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Home My WebLink About16036 (28) CITY OF DIAMOND BAB � - -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 140 t�>s6a-3ivs�a�t��s��-�z x� PRESS �� BUILDING PERMTT APPLICATION FIRMLY o ADDRESS!��S r �� Ut S"� � DATEICATION t.. ��} NU BER t I ^ ., #!C � � �""`' -�� APN LOT TRA�T��i 2�&� �SSUE TYPE OGC �% QATE CON�T GRaUP p OWNE� p ADDRESS��" S.' _` 2�NING SETBACKS � CITY�'�2�,(�ilr� ZIP Q2��'L TEL.�i'r�1?�1`T�f{�' FRONT RW C7 APPLICANT � TEL. REAR ❑ � SIDElSlDE STREET RW Cl GONTRACTOR_ S�dE �-- qG AQDRESS ��.��'T"_—. ""- � CiTY 2IP TEL PROPOSED USE �'`' ' ,�,': � u--� � ARCHJENG! � DESIGNER_ N(�.DWEL. NO. ' ' NO. g ADDRESS�, UNITS STORI BEDRdOMS � ClTY ZH�' - L � DESGRIPTION 5Q.FL FACTOR PSF AOJ.AREANALUATION CI� � dWNER-BUILOER DECIARATIUN SFR/ADD/REM Q i HEREBV AFFIIRM UMDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE WNTRACTORS LI- �a�898JCd(P01I tit C£NSEiAWFORTFtEiOl40WIN4REASdN(SEC.7037.SBUSINESSANOPROFE9SIONSIX7DE:ANYCITYOR (n . C� CIXIMYWHIGNflEQUIflESAPEAlATT4CQ�lSTHUCT.ALTFRtMRNOYG.DERIOItSH,ORREVAIRANYSTRUG W patiolDeck � TUF1E.PRION ip 178 ISSUMlCE.ALSO REIX11RE5 TNE APPLICANT F9R 5UCM?FRMIT 70 fllE A SIGNED W .� SUTEMENT THAT HE pR 5HE IS LICENSEO PUR5UANi TO THE PROVI310N5 UF THE CANTRACTpRS LI• � CEtJ$E(AW(CHAPtEfi Y(CbtdMENCiN6 V.1TH sEG7KKt iWo}OF pIViSIdN 3 OF THE BU5WES5 AN6 PRo- � PooUSpa FESSqNSCO�E)4PTHATHEOHSHEtSE%EMPTTHEAEFfl(MIAMOTNE6ASISFORTNEAL�EGE6E%E{dP- (� TION.ANYVIOLATIONOFSFCTION7tl31.5BYANVAPPLIGANTFORAPERMIT5U8JECTSTHEAPPIICANTTO Z R2-ROOf � XCMLPENATVOFNOTMOflETHANFiVENUNDREU00LLARS(5500).): � ❑l,ASpWNER6FTHEPi�PERiY,ORMYEMPIOYEESXRTHWAGESASTNE7flSOLECdMPENSAT�ON, C�I COf11mOfClal WILL IX7 THE WpFK AND 1'NE STqUCTURE IS Nf7T 1NTENOE�Op OfFEREb FOR SAtE(SfC.7A4a,BUSF �1 NESS AND PFqFESSiGVS GVGE:TNE CANTRACiORS LICENSE UW DOES NOtApPLY TO PN OWNER OF �� PROPERTYNtiDBUKI}SORIMPROVESTHERE4N.ltNDWHODOESSUCHWQRKHIMSELFORMERSELFOq � ('t 'MflOUOM MIS OR HER¢WN EMPl.0YEE5.PRUYIOED LHAT SUCtf MAPROYEMENTS 0.R6 N4T iNTENDW OR � � OFFEREDFOflSILEIf.HOWEVEfi,7NE9UtlDMGORIMPROYEMENT19501DW1THINONEYEAROfCUMtsI.