HomeMy WebLinkAbout12048 (13) CITY OF DIAMOND BAB � ` � � ���V— Y �
--���-1 DEPARTMENT.OF COMMUNTTY&DEVELOPMENT SERVICBS
� Z��o e.c��y nriY�s�c�i90 PRESS
(909)860-3193 Fax(909)861-3117
' ���� $iJQ.DING PERMIT APPLICATION FIRMLY
� JOBSITE f SO D ��h�/ Gv u r�'' APPLICATIO ��� PERMIT��� P/C
o ADDRESS DATE NUMBE N
� ISSUE TYPE OCC
APN LOT TRA T DATE CONST. GROUP
� OWNER „ �rd kG� �G
8 ADDRES � • C 1� hf ZONING SETBACKS
� CITY t � ZIP��� TEL. - G FRONT RW ❑
m y.E�, _ � REAR O
APPLICANT SIDElSIdE STREET RW ❑
� CONTRACTOFi , � I.(i � .T'lu• SI�E O
¢ ADDRESS PROPOSED USE
o CITY ��s��� �r� ZIP Y TEL� -6 �
� ARCH/ENG/
DESIGNER NO.DWEL. NO. NO.
ADDFiESS_. UNITS STORIES BEDROOMS
� �IIY ZIP TEL.
y ,� OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
� ONMER-BUILOER DECLARATIDN SFFVADDIREM
O
�pp 1 HEREBY AFFAW UNDER PENALTY OF PERNRY IN�T I AM EXEMPT FHOM iTiE CONiRACTORS U- Gef8nB/C81p01I
CENSEUWPORTMEFOLLOM�WONEASONI9EC.7W1.6BUSWE33ANDPROFESSIONSCOOE:ANYCIttOR (n _
pOUfftYWF11CFIqEGtARESAPENMRTO00N5THUCT.ALTERNICROYE,fSuRJW�JiORREPAINANYSlRl1P W pg�ip/Deck
..tlNiE,pqqq TO(f8159UANCE,ALHO pEOIlIREB THE APPLICAM FOR BUGi PERMIT TO FILE A 610NED �
BTATEMENT 7H11T ME OR BHE IS 1JCENSED PURSUAN?70 TNE VRONSIONS OF 1HE CONTMCT0113 ll-
� CFNSE lAW(�PTEH 0�CO6IMENGNO MIITIBECTION 7000)OF DfVI510N�OF TIIE BUS�NESS MU PNb 'V' PooUSpa
fESSpNS CODq OR THA7 HE OR SHE IS IXEMPT TMEAEFROM ANO THE BASIS WR THE ILLLEOEO IXEMP-
TION.ANYVIDlATi0NOF8ECT10P/7091.6BYANYAPPLICANTFORAPERMIT8U8JECT5THEAPPLICAHTTO Z Re-Root
� A CML PENIVLiY OF NO7 MORE 71U�V FNE NUMORED OOLLM9(i5oo�.y .,
�4u0N�NEROFIMEPROPER7Y,OHMYB+IPIAYEESWITTIWAOESASTHEIRSOLEpOMPENSATqN, Q Cammerclel
WIl1 p0 TME WORI(AN�TME STNUCiLRE IS NDT NRENDED OR OFFEREU FOR SALE(9EC.TWt,BU51- J
� NESS AND PiWFESS10N5 CODE:INE CONiRACTdtS UCENSE lAW DOES NOT APPLV TO AN dMNER OF =
pROPER7Y MM1iO BULDBOR IMPROVES 1MEREON.AND WI10 DOE3 9UCH MAORY(NIMSELF OR HERSELFOR
� 711i10110HNISORHEHOWNEYPIAVEES.PIIOVIDEDTHATBUCNIMPROVEMENTBMENOTIM6NUE00R m '
OFFEREDPoRBALEIF,YIDWEYER7MEBUIIWNOORNIPFIOVEMENI'19" �WItriNONEVEAAOFCOAAPLE
TION,iHE OWNEIi�&1MER WILLlNVE 7NE WRDEN OF PROVWO THAT HE OH&HE DIO NOT BUIID OR
,f MPHOVE Pofl THE PURVOSE OF BALEJ. .
