HomeMy WebLinkAbout15972 , ���� CITY OF DIAMOND BAbt
DEPARTMENT OF COMMUTTITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 PRES$
���^�' BUII..DIIVG PERMIT APPLICATION � � 'FIRMLY
� JOBSITE APPLICATIO PERMIT q � PJC �D 1. �
o ADDRESS �� �T��ti ��7�5� ��-• DATE � J NUMBER� < <�_ I
ISSUE TYPE OCC
� APN LOT � Z TRACT � DATE � O CONST. GROUP
p OWNER '� �.. r► ►tS
p ADDRESS C� q.GC� � v� r,�C.:� ZONING SETBACKS
Z CITY ZIP � U TEL FRONT RW ❑
g APPLICANT 11/I�} �1.4 wi"� TEL. . � REAR ❑
� �� � � SIDE/SIDE STREET RW ❑
CONTRACTOR C.FJv� Gu��PTs �• SIDE ❑
� ADDRESSI�.�.Lt+ TY:'��J !'w� � '
PROPOSED USE �
CffY ��G�Al7le(�(7 ZIP �� TEL��:�P . . .
o ARCH/ENG/ , �
� DESIGNER �► _ s- f'-+J� � ��� .,
NO.DWEL. NO. NO.
N CITY� n t'7(�./�� µ ZIP�j L.� Q4. UNITS STORIES BEDROOMS
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
O OWNER-BUILDER DECLARATION SFR/ADD/REM �
. p 1 HERE9Y AFFIiW UHDER PENAL7V OF PERRIRV THAT 1 AM EXEMPT FROIJ THE CONTMCTORS tJ- G8f8QB/CBfPOR
L11 CENSELAWFORTHEFOILOWINOREASON(SEC.7WI.SBUSPIESSANDPROFESSIONSCOOEMIYGTVOR (f� �t� �
C.7 COUHfYWHIGIREOUIRESAPERA1fTTOCONS7RUCT,ALTER,IMPROV�DEMOLISH,ORREPAIRANVS7AUC- w
�Z TURE.PRqR TO RS 158UANCE,ALSO REWIRES THE MPLICANT FOR SUp1 PERMR TO FILE A SIONED w Pa�iO✓DBCI(
STATEMEHT i1MT ME OR SME IS LICENSED PURSUAPlT TO h1E PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(GIAPTER Y(COA/MENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- LL POOUSPB , �
FESSIONSOODE)OR7HA7HEORSHEI9EXEMPTTIEREFROM/JlDTHE9I�SISFOP7HEALlE4EDEl(EMP• (!�
TION.AHVVIOLATIONOFSECTION70J7.6BVANYMPLICANTFORAPERMITSU&IECTSTNEMPLICANTTO Z Re-Roof
� A CIVIL PENALTY OF NOT AqRE TMAN FNE HUNDRED DOLLAqS(f6o0).):
� 04ti4�WNEROFTMEPROPERN,ORMVEMROYEESWI7HWAGE5A57HEIR50LECOMPENSATION, 0 COmrtlefCl01 . � �
WILL DO THE WORK,ANO THE STRUCNRE IS NO7IMENDED OR OFFERED FOR SALE(SEC.70l1,BUSI- J
� NESS AND PROFE3310N3 CODE:THE CONTRACTORS LICENSE UW DOES NOT MP�V 70 AN OWNER OF
PiqPEHfYVAqBULD90RIMPROVESTHEREON,ANDWFIODOESSUCHM/ORICHIMSELFORHERSELFOR � Y�he
Q TMROUGH HIS OR HER OWN EAIPLOVEE3.PROVIDm 7NAT SUCH IMPROVEMENTS ARE NOT IIJTENDED OR m
OFFEAED FOfi SKE IF,FqWEVER��1LLDINC7OR IMPROVEMBfT IS SOLD WfTHIN ONE YF�W OF COM7LE -
�'TION,THE OWNERAUILDER MIILL HAVE THE BURDEN OF PROVWO 7MA7 HE OR SHE DID NOT BUILD OR •
WPfqVE FOR THE PURP0.5E OF SALE). '
� 04��WNEROFTHEPROPERf1;AMIXCLU3IVELYCONTMCTN�WfTHIICENSEDCON7RACTOR9 �
70 CONS7RUCT THE PR0.IECT(3EC.7041,BU91NE55 NA PROFESSIONS CODE THE COHTRAC70R5 LI� V01UetiOn ADJ.AREA
CEHSE UW DOEB NOTMPLY TO AN OWNER OFA PROPERTY WFiO BULDS OR IMPROVE9 THEREON.AND
� MM1IOCONTiiACTBFORSUGiPR0.1ECTSWI7HACOHfRACTOH(5)LICENSEDPUR9UANT70THECONTRAG ��Jqry7�Ty DESCRIPTION FEE �
� 70RS LICENSE UW.). . .