€ Z t10N,THE OWNER�6URAER'MLL NAVE 7HE$URDEN OF PROVING THAT HE OR 9HE DIlS NOT BUILD OR � WPRQI'EFOFtTHEPURPOSE�SALEi. ❑1,AS bMMER�F THE PHOPER7Y,Mf E%CCUSIYEtY COMTRAGTkJC Wi7H tICEN5E6 CONTRACTOFS � TO CONSTRUCT TH8 PR0.1fCT(SEC,1tlls,BUSINESS AND PROFESSIDNS COOE�THE CONTAACTOP,S 1.1- Y8It18IiOR t✓�� AG�.f1flEl1__,,, t�t! CENSEGWD6ESNOT�PPLYTONNOWNEFOFAPROPERTYWHqBUILO50FIMPROVESTHEREON,AND F WFN7WNTAACTSfQRSUCHPf{pJEGTSW117iACONTRACTOR(5}UCENSEDRURSUANTTOTNECONTMG QUANTITY DESCRIP710N FEE � 70RS UCENSE LAW.I� ..._—_..._..� . ' O i Mi EXEMPT UNOEit SEG._.,� ,_,_B.8 P.C.FUil THIS REASON � _, a �'+ DATE OWNER�. . ..._ _ U � J � LICENSED CONTRACTORS OECLAAATION W � i MERE6Y AFF�2M UFWER PEN.5L7Y OF PERJUflV THpT I AM L�CEN5E�VNpER PROViSiONS OF GHAPTEN � q� Y{CqMMENCIN(iWY1NSEC'l9CNJ709tljOFD1VIS10N30fTH£BUStNE55ANOPqOFESStOrvSGODEAND Z X MY UC6NSE 15 W FULL FORCEAND EFFECT, m � �� '" � _ � UCENSE C[ASS LIC.N0. / �� J � DA7E �_'.,,��CONTRACT6R n- W � WORKERS'COMPENSATION DEGLARATI4N a � i HEREB t,FFlRM UN�ER PEFIAITY�F PERJUpV bNE CF THE FOLLOWING�ECLAHATIONS: � � Z C! . �1lfAYE AND WfIL MAINTAIN A CERTIFiCATE OF GONSEMT TO SEtF-INSURE F�R WORKERS' _ � COMPENSATION,AS PR041DEO 9Y SEC710N 37090F THE LASnR COQE,fOP TriE PERfOflMAh�E `U �OFTME WORN FUR WHICH TNIS PERMIT IS ISSUED. � Q W i HAVE M'D NMLl.A+A�NTJUN WOqKER5 CAMPENSATpN�N3UHANCE,AS flECIUIRED BV SFCiION ��-�^�} ��"�;';, � Q31WOFTNEtA80ftCODE,f-0RTHEPERiaRAiANC.E4FTNEWOR%FORWHICHTNISP�pMiTiS ,� 4+ '� ' 7 ��1�.� _ ISSUED.MY KERS'CbMPENSATfON{NSURAMCE C RIEft AN�POIICY NUMBERARF:�/�rt GONSTF3UCTIO _�,'� "��'-� jc+�rsAi[-R�L�'.',p'_�--r�� .�- � f. C..."tirz. PLANREVIEW r'� "�-' •V '�'�. _ J _.-- z aa.icvNUMeEFl �� ' E�EGTRIC � � 6 � g t�SEct�+��wreEo�r.w.srsoqF'n�aEwxr�seoaonEsiut�+EDoainas(E1oNoa�Ess1. PLUMBING _.._.�.� ._._._. � �� .. , � �_'1'� �� I C6RTIFYTHAT INTHE PERFCJRMANGE OF THE WQHK FQR WNICH THIS RERM17 t5lSSUEO.� ��HANIGA� V - ,� . . .. , ._:. C� SHALL NbT EMPIOYANY VEHSIXJ IN ANY MANNER SU AS 10 BECOME SUBJECT Tp THE ��-�`tt � ` `'��""��"��*��4��TM_ � NC?iiKERS'GOMPENSATiOM iAW$QF ChLIFOPNIA.AND AGAEE THAT IF I SNOULD 6ECOME IN PEGTION FE�"�� }-�-- _ SUBJECT T�TMt WQRiCERS'COMPENSATMN!PAOVISiONSOF SECTIQk 9loDOF TriE LAf30R �"t��`��'�..�n � Wl7E,I SHW.I.FOflTHWITN COM7LY WITH NQSE PROVISIONS. sU� ��' -�=—�?S� p bATE:�r-��.ft-tl APPLICANT.�`��-.