HomeMy WebLinkAbout12038 (13) , , � � �,P,�t,,,,, �,�R
� _ CITY OF DIAMOND BAx P
DEPARTMENT OF COMMCnYITY 8c DEVELOPMENT SERVICES
� . 21660 E.Copley Drive Suitc 190 '
(909)86Q3195 Fax(909)861-3117 PR ESS
��^'�f BUII.DING PERMIT APPLICATION FIRMLY
JOBSITE rsOO� �JKb N � PER T� 7J)� P1C
� APPUCATION / ..
a ADDRESS__ �� r� y C:� r�" �
o DATE N�gE /"v
� ISSUE TYPE p(x
APN L T TRACT DATE CONST. OROUP
� OWNER h rd eELi 'C
8 ADDRESS . ZONING SETBACKS
CfTY e a ZIP �- • TEL �+� FRONT qyy p
� APPLICANT TEL � � SIDE/SIQE STREET qW ❑
� CONTRACTOR ev�. SIDE p
ADDRESS
g CITY ZIP t- TE �O p PROPOSED USE
w ARCH/ENG!
� DE5IGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
d OWNER•BUILDER DECLARATION SFRlADD/REM
O
1 NEREBY AFFliqI IAJ�ER PENALTY OF PER.KIHY T/AT I NA EXEMPT FqOM TNE CONTRACTORB LI- G8f8QfiJG8ry0R
CENSEIAWFOqTiIEFOLLOWINOREASON�BEG70s1.68l/SINESSANDPROFFSSqNSCOOE:ANYCITYpR (n
OOtMiYYYHKXiREONRE9AFERMRTOCON97RUCT,ALTEIiIMPROVE,DEMOLISH,ORREPMqANVSiRUC- W PeSlp/D6Ck
111NE.PRIDR 70 TfS I65UAqGE,ALSO REGUIqES iME AP%ICANf FOq BUCM PEtiM1T TO PILE A&ONED � ' '
STATEMENf 7lU7 ME OR 9HE IS LICENSED P7JRSUM7f TD TME PROYISIONS OF THE CONiMCTORS LI•
CENSE U1W(GTUPfER i(CqAMENCINO WfTH BECTION 700�)OF DMSION 9 OF THE BUSINESS MID PRO- LL' PO�USp9
FESSIONS CODEj OR 1Ti�T HE OR 9HE IS EXEMPT TNEREFRdA ANO THE 811515 iOR THEALLEOE�EYEl/0• (�
TION.ANYVIOLATIONOFSECTION7W1.6BYANYMGIICANTFORAPERYITSUBJECTSTHFAGPLICANTIO Z Re-Roof
� ACMLOENALTYOFNOTMORETMMlFNEMUNDNEDDOWIRS��SW}l: "
01A60'MIEROFTFIEPROPEqTV,ORMVEMPLOYEESNA7HWAOESA5hIE1H50LECOMPEN3ATIDN, CORIRIB�d81
WLLL 001HE M/OHK AND THE STRUCTURE 19 NOT IHfENDED OR OFFEHED FOR BILLE(9EC.70«,BU51- �
NESS AND PROFESSpN3 COGE:T1E OOMfRACfORS LICENSE lAW OOES NO7 APPLY i0 AN pWNER� j
� PiqPENiYMl110&11D5IX11MPROVESTNEHEC7N,ANDNMO00ESSUCMWORKHIMSELFORHERSELFOR
� TNi10UGH NISOR NER OVYN BdPLOYFES.PFONDEO THAT M1C1i IMPROVEMENTS ARE NOT RITENDED Oi1 m
OFFERED POit6ALE IF.110WEYERTHE BUlDIN00R IMPpOVEMBIT IS SOLD WIiHIN ONE YEAR OFD�MD�E•
lqN.iNE OWNER�8IkL0ER WILL 1MVE THE BLIRDEN OF PqOVINO THAT NE OR BHE 010 NOT BU1lD 6R
NdPROHF FOqTNE NRPOSE OF SALEj.
