HomeMy WebLinkAbout12407 CITY OF DIAMOND BA& �
--- — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/
21660 E.Copley prive Suicc 190 �
�, (909)660-3195 Fax(909)861-3117 PRESS
��. BUILDING PERMIT AFPLICATION �' FIRMLY
JOBSITE �--� APPLICATtOM1i) �j PERMR P/C
o ADDRESS %S�Z� T1�C3 Y C��rilE'.R� DATE L��'� ! NUMBER � � M
� APN lOT�_L- T ACT �� p TEE CONST. GROUP
� OWNER 1
ADDRE ZONING SETBACKS
CITY ZIP TEL.Z,/�/-S�/G '"' �O�'�T RW ❑
APPLICANT �L.�/�/ REAA ❑
SIDFJSIdE S7REEf RW ❑
CONTRACTOR tr 61DE ❑
p� ADDRESS t < '
� CITY ZIP�TEL. ' - 7,� ' PROPOSED USE
� ARCH/ENG!
DESIGNER NO.DWEL. NO. NO.
ADDfiESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� OESCRIPTION SQ.Ff: FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFWADDIREM
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1 HEREBY AFFIRN UNDER PENALTV OF PEFWRY hIAT t A1A IXEMCT FROM THE CONTMCTORS U- ��g�s�h
CENSElAWfORTMEFOLLOINRIOPEAS�N(SEG.7031.6BUSM1E95AN�PROFESSIONSCODEANYCRVOR (/)
p01RlfYYYiCCNpEOUIpESAVEqMRTOCON3TRUCT,ALTERIMPROVE.�EMOLISH,ORFiECAIRANY8TRl1G W pa��dpeck
1URE,PRqR TO ITi ISSUANCE,ALSO REOUIRES THE AP0.IGNT FOR BUCH PENMIT TO FILE A WONED
BTATFJAENT 111A7 ME OR SNE IS LICENSFD PUfiSUANT 701HE PROVISIONS OF TXE WIJ7RIVCTORS LI•
CENSE Wk(CHAPTER 0(COMMENGNO YNTH 9ECTION 7a00�OF DIVISION f OF TV1E lUSMESS MA PRP V" POOVSp9
FES510N5 CODE)ORTINTNE OR&1E IS EXEMPTTFIENEFROM AND iT1E 6A313 FOR TNE ALLEOED IXEMP•
iDN,ANYNOLATI0NOF6ECTION70]7.6BYANYAPPLIC�NTFORAGERMIi&161EC79THEAPPLMdNT7D � pe.qaoi
� �CML PEN�LIY OF NOT MOAE THMI FNE MINDREO DOLURS(6600).): . . . � ..
❑I.ASOYrtiEFOFTMEPHOPEA7I.ORMVEMPLOYEE9WITHWROESASTHE1R50LE00MPEN5ATION, CanT6�C181
YYILL 00 TFiE WOHK,M7D TFiE 6TRUCNRE 19 NOT 1NTEN�ED Oi1 OFFENED iOR SALE ISEC.7W�,BUSI-
NESS AND PROFESSIONS ODDE:7HE COHfRACTORS LKENSE Uw DOES NOT APPLY i0 AN OWNER OF
y VROPERiYMM1iOBULLO6ORNAPilOVE87HEREON.ANDWNO�OESSUqiWOf1KMIMSELFORNERSELFOP �
� flYqIMF1 MS OR 1£R ONM E4IPLOYEEB,PROVIDED TNAT BUCH MPAOVEMENTf�RE NOT MTENOED OH �m
OFFERED FOR SALE F,11frNEVEiIiMF&IRDINO Oq WiROYEMBJTD BOLDNITIIINONEYEAqOi CONPI.E-
i1DN,TME OWNER&11lDER WILL MAVE 1TIE W ROEN OF iROVINO h1AT ME OR SFiE DID NOT BUYLD OR
I►IPROVE FOR THE RIRPO"..E OF BN-El.
O 4 AS ON�NEN OF iHE VFiOPERfY.AM EXCLU9IVELY CONfMCTIN(f NTTM LICENSED CON�R�LTORS
� TOOpNSTpUCTTXE PiiOJECT(8EC.704t,BUSINESS IWD PROFE5910N5 CODE:TNE CONTIiAC70F5 LI- Velu9�lOn AQI.AREA
CENSE UW DOEe NOTAGPLV TO AN ONMER OF A PHOpERN WFiD BUILDB OR NIPROVES 7HEREON,ANp
NM1IOODNTMCTSFOHSUCFI►RQIECTSWITMACON�RACTOR(5)LICEMSEDWRSUN�RTOTNECaNTMG pUANTITI OESCRIPTION FEE
� 701t6110ENSE WN.).