�— "S _ �C� —...._ � WMNING;FAIWFiETQSEGURF.WUftKEftS'C.OMPENSATIONCAVERApEiSUNUWFltI,ANDBHAlt6E GYP/G "__., _ _ ._ � SUBJECT AM EMPLOVER TO CRIMINAL PENAITIES ANd CIVIL FMES UP TOONE HUNpREp Tli0U5AND ENERGY PERMIT DOLI.ARS(Sio0.600},IN PADITICYN TOTHE COSTOF COMP€NSAiION,DAMAGES AS PROVIDEO FOR IN - � SECTION 3'7G80F THE:A80A tkXtE.WTEREST,AND ATTORNEY'S FEES. ETENTION FEF_: u` .,.� � GONSTRUCTIpN LENpING AC,ENCY pR - FEE: �...-.._. ,—. � O � IHEREBYAFFiRMUN6fHPENALNOFPEflJUHYTHAT7HEREISACONSTRUCTIpNIEN�INGAGENGY . n- FOR TNfi PERFOftMANCE Of THE K iOft Wt11CH TkiS P RMIT 15 iSSit60(SEG.3087,GV.C.j. - Z W ��i�� - � IENpEA'5NAME_ G�� . _ H LENDER'SAbDRESS _ . � ' � tCERTtFYTNATiHAYEAEADTHISAPPLiCA7�ONANDSTATETHATTHEABOYEINFORMAiKKJI5CONRECT. TOTAL FLEJ � �J�� ` �� w 1 A6flEE TO GDMYI'!thTH Ai,t G7Y AMD CAUNTY DRCINANCES MD STATE IAWS RELATtNG TO BUILDING � � -J � CONSTRUCTION,MlpHEREBYP.UTHQRI2EREPpE5ENTATNESOFTNlSCqVtJTY70ENTERUPON7,4E ZA60VE-MENTIONED CIiOPERN FOR INSPEC7 N PURPOSES. COMMENTS� . O �,`�._7� _ _ �f� QPERMITTEE NAME(PFUNT)� . _ .__� Cf) -�'�'�."'{,�.' � S1G UAEOFPERM� �E � �ATE 2 RECPT.NO. } PAID BY �' VALIDATION ~ WHii�--Department Copy,vELLOW—Finence Copy,PiNK—Assessa Gopy.GOLOENROD-�•File Copy,GREEN—ApplicanCs Copy ��"Y4 �� i�� "�� - � � i , � �� w .w,.. � � �,� � €"L��' ��.,��-� � , �_ . .__, _. � __ _ _ _ . _ _ " i� z�S'�'�tC �i"'7,r SF � � '. ' +2.1 r� �^�. .. 3 - i � .''_.. - __. 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Y� _. _.�.___� _ _ �.. .. _. _ _ _ __ _ __ _ a ; ,�a �� P�,��E�� _ _ _ _ _ � _ . __. _ _. _ 3 " , , �� ;�;��1 � t „ r'` ' �� , � � . � ; ��'� ��, —_ _ _ ___ f � � � __,..�.... _.. . _ _ _ _ _ __..,_ . -. ....,� � __�� CITY OF DIAMOND BAA DEPAItTMFNT OF COMMUNITY 6�t DEVELOPMEN'I'SER.VICES �t ai�o E.c�i�Y�v�s��igo C°f/�-S s«5 �, ,,,.+��.,.� (9U9)86Q-3195 Fa�c(909)$61-3117 µ t i PRESS BUILDING PERMIT APPLICATION �f/Q-f�,( C. �' �l�,Q f�� FIRMI.Y $ DQRESS��5/ �y�t1 l�rs?x-GT-° O S��A710N f� b�� NUMBER p �/C/1(��, � t.il._ � A P N L D T T R A C T 1-Z r i+ DATE TMpE �G p OWNER U I � CONST. GROUP p ADDR�ESjS�_� �� SS •i'fi'f�_{�"','�' ZpNING SETBACKS �W C�Tti' �tl.Ct-t''� Z / L TEL.`J��_'981 g2/ FRdNT Ryy � APPUCANT _,�'� TEL. REAR � SlDElSIDE STREET _ Ryy Q � CONTRAGTOR V I'7�- p�,,/�„ y SIDE L t� ADORESS,� b�_V _�_A1Llh..A�.'