� OI.ASONRIEROFTHEPROPERTV,AYEXCLUSNELYCONTRACTMaWITMLICENSEUCON7RACfOi1S
10 OONSiRUCTTHE VROUECT(6EC.TOM.BUSINESS MA PROFESSIONS OODE:THE CONTRACTOR9 ll- V8W8tbR ADJ.AREA
CEN5E UW DOES NDT APPLYTO AN OIM�ER OF A PROPERTV NRIO BUMDS OR IMPROVES THEREON.AND
WIiOCONfMCTBWHlUCMiR0.1ECTSIMTMACOIJTRACTOR(S)IICENSmPURSUANfTOTNECOWTRAP QUAfJTITY OESCRIPTION FEE
� TdiSIJCENSE WY.�.
O I AM IXEMPf UlDER SEG B.l P.C.FOR THIS REASON �
U
V' OATE ONMER � �
� LICENSED CONTRACTORS DECLARATION �
� I NEREBY AFFIRM UNDEp PENALTY OF PE0.NIRY 1HAT 1 AM UCENSED UNUER PHOVISIONS OF CHAPTEfl � ' ', �.
s i(CqAMENGNKi WITH SECT%1N 77a0)OF DMSION 9 0F TlfE BU8 W E9S ANO PROFE9510N5 COOE,AND Z
X MY LICEH6E 6 N FUl FORCE M1D EFFECr. m i ►
LL! J (`�// �
�
� LICENSE CLASS �_UC.NO. .. �a w J
� UAIE CONTRRCTOR � /X II� a.
WORKERS'COMPENSATION DECLARATION ,�►K • �
N IMEqEBVAFFlRMUNDERPENALTVOFFE0.1UIiYONEOFTHEiOLLOWWGDECLARATIONS: U
f� Q
� _IINVEANDYYILLMAMTNNACEHTIFlGATEOFCONSENT109ELF�INSUREFORWORKERS' _
COYPENS1iTION,AS PROVIUED 9Y SECTION 97000F 7HE LABON O00E,FOR THE PEFFORMANCE �U
OF TiE MIORK FOA VMICFI TNI9 PERMIT IS IS3UE�. �
d
Q �1 HAVE ANO N7LL MAIMAM WORKERS'COMPENSATIDN INSURANCE.AS REOUIRED BV 8ECrION
�97000F TNE LABON COOE.FOR 1NE PERFORMIINCE OF Tl1E WORN FOR WIiICHTFll3 PERMR IS
� ISSUED.MY ERS'rc�VENSA NSURIW RRIERANDPOLICYNUMBERIIRE: CONSTRUCTION
� c�aweA �I�1SM ��I L �• PLAN REVIEW
� POLICYNUMBEH AIi�,T��oPn��nV ELECTAIC
� (nseEcnonir�NorBEoa�ErmoFnf�a.rt�sronor+Etitaaf�ooqlu�sR+m)oa�ry PWMBING � �
Z 1 CE1i71FY TFI�T N THE PERFORMANCE OF THE WORK FOR WH�CH TNIS VERAIIT IS ISSUED,I MEGHANICAL
(� 9HALL NOT EMPLOV ANV PERSON N ANV YANNER 50 AS i0 BECq.IE S TO 7HE
� WORKER6'CWAPENSATIONUWSOFCALIFORNI�,ANDAGREETHATIFI UULOBECOME INSPEGTIONFEE
5 ffi1BJECTTOTHEWORKEAS'COUIPENSATIONPROVISIONSOF6ECT 00 1TIELABOR
OODE.I SNiYJ.FORTNWYfM COMPLY WI E P�� ISSUANCE r
� / SMIP
p DATF���APPLICANT y/ .
