF�PE/IRRIG. �
SEEP P1TlL.L. � -- 1 - � � OfJ SiTE li:i?:. _-- � �
GAS AIR TEST � I ,� ; FRJAL 7_D":C�+G � �
FINAL CONST. j i ! ! �IRE D�='T. Fif•:F,•_ �
...i_
FIPJAL HEF,TIiJG � � �_ fiEALTf i DFPT. FIfJ,�L
I-�-- -- - �--
FI1dAL ELECTRIC ;�"`�1�-?�v�-•----- � I DEV. FE�:� PAID � _
FIN/1L PLUP�IBING � � � � EhJERGY �
I I �I ----_..�-- -- -
-1-r_.,...R...,.__,..�._.,_•
� , �.._;. .:�- .�i.„'"'_
_
. .. .
� �— �,� , _ , _._ �---_:... _.._ .... .... .......- -- -
CUMPJIENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE - ---
_!S�,.....____�.�. _
1�1F� —
� , ,