��t317 - p ��T�'-��.�L1��'�_�L°1�_ ZIP�,�TEL�,��,�� PROPQSED USE w ARCWENGI ' ` _. � QESIGNER� �� /ROV . NO.DWEL. � NO. ryp. � ADRFiESS � �tl� D�LT'" � (2.��/�' � CITY�fF_,�pG�r7'_,=�_R'f_-y/1 ZIP 24�D TE�.��,�(vD lJ8 j UNITS STpRiES z BEDRQOMS � DESCRlPT14N SQ.FT F GTOR P$F DJ.A EA(VALUA IQN 4 OWNER-BUILDER DECLARATtCiN SFRfADD7REM � 1 NEREOY�tfFNi4i iJNp6R PENALTY OF PEHJURY iHAT 1 AM fJ(EMF7 FqOM THE CANTRACTOpS LI� � Gare 0/C8 11 5 1 (J t1J CENSEUWFORTHEiOttOWINORfA50NtSEG.T93/.5AUSWESSANDPRCIFESSIONSCODE:ANVCITYOR 9 � � CWNTYWHIG9IREWIRFSAPEflMfTTOCpN$TAUCT,ALTER,�MPROVE,pEMOL�SH.ORREPAIFiANYSTRUC� W � TURE,PRIDF TO ITS IS9UANCE,AL50 REi]UlAES FNE APpUCANT FOP SUCH PERMI7 70 FIIE A 5lGNED W PflNO/DeCk STATEMENT THAT FIE OH SHE IS LICEPISED PUi�UANT Tp iHE PROVISIDNS OF THE CONTRACTORS Li- c CENSE I.AW(p1APTEft 9(COMMENCIM�Wt7H SECTpN 7000}OF OIVISK7N]OF THE BUSINES$AND Ff�� u' PootiSpa '.4C{' FFSSIQNSCODE�OflTNATHEORSNEiSEXEMPTTHEREFROMANDTME8A515F09THEAlIEGEDEXEMP� (!S y TN7N.ANYVICM.pTl4NOfSECTiON)03tS8YANVpPPLICANTFORAPERM175U&IECTSTHEAPPttCANTTp Z Re-ftoof � A CIVII PENN,TY QF NO7 R40RE THAN FlV[HUNpRED DOLI.ARS(SSOD1.): � �l.AS4WNEHOFTi1EPqOPERTY,ORMYEMPLOYEESW�TMWAGESASTHHRSOIECAMPEN5At10N, �011i(I18fC181 YALL W TNE WORK,AN6 iNE 5TRUCTLIqE IS N�7 MTENOEO OKt QFFEREO FOR SALE ISEC.704�,9US1- � � NESS AN6 PFlOFESSIONS CPDE:THE CONTMCTORS LICENSE LAW DOES NOT APPLY TO qN OWNEfl OF PROPERTYWri08U1LA50PIMPROVESTHEFIEON.ANDWHUDpE3SUCMWC%iKHIMSFLFORHERSELfOfi � � 7HRIX/OHHISORHEROWNEA1PLdYEES,PF�VI�'c�THATSUGH�MPqOVEMENTSARENOTINTENDE00F CO ' 6FF@REbFOR SA�E IF,FIOWEykR 111E BUIIDINGOR IMPftOYEMEN7 5501,D WRNIN ONEYEAROF CdMPLE z T�ON.TME OWNER-BUILpER WILL HA4E 7HE BURDEN OF PROVMG 7HAT HE oR SHE DID H(}7 BUilp pq = IMPROVE�OpTHE PUftPOSE 4F SAIEy. �.- �,{J ❑4hSQHMEHOFTMEVROPERTV,M1[xq.USrvELYCANTRACTINGWITHLICENSEbCONTRACTORs � TO CONSTF4VCT Th7E PFM7.IECT(SEC.7o4a,pUSINESS ANp PROFE5514N5 CODE:TNE CANTPACTORS LI. ydlll2tlOf1 ,_ _,ADJ,pREA CENSE UW DOES NOT APi�tV TO AN pWNER OF A PROPERTY WNO HUNDS Oft IMPROyES THEfiEON,AND wfwconnucTs�oasixa+aawEcrshmm�cwrrrA,acroats�uc�useopuflsuuarrorHEcao-rrruc. qUANTiTV DE GRIP714N FE� � TGiSUCENSEthW.y. _ y ❑I hM EXEMPT UNDEH SEG B.d PC.FpR THIu REASON Q } C.} � OATE .