y� OI,ASONMEROFTMEPROPERIV,AME%CU181VE1VC01lTRACTMaWITF1�ICENSEDCONTMCTOqS
� TO OON6TRUCTTTIE PROIECT(BEC.7aM,BUSINE55 AND PAOFESSIONS COOE:THE CONTRAGTOR9 U• V91U6110fl �p�,ppEp
CENSE UW ODES NOTMPLYTO AN ONRiER OF A PROPER7Y WI10 OURDS Ofl NAPNOVES THEREON.AND
101tsLICEN6EUW.1�. $�P�ECfSWfTHACOHfR11C7pR(5)LICENSEDPURBUMITTOTHECON'fMG QUAIYTITY DESCRIPTION �E
� O I AIA EXEMPT UNDER BEC. B.�P.G FOR TYHS REA60N a
U
� �
o�re owNeR
�6 LICENSED CONTRACTORS DECIARATION W �
S I MEREBY AFFIRM IXiDEH PENALTY Of PERXIRY 7HAT IAM LICENSED UNDER PROVISqN3 OF CHAPTEA
� �1COYIAENCWfiW7THSECTqN7000)OFDIYISION70FTHEBUSINESSAN�PR�FESSIONSCdDE.ANO Z �
�V W UCENSE B N EU.L FORCE AND EFFECT. m
0 UCENSE CLASS �LIC.N0. o�'" jJ
� DATE CONTRACTOR M� 6.
WORKERS'COMPENSATION DECLARATION ��' a
� IHEHEBYAFFIRMUNOERPEN�LTYOFPERA/RVONEOF?HEFOLLAWINOOECLAqATqN3: Z �
� _IHAVEANDWILLYMMAINACERfIRCATEOFCON5ENT1D8ELF-INSUREFORWORKERS' _
O04PENSATION,A9 OpDVIDED BY BECTION 77uo OF 7NE LABOR COOE.FOR THE PERFORMMICE U
Q OF 1NE YVORN FOR VMIq11XIS PERMI718155UE0. �
� _INAVEANDWILLMAIN�ANWOf�CER3'COMPENSA710NINSUFi11NCE,ASNEWIREDBYSECTION
0 l700 OFTHE LABOR OOOE.FORTHE PERFORAIANCE OF iHE WORN FOR WH�VI TXIS OERMITIS
� LSSUED.MYKORN��E+RS�'COA/PENSATION INSURANCE CAR-R�IE"R M1D POL�CY NUMBERME: CANSTRUCTION
17T��deY1 �Q I!_� yciS. PLAN REVIEW
g POIICYEMUMBER._�IAIC ��(�,-;oa ELECTRIC
�
�j In+s�+���eeox�m�EhnOFnE�ra.rrswaa+eM�r+Drmaa�tsls�aolw�sSR PLUMBING l
z I CERTIFY 7Ha71N THE PEqFORMANCE Of THE WdiK WR wH1CH TFi15 PERMIT W ISSUEO,I MECHANICAL
6HALL NOT EMPLOY ANY OERSON IN ANY NANNER SO AS TO BECOME 6lB.lE O THE
(q WOHKE115'COMPENSATION LAWS OF GALIFORNIA,ANDAOREE TIMT IF 16 0 BECOME INSPECTION FEE
S 8UBJECT T07HE WOHKERS'OOMPENSATION PROVISIONS OF SECTION F 7HE LA80R
CU�E,I6HALL FO TH QOMPLY 'E PR I S. ISSUANCE 1'
�
p DATE•.��� APPIICAMi: SMIP
� ENERGY P/C
WAFW INO:FMUR[TO SECURE NORKERS'OOMPENSATION COYERI1CiE IS UNUWFUL,AND SNALL BE
�y BUBJECTAf/EMPIAYERTOGiHANN.PENALTIESMI�CM�FINE5UP700NEMWDREDTHWSAND ENERGYPERMIT
Y DOlLAR81i1 W.OW1,IN ADDRION TO TFIE COST OF COMPENSATION.DAMA(iE5 AS GROVI�ED FOR IN
� SECTION370lOF7HELABORWDE,WTEREST,ANOAlTOqNEM5FEE5. RETENTIONFEE: ��f "
g. CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
� �
1 FiEpEBYAFFIRM UNDER PENAITY OF PERAIRY 7HATTHERE IS ACONSTRUCTION LENDINO AGENCY
Z FORT/IE iERFORIAANCE OF7HE NPDFtl(FOH NMIpI71iIS GERMITiS ISSUEO(SEC.90i7,dV.C.�.