WqRNMO:FNLUH[TOSEGURE WOFiKER9'COMPENSATION CAVERAOE IS UNUWFUL,AND SFLILLBE ENERGY P!C
� BUBJECTANEMPLOYERTOCRIMINALPENAlT1E5M1DG1YILfINESUPTOONEHUNDREDTFIW6AND ENERGYPERMIT ; ��
�, OOLLARS�t700,000J.MIW01710NTOT11ECO5iOFCOMPENSAiqN,OAMAGE5A5P1iOVIDEDFOhIN
��,; BECTpN Y/o!OF 7NE LABOA OODE,IN7EREST,AND ATTOHNEYB FEES. RETENTION FEE:
p. CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O
� INEREBYAFFIRMUNDERPENALiYOFPERJl1RYTMATTqERE19+tCONSTRUCTIONLENDINOAOENCY
FOR iHE PERFORM/WCE OF TNE WORK Wfl WH�GM TMIS YERNI715135UE0(SEG.30D1.qY.G�.
� LENDER'S W1ME �
�s IENDER'S:10DRE38 �� f
"� ICEfITIFYhIATIM�YEREADTHISAPPLICATIONANUSTATE7M11TT1EA80VE1NFORMAT�DN�SCORRECT. TOTAL FEES
� IAUflEETOCOMPLYN7TH11LlCIfYANDWUNfYOFiDINlWCESMq6TA7EUWSXELATNa1DBULDINa
CO�LS7RUCTION,AND XEREeY AUh10RIZE iIEPRESEMATNES OF THIS COUN7Y TO EMER UPoN TFE
S� ABOVE•MEIY�IONED PpOPEFTY FOR WSPECf10N Pl/RPOSES. COMMENTS
9 ��� ����
� PERMITTEE (PRMfI) r
N -''�"9► I �,f r_ i,., r/ , i ,
y iNiNAN ERIAITfEE DhTE -[�l �
� RECPI:NO. PAID BY VALIDATION
WHITE—Departmen�Copy.7ELLOW--FM�ance COCy.PINK—A�sassa Copy,GOLDENROPfIe Ca{ry,GREEN—#pplicenYs Copy
CITY OF DIAhROND B/�►R �
` ' � ' ' INSPECTiON RECQRD � � . �
i E � ■ E ■ . � ! � ' � '
5ET BACK FLOOR JOIST'� ��. } , ', .
FTGS/FORMS/STEEL FNA REQMTS :
ELECTRtG GROUND. UNDER FLOOR DUC7 ' �
GROUND PLUMBING UNDER FLOQR COM�UIT • '
SLAB GRADE FIF�EPL'ACE'FO �NDATION -
TEMP POWER FIpEPLAC�BONDBEAM � ' ' " '
WATER SERVICE MID HL BON��EAM ' • -
RDOF SHEATHING $FT.BOND BEAM � �� � � �
FRAMINGNENTILIATION FINAL BOND BEAM
ROO�COVER : PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBtNG FINISf-I GRADING .
SHOWERlTUB TEST POOL ELECTRIC r ^
EXT. LATH/SIDING I � PC?OL FENCING
WALL INSULATION ( POOL FINAL
CEiLING INSULATION ! i OFF SITE IMPS.
QRYWALL NAILING ' i ( DEDICATIONS
SEWER ; I FINAL ENG.
SEPTICTANK. � � LANDSCAPE/IRRIG.
SEEP PIT/L.L. � ON SITE fMPS.
GAS RIR TEST FINAL ZONtNG
FINAL COIVST. � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL �
FiNAL ELECTRIC � ' DEV. FEES PAID
FINAL PLUPABING z � ENERGY
, . �
�- a� • .
�O(VIE��lEIVTS � ,
. _ _. . ..
i
4
` _ ....
SEPTIC TANK SIZE ���'W ' �2
SEEP P!T/U SIZE .,... : .....,...... �.... .... .....
'
,'�,,
� ,
, , -
• y �t
' . . . � . _ . . � ' .