�. _. OWNEfl� ��._._._ a . U � Ltt:ENSED CONTRAGTORS DEC�AAATION W " � 1 NEREBY AFf%iM UNDER P6�VALTY OF PERIURY TIlAT I AM UCENSED UhtDE(i FpOVi510NS Of CHAP7EF � � ' �[ P(GOMAIENCMi(i WIiH SECTIqy�ppp1 pF 04YISKXd 3�f THE BUSiNESS ANO PROFESSIONS COOE,AND Z �'� MY LiCENSE�S M FlJLL FORCE AHD EFFECT 411 /y^ d LICENSE C�LA'+SS.._q.�A_(�.___LIC.Np.�-� _ V RATE._,_[___,�"' Q� CON7RACTOR, (/ wfJ� , d �� tJJ ' � �� WQHKEflS'COMPENSA'fION DECIARAT70N Q -� ��-- � �NERE YAFFIFM UNDEfl PEN,LLTY OF PERJURV ONE OFTHE iOILOWING DECLARATIONS: � �!' z C� .� IFFAVEMlOWIIiMAMi'tAiNACEpT�FlCA7EOFCONSENTTOSELf-INSUflEFORWOfiKERS' a 2 ,�� Cw�MVENSAT�ON.AS PROVipED BV SECTION 37�OF THE LA80R CODE,FpR THE PERFORAiANCE C� OFTHE WORK F6R WMICFi THIS PERMIT IS ISSUED. W �- W � _I HAYE AND W!LL MAWi'Ak/WOAKERS'COMPENSATION INSURANCE.AS AEQUIftED BY SECTION Q 37o0bF 7HE LA80p tX)OE,FOR THE PENFORMANCE OF THE WORK FOR WHICkTHiS PERM�T�S 'Jry � ISSUED.AiYW(J�K ER5 CfJMPENSA710N INSURANC CARRiER AND AOLIGY NUMBER AR� COfVSTRUGTION __ „ � � _ , '_`�� ✓,^�Yl �. CARPoEA-,1�/ C �.- �O _ �O• PLANAEVIEW / � POLICY NUMBER�i G .-Q-1�� .._-- EtEC7RiC .~_ _ .. �C� �-__p/ /��ry � (n*sscthnr�r�5�»�7aEa�.FrEooF'nr�rerr.vr�swaaniEH�NoaE�oau�as�t+ao�a¢�Ess�. PLUMBING -------��V_Cf-� � i CERTIFVTHAT INTHE PEFlFORMANCE OF THE YK7RK f4R WN1CH THIS PERMIT IS iS5UE0,I MEGHANICAL ___�D�� , _ SMALL NOT EMPl4V ANY PERSON IN ANY MMINER Sq AS TO FlECpME SVBJECT TO THE (,J) K+CIRKER5COMPENSAT/Jf/LAW50FCAUFQRMtA,ANOAGREETHA7'IFISHOULDBECOAAE iNSPECTIONFEE � SUBJECT Tp THE Wi1RKERS'CCkAPEYSATIOk pROV(SIONS OF SECTION 3700 OF TN6 4ABOR `— '— '-""' '-�_� � CADE.I SHALL FOftTHW1"�N CONlVIV WITH THOSE Pqqy�5ION5. v`� �S�aUANCE p DATE:f��LQQ_ APPLICANT. � � � � SMiP W SUtlJECTANEMPOYERTOCRIMINN.P�NAITi�ESAN�CtVpitF��MESup O5� `- � ENERGY P/C 4 � J UNLAWFUL,ANbSHALL6E ... _ lL ONEHUN�REDTHOUSANP ENERGYPERMIT � �-,,_? e OOLURS(f f 0o.6W),IN MbiT10N f4 7HE C45T QF COAipENSATION,�AMAGES AS PRQVIDFp FOR IN --�� _4._.... J SECTIONa]oBOFTHEUOUF#COfiE,iNTEREST,ANDA77DANEYSFEES. �� FiETENTI6N FEE: aCONSTRUGTION LENDlNG 0.GENCY pRE�ALT�/ ---��- ----- ._.. � i HERE6Y AFFIRM LINDER PENALN qF AERJUflY TiiAT THERE�S A CONSTRUCTION LENDING AGENCY � � FOR THE PERFORIAANGE OF THE WOf{N FOR tCN TN{5 PEflMIT�S�IS/Sj�ED(SEC.308f7.y��{V C.) � � -- - �W --�JI��v(l�'_l '+i� l�'_ '�'��%��/7''�' ��I� LENOER'S NAME D _'_��'1'1_ � �.._.. -..