O I A1A 6XFYM UNDER SEC. 8.�V.C.FOH THIS REA60N �
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��[ LICENSED CONTRACTORS DECLARATION W
2 IMEREBYAFF1161UN�EpPENALTYOFPEiWRYTXAT1lIMlICENSEDUNDEH7fiOVI510N50FCHAPTER �
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��� IlY LICENSE 16 M FUIL FOFICE AND EFFECT. �
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� 'D�YF� � �`��CONTRAGTOR / � �'SLL� d
WORKERS'COMPENSATION DECLARATION � .�� —��
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� IHEREBYAFFPMIUHDERPENKTYOFPElWRYONEOFTHEWLIOWINf3DEClMATqNS:
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� �IFMVEANDWIL4MA�NTAINACERfIFlCATEOFOONSEMTOBE�F-INSUREFORWORKERS' _ ��. ��
O04PENSATIDN.AS PFiOV1UED BY SEC710N 5700 OF 7HE LAB�R WDE,FOR 7HE PERFORMANCE U
OF7MEVYORKFORYlHIq1TNI6PEAMIT1818SUEO. � � ��
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�1 HAVE AND WIL4 MAINfAIN N�ORKERS'COMPENSATION RISURANCE,!1S REWIRE�BY SECTION
� 9fo00F1XEUBORCODE.FOHTMEPERFOIiMNCEOFiHEWORKFOHWMICMT711SPERMRIS
� ISSU�.MY WORKERS'COMPENBATpN INSUMNCE CARRIER A!D POIICYNUMBER ME CONSTNUCTION
? c,waiea f �t1TIf1g'C.._ PLAN REVIEW
� POLIC�'MN.�Ep .�T_�/���-c��� ELECTRIC
0 �nSSEcnoNr�rar�oo�rmoFn�rErwarpwr+or+e�nr+moa+�ns6+�lIX+�ss4 PLUMBING
Z 1 CEHTFY 7W1T Ml THE PERFORMANCE OF TI1E WORK FOH WHiCN iFil9 PERNI715155UED,I MECHANICAL �
� BHAI.LNOT EMPIAYANY PERSON INANY AIANHER SOAS TO BEC E 9UBJECTT0711E
� YYORKER9'COLIPENSATqNUW50FG�ll IA,ANOAOq j18�1L�BECOME �NSPECTIONFEE
S SUBJECT707HEWORKERS'COMP N OVi519y [Jr1 0¢OQTHFU,�pR _ .
cooe,i sw�u roanav�ni IN1 era6 /-[f�i��T�� ISSUANCE �
� SMIP
p CATE: 9/� RP �cAM:
� ENERGY P/C
WARNINO:FhIIUHETO SECURE WOHKERS' P A ERAOE IS IlhLA4YFUl.ANO SHALL BE
� 8U&IECTANEMiLOVEHTOCRMqNALPENAL ANO WESUPTOONEHUNDREDTFiOUSAND ENERGYPERMIT
�OLLMS(f IOD.000�.IN ADDI710N TO TNE COST OF COMVENSATION,�MV10ES AS PROViDED WR IN
� SECTIDN970BOFT7ELABOROOOE,NI7ERESL/J1DATiDqNEYBFEES. RETENT�ONFEE: "
� CONSTRUCTION LENDING AGENCY PHE-ALT FEE: '� "q�
1 HEREBv AFFIRM UNDEN PENALTY OF PERIUIIY 7HAi iNEAE IS A CONSTRUCTION LENDINO ilfiENCY
FOR TNE iERFORMANCE OF THE YYORK FOR MMIGI 7NIS VERMIT IS ISSUED(SEC.3oW,CIV.CJ.
� LENDERBNMIE � ��✓�
� �ENOER'SADDRESS �V/ �K
� ICERTIFYTMTIHAVEREADTHISAPPLICAiIONMIOSTATET}�RTHEABOYENFNWATpNISCORREM TOTAL FEES /��• L ` '
I A(iPEE TO COMPLY M7TM IILL CRY AND COUNTY ORDIW W CES AN�8TI1TE LAVfS REU71N0 TO BU0.DING
CONSTAUCTION,AND HEREBY AUiHOFiRE REGRESEMITIVES OF THIS COl1NTY TO ENfER UPON THE
S� I180VEdAENTqN�PROPEHiYFORWSPECTIONPURPO3E9. COMMENTS
�,�, � /' �
6 PENMITTEE (PWNn �
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� SWNATUREOFVE .
� RECPT.NO. PAID BY 1/JW�ATION� �
I7E--0apartmsnt Copy.YELLOri�tisnce Cop�.PINK—Asssasm Copy.(iOIDENROD--File Copy.OREEN—Applicanl'a Copy
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• CITY OF DIANEOND B�►R
INSPECTiON RECORD :
:" t . ` , ! ■ • . ! 1 i S �
SET BACK '' FLOOR JOIST� -, "
FfGS/FORMS/STEEL FHR REQMTS
E�ECTRIC GROUND. UNDER FLOORUUCT� � ' :
GROUND P�UMBING UNDER FLU�R•CU�IQIJIT, _ . _ _ '
SLAB GRADE FtREPLACE FOUNDATION� -- � - -� - � -` �
TEMP POWER FIREPLACE�OND BEAM. - � � ,
WATER SERVICE MID HT.BOND BE74M � � • • ` -
ROOF SNEATHING 8 FT.BOND SEAM . t _
FRAMINGNENTILIATION FINAL BOND BEAM �
ROOF COVER ! FRE-GRADING
ROUGH HEATING i � � ' BENCHING '
ROUGN ELEGTRiC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING �
SHOWER(TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING �
WALL INSULATIC?N POOL FINAL
CEILING INSULATIDN j OFF SITE IMPS.
DRYWALL NAIUNG DEDICATIOIVS !
SEWER � FINAL ENG. '
SEP7tC TANK i LANDSCAPEIIRRIG.
SEEP PIT/LL. ! ON SITE iMPS.
{'.aAS AIR TEST i � � FINAL ZONING � i
FINAL CONST: I I I FIRE DEPT. FlNAL j !
FINAL HEATING � -' I i HEALTH DEPT. FINAL
FINAL ELECTRIC j DEV. FEES PAID _ �
FINAL PLUMBING � ' j ENERGY __
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COMMEf�!TS �� -- � ' ' ,�' ,`
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SEPTI�TANK SIZE
SEEP PIT/U SIZE,,,! ^
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