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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 S-IrtriCr4--75 BUILDING PERMIT APPLICATION
PRESS
JOBSITE t?/ 1 0 .
ADDRESS -.-Op., iii OA1 ki 1 ,,,,if4,1 C2-1-
APN LOT 4.TRACT o-2-"2-k7
OWNER PUL,?t__..0 MES
ADDRESS J804 VON IcA'R MEN STE. 200
CITY---I-R-V---I-NE---zIP916'12 TEL. 949 797 4
APPLICANT TEL
CONTRACTOR
_„S,A,VIE
ADDRESS
CITY ZIP TEL
ARCH/ENG/, ;., ,,< "--• R A ,
DESIGNER /4litit..-r—61?-6:71.) .41----fi...,--_--, oel,-
ADDRESS
MY F,Ii, i" 1 'T •• •4
SANTA ANA 92705 714 550-97
0 ER-BUJ EFI DECLARATION
I HEREBY AFFIRM UNDER P OF ERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING' • • EC. 7031.5 BUSINESS AND PROFESSIONS OODE:ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT• * STRUCT,ALTER,IMPROVE,DEMOUSH,OR REPAIR ANY STRUC-
TURE. PRIOR TO ITS ISSUANCE,ALSO••IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT TIYEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(M).).
O1,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION,
Imu. DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUM-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
,OFFERED FORSALE IF,HOWEVER.THE BUILDING OR IMPROVEMENT'S SOLDWITH/NONE YEAR OF COMPLE-
TION.THE OWNER-BUILDER WILL HAVENS BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
DL AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC,7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
0 lAM EXEMPT UNDER SEC. B a F.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISIONS OF TOE BUSINESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
' LICENSE CLASS LIC NO
517.3
DATE A CONTRACTOR 9
EXP.9-30-03 PULTE HOMES
WORKERS'COMPENSATION DECLARATION
, I HE EBVAFFIFIM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'
, COMPENSATION.AG PROVIDED BY SECTlON 3700 OF THE LABOR CODE. FOR THE PERFORMANCE
(OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
,911„IHAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION
3700 Of THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE.
CARRIER PACTETC EMPLOYER TNS CO
PMICY NUNI"R
-WORL43011874 EXP. .0-0.
(THISSECTIONNEEDNOT BECOMPLETED°FRE PERIAT IS FOR ONE HUNDREDCOUARS($100)OR L ).
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CC)/S—tOtf— H COMPLY WITH THOSE PROVISIONS_
) ,I
PULTE HOMES
DATE: ICANT:
I
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE
- SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($100.000),IN ADDITION TONE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
3
CONSTRUCTlON LENDING AGENCY
,7.
- 1 HERESY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
I- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3007,civ. C)
NONE(PULTE)
C LENDERS NAME
- LENDER'S ADDRESS
IS
C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1.1
L 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.
3
_ JERRY/HAINES
5
cl PERMITTEE NAME(PRINT)/
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,r) SIGNATURE&PERMITT DATE
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APPLICATION49-c9/0
DATE
I PERMIT N EI (L3 P,col (91.0_,
NUMBER ! i ... " #
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
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0
SIDE/SIDE STREET RW 0
0
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UNITS
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STORIES BEDROOMS
7 DESCRIPTION S0. FT FACTOR PSF ADJ.AREANALUATION
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WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy, e Copy,GREEN-Applicant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
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LECTRIC GROUND , UNDER FLOOR DUCT
ROUND PLUMBING-(-0 A r,,... UNDER FLOOR CONDUIT
LAB GRADE ifr/ 0 FIREPLACE FOUNDATION
EMP POWER FIREPLACE BOND BEAM
VATER SERVICE MID HT. BOND BEAM
t00F SHEATHING ,ar1.40."111 8 FT. BOND BEAM
'RAMINGNENTILIATION ^Or-" FINAL BOND BEAM ..
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100F COVER PRE-GRADING ,
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lOUGH PLUMBING 1. I FINISH GRADING
POOL ELECTRIC
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VALI INSULATION
:;EILING INSULATION OFF SITE IMPS.
)RYWALL NAILING DEDICATIONS
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SEWER
SEPTIC TANK LANDSCAPEARRIG.
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:INAL PLUMBING • 1 ENERGY
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