— � LENOER'SADpRE55 ___, � � � i CEHT�FY THAT I HAVE READ 1'HISAI�PUCqTfONANO STA7E`HAT hiE A50VE MFORMAiKKJ IS CAi3RECT, TOTAL FECJ / � • � (�j �+/jf � i A6REE TO C-0MPL�wITH ALL CIN ANO COUNTY OROMANCES ANp STA7E LAW$REIATING TO BUILDING � y � � � j+ ! � CUNSTRUCTION,AND HEflEBY AUTHOfifZE fl��RESEtJTATNES OF 1HI5 COUN7Y TO ENTER U.°ON TME �/ ��_•��'�_�� ABQVE�MENTqNED PROPEflTY tOfl iNSPECTiDN AURPOSES. (',QMMENTS �� ♦ � � "'r`J`X-�'J /{ /Y _�_ f _ � __1�� . . .._.. 4 PERMITTEENAMEfPr4N' .._. v_� t 2.—/-00 � {/� 8!6 UflFOFAEA iTFE � DATE i� �- � RECPT.NO. 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FACTOR PSF ADJ.AREANALUATION ,p� OWNER•BUIIDER DEClARATION 9FWAOO/REM O � 1 HEREBY AFFIRAA UMOER PENN.TV OF pER1URY THAT I AM E%EMPT F%OM THE CON7RACTORS LI- Gafa�B/Cafp4rt CENSEUIYfORTNEFIXIOWINGREAt30M{SEC.743t.58U51NESSRNDPAOFE5510M5G�E:ANYCi7Yt5R (� COUNTYWMCHREOtriFE5APERMR?4CONSTRUCT,AL7EH,IMPROVE,DEMOLISH,OpREVAIRANYSipUC- W Patlo/D6Ck 7URE,PRIOR TO IT5 ISSUrWCE,AL54 REW IRES TNE APPLICANT FOR SUCN PERMIT TO FILE A SIGNED � .� STATEMENT THA7 ME 4R SHE!3 CICEMSED PURSUANT Td T4�PHOYIS�ONS OF iH£CONTAACTpRS Li� � � CEN$E UW(qiAPTEH Y(1.'OMMENCINO WITH SECTpN 1000)Of OIVISIpN 3 OF THE BUSINESS ANO PqO� � PooUSpa FESSqNSCqDE)ORTMATHEpRSHEiSE%EMPTTHEAEfROAAANDTHE8A51SFORTHEAL4E�EDEXEMP- (� 7qN.ANYYqLATiOi'lt7FS'cC7iIXi7Q31b8YANYAGPUCANTFORAPEflMiT5U9JECTSTHEAPPCICANTTO Z Re-Roof � �CIVII PENAI,TV OF NOT MORE 7HRN FIVE NUNDRED 0041.ARS(FSoo).); � ❑I.lSQNMEROFTHF_PRQPERTV,OAMYEMPLQYEE3WITHWRCESAStNE�R50LECqMPENSATpN. C� �o(t'imetCidi WILt 0�THE WOA1(,Mi0 THE$TRUC?URE IS tiO11N7ENbED OR OFFEFED FOR SALE(SEC.7044,BUSI� J � NESS AND PROFESSIONS COOE:THE CONiRAciOR5 LICENSE I.AW DOES NOT APP�V TO AN OWNER OF � PROPERiY M4fO8UKD50q IR#�ROVES 7NEflEON,AND WHO DOE$SUCH PRJqK HIMSELF OR FtERSEIF�R � THROUGHHISORHEROWNEMpLOVE6S,PR(7VIDEDTHATSUCHIMPROVEMENTSApENOTINTENDEDOR m OFFEpED FGR SALE IF,IqWEVER 7HE 9UILDWC.Ofl IMPROYEMENT IS SOID WITHIN ONE YEAA OF CQMPIE- TpN,THE pWNEFl�8t/lLDER MFLL kAVE THE BURpEN OF PR4VtNG THAT HE 4R SHE O�D NOT BU�ID OR IMPR4YE FOR TME PJflPOSE OF SAL£�. U�.AS OWNