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Home My WebLink About15537 - 22939 RIDGELINE RDAV ` CITY OF DIAMOND BAR \ DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)960-3195 Fax (909) 861-3117 PRESS BUQAING PERMIT APPLICATION _ FIRMLY JOBSITE ADDRESS PPN LOT TRACT OWNER -MlYCII. 410tV ADDRESS ZZ Z !? " CITY P" o.•� C� ZIPS % TEL. � .� (1PPUCANT I ii-92 �a 1A- BLSC TEL2 CONTRACTORClIj- ��L K•l 1a._ % M1 ADDRESS A VIE CITY ,[�:A P h i iv S ZIP 9/! !a TEL C W ARCENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THEFOLLOWING REASON(SEC. 7081.6 eUS W ESSAND PROFESSIONS CODE: ANY CITY OR COUNTYNHKYI REONRESA PERMITTO CONSTRUCT,ALTER, IMPROVE. DEMOUSH.OR REPAIRANY STRUC• TORE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE N LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL CENSE LAW (CHAPTER 8 (COMMENCING WITH SECTION TODD) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7051.E BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS WWI* O LAS OMER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK, AND THE STRUCTURE S NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, 111 NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BLA DS OR IMPROVES THEREON, AND W 40 DOES SUCH WORK HIMSELFOR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THATSUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED PORSALE F. HOWEVEILTHE BUILDING OR IMPROVEMENT IS SXD WITHIN ONE YEAROFCOMPLE- TOM. THE OWNER$UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 704/. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LL CENSE LAW DOES NOTAPPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. a. A P.C. FOR THIS REASON DATE OWNER I LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 A.1 LICENSED UNDER PROVISIONS OF CHAPTER 8 (COMMENCING WITH SECTION 70DO) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE �ANjD EFFECT. LICENSE CLASS 6 14I C- LIC. NO. DATE — ? DQ,I CONTRACTOR L"'r-g ('1+y,_� WORKERS'COMPENSATIONDECLAR//ATION 1 HERESY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATKNGS: 1 i FNVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE THE WORK FOR WHICH THIS PERMIT 18ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY AS' PE TION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER �G-k— POLICY mAABER �'� 1• (THSBECTi7tI NEEDNOr BECCMPLETEDOFTHE PERMIT 6 FOR ONE HUNDRED DCUA. OO)ORLESS} I CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL NOT EMPLOY ANY PERSON M ANY MANNER 80AS TO BECOME SUBJECT TO THE WORKERS' OOMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION! 3700 OF THE LABOR CCOF, I SHALL FORTHWITH COMPLY WITH THOSE PROMS OATS: z'z:S APPLICANT: VI WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES LIP TO ONE HUNDRED THOUSAND DOLLARS (SIM.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE W A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, CIV. C). LENDERSADDRESS 1 CERTIFY TWIT 1 WIVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION• AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE•MENTIONED PROPERTY FOR INSPECTION PURPOSES. ha..r 1 & MJ s �- PE! EE NAME (P INfj p SIGNATURE OF PERMITTEE DATE APPLICATION 2� J� PERMIT rJ P!Q� DATE �l.J/ NUMBER 6 ✓/ / / V� ISSUE TYPE OCC DATE CONST. GROUP ZONING SET6ACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSEDUSE LIQQA_ ` 1 (,� J t ' NO�p . UtF/EL. NO. NO. UNITS STORIES_ BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM W Garage/Carport WPatio/Deck LL POOVSpa ZRe -Roof 3 as z Commercial m Valuation Oa J ADJ.AREA QUANTITY DESCRIPTION FEE U W J W a Z U Z Q U W CONSTRUCTION PLAN REVIEW I CTRIC PLUMBINGAI, MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C BtfltDINU [� T�T.AR ENERGY PERMIT U SAFE RETENTION FEE: PRE- T FEE: TOTAL FEES 1 COMMENTS I RECPT. NO. PAID BY VALIDATION Copy. GOLDENROD --File Copy, GREEN —Applicant's Copt/ jV1 I Z.O.. CITY OF DIAMOND BAR INSPECTION RECORD M 'Wk 131WIPM: SET BACK FLOOR JOIST FHA REQMTS FHI___ — -------------- FTGS/FORMS/STE EL ELECTRIC GROUND_ 1 j UNDERFLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOVRqATI(?t4____ TEMP POWER 11 _FIREPbACE'BOt4D BEAM WATER SERVICE MID HT BOND BEAM ROOF SHEATHING 17_�$ •d5p Cu 8 FT. BOND j3EAM FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING I FINISH GRADING SHOWERfTUB TEST r POOL ELECTRIC EXT.. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING j DEDICATIONS SEWER FINAL ENG. SEPTICTANK ------ SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST I -A FINAL ZONING FINAL CIONST. -._.-__-- FINAL HEATING HEAL-firi DEPT. FINAL PLUMBING i ENERGY CONIMENTS . ... ............. SEPTIC TANK SIZE SEEP lPiTl/U SIZE - ---------