❑I AA1 E7mdPT IRIDER SEC. B.8 P.C.FOR THIS REASON Q
3 � �
LL ¢ G vticv�
DATE OWNER � `�
W '�
! � UCENSED CONTRACTORS DECLARATION � w
I HEREBV AFFlRAI UNDER PENN.TV OF PERIUM lYiAT I AM LICENSED UNDER PROVISqNS OF CHAPTER �
� Y(COAGIENCWO WITH SECTqN 7000)OF OMSION 3 OF THE BUSINE55 AND PROFESSIONS CODE.AND Z
YY LICENSE IS W FUl FOR AND EFFECT.
L{.''] '] m
� UCENSE ' IJC.NO. � • 1.� y j .
V DATE��7 �Z.i CONTRACTOR � �S d
W
� WORKERS'COMPENSATION DECLARATION �
�
� I HEREBV AFFlRAI UNDER VENALTY OF PE0.AJRV ONE OF 7HE FOLLOW WG DECLARATIONS: Z
� _1 HAVE AND WILL MAINTNN A CEHTIFlCATE OF CONSENT TO SELF•INSURE FOR NORKERS' $
COMPENSATqN,AS PROVIDED BV SECTION 3/OOOF THE LABOR CODE,FOR THE PERf-0RAIANCE U
OF 7HE WORI(FOR WHId17H15 PERMIT IS ISSUED. W
�
I NAVE AND MALL AIAWTAP7 WORKERS'COMPENSAiION INSURANCE,AS REOUIRED BV SECTION
� 97000F THE LABOR COOE,f-0R hiE PERFORMANCE OF 7HE WORK FOR WHICH T115 PERMR 19 �
� ISSUED.A/Y WORKEAS'COMPENSATION INSURANCE CMRIER AND FOLICY NUMBEH AAE: CONSTRUCTION
�j CARPoER ��✓ ��'wJ PLANREVIEW
Z �rnuMeER � � ' ELECTRIC
Q (naseEcna+r�r+oreeoonRtr�oFn-ee�wwrsrna funu�ooun�is( m�oa�ss� PLUMBING TIT)� T��\
� �
Z I CERTIFV THA7 W 7HE PERFORMANCE OF THE WORK F IS PERMIT IS ED.I MECHANICAL
L'} SHALL HOT EAIPLOY ANY PERSON IN ANY MANNER 50 BE SU&IECT TO HE
(n WORKERS COMPENSATION UWS OF CNJFORNIti A REE THA IF I SHOUID COME INSPECTION FEE
S SU6IECTTO THE WOPo(ERS'COMPENSATION P SION OF SEC 3700 0F E LABOR (�
cooE i Foan+win�cw�P�r win�nas ao�s s. ISSUANCE `�1 �
O �{�
p DATE: � ��� APPLICANT. �SMIP CI� i'ZT���t � � O
� WARNINO:FNWRE TO SEWRE WORKERS'COMPENSATION COVEMOE IS UN L,AND SHALL BE ENERGY P/C g
�y SU&IECTANEMPLOVERTOCAIMINALPENALTIESANDCMLFWESUPTOONEHUNDREDTHOUSMID ENERGYPERMI'Y�
OOILARS(t100.000),W ADDI710N TO THE C0.5T OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 970!OF T1E UBOR CODE,MTEREST,AND ATTORNEV'S FEES. �
p� RETENTION FEE: a
OCONSTRUCTION LENDING AGENCY � PRE-ALT FEE:
� I HEREBV AFFIRM UI�ER PENALT/OF PERIURV THAT THERE IS ACONSTRUCTION LENDINO AGENCY ' �
FOfi TFIE PERF/OR/'MANC/E OF THE WORK FOR WHICH THIS PEqMrt IS ISSUED(SEC.30W,GV.C.). � . .
� LENDER'S NMIE ✓ �� t/ 7�/� �/7 �P�� � . .
� LENDER'SADDRESS
W I CERTIFY THAT I HAVE RFJ�D THIS MPLI s E rw�rrHe�eove wwaM�ran is coanEcr. TOTAL FE ES � � . � � ��
� I ACiREE TO COMPLV WITH ALL CITY O CES MID STATE UM5 REUTINO TO BUpDINO �
� � CONSTRUCTION,M1D HEREBV A IZE REPRESE A71VE5 OF 7HIS COUNTV TO EHTER UPON THE � � . �� , .
Z PBOVE�MENTIONED PROP f-0 NSPECTION PU E5. �
Q � COMM NTS '
� Q (� ,J�r�-f ,'—� . �
�
m PERM . PRIHf) ' R � � - �
¢ , i
N
� saw�Na�o�a� . �� RECPT.NO. PAID BY VALIDATION L
� ITE--0epaAment Copy,YELLOW—Finence Copy.PINK—Asaessa Copy,GOLDENROD—File Copy,GREEN-- i Ys Copy
. �b�'�'.
CITY �� L71A�fi0�lD �e4f�
!(�lSPECT80i\! I�E�C)RD . '
,
. ,.� �. _ , _ y�. . �y����
0 � '�- D � "` • p e� � �,$;•,; o " p •`�,���rz�,%;L�/�� • UnJ�!'IS�V'U LanS
"� .P'� J
SE7 BACK � FLOOR JOIST
FTGS/FORMSJSTEEL FHA REQMTS '
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PI.UMBING UNDER FLOOR CU�IDUIT
SI.AB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM ' •
WATER SERVICE MID HT. BOND BE�AM
ROOF SNEATHING 8 FT. BOND BEAM -
FRAMtNGNENTILIATION FINAL BOND BEAM
ROOF C4VER PRE-GRADING ' '
ROUGH HEATINC BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PI,UNIBING FINISH uRADING
SHOWER/T'UB��EST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL :
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAIUNG DEDICATtONS �
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/lRRIG.
SEEP PIT/L.L. ON SITE IMPS.
G.AS AIR TEST FINAL ZONING
FINAL CONS7 FIRE DEPT. FINAL
FINAL HEATING � • � HEALTH DEPT. FINAL
FINAL ELECTRIC • • DEV. FEES PAID —
#=1�VAL i�LUM8ING ENERGY
�---
� m p� �� .� k�;.�a"��� _ --
� COIUfMENTS ' _ _ - -. - .
SEPTIGTANK SIZE
SEEP PiT/U SIZE ---
.��� �s.� �z � �. ..� —
.� � �`,���' a q� „µ" ,�.
� ,� �
`�� �'�. ,;;,� 0 5r � ;' `
r. ..-: o_a
}I,*�rv x�' S `a
d•
�� �'�� � -�'�a °'�
�'>-e
��1
�4 • J �. '`,
R °} , •
t� "
',t�.�sw �t' �F.:.�i,. .
. ���, =q _ _ •
,��� ��`'�.
�' F .��, a � ' .