117
�T LBOERSNMIE
3
C LENOER'SADORESS
� 1 CERTIFY iMAT I NAVE READ THIS MPLICATION�MJ STATE THAT THE ABOYE NFORNA710N IS COpqECT. TOTAL FE ES \�
d I A6REE TO COM%.Y WITH ALL qTY AND COUNTV OR0INANCE3 AND BTATE UWS RELA7N6 TO BURDINO
� CONSTWICTIOk/ND MEAEBY AUM1IORIZE REPRESENTATIVES OF THIS COUtJTY TO EMER UPON 7HE
ABOYEd1ENT10Nm PROPER7Y FON WSPECTION PURPO6ES. L'QMMENTS �
� � ,rrl A-• h'1�1 �
� �� E�o � �'�
�
� SNiIUiIM OF PERMITiEE ATE � � .
RECPT.NO. PAID BY _VALIDAl10t3
WHITE--Oapahment Copy,VELLOW—Finance Copy,PINIf�Asaessor Copy,dOLDENROD--FIIe Copy,GREEI�ApplkanYe Cqry
.�.�. -- - — —. -----------
CITY t�F DIANlONQ BAR
IPJSPECTfOt� RECORD
� � � • E ' ' ! � � • 6 '
SET BACK �. ' . FLQOR JOIST �,. ! ;
FTGS/FORMS/STEEL i FHA REflMTS -
EtECTR.tC GROUND UNDER FLOOR DUGT ,
GROUNp PLUMBING UNDER FL�OR CU�IDUIT•`:__. �
SLAB GRADE FlREPLACE FOUNDA�ION •• ' `-
TEMP POWER FiREPLACE BdIVD BEAM � '' "
WATER SERVICE Mip HT. BOND BEAM - -
ROOF SHEATHING 8 FL BOND BEAM . �� ��
FRAMINGNENTILIATION ! FINAL BOND BEAM
ROOF COVER. PRE-GRAOING
ROUGH HEATING BENCH4NG �
ROUGH ELECTRIC R�UGH GRADING
ROUGH PLUMB[NG FINISH GRADING
SHOWERITUB TEST � POOL ELECTRIC
EXT. LATH/51DING POOL FENCWG
WALL IIVSULATIQN POOL FINAL �
CEILING INSULATION � OFF SITE IMPS.
DRYWALL NAILfNG DEDICATIONS
S�WER .. � P — FINAL ENG,
SEP71C TANK � LANDSCAPE/IRRIG. �
SEEP PIT�LL. , ON SITE IMPS. ^
GA5 AIR TEST j ! FINAL ZONING �
FiNAL CONST, i. FIRE DEPT. FINAL ! ��—I
FiNAL HEATiNG i � HEALTH DEPT. FINAL I
FINAL ELECTpIC ' � DEV. FEES PAID j
FINAL PLUMBING j � i ENERGY
� '
� �' � a -_
COMMENTS
� ; - - -
'.
. �, . ,_ .
SEPTIC TANK SIZE �.
-r--,—::,.:_
SEEP PIT/U SlZE�,T��_�-- +•�
!I �', ..._, �
. ,� . , . _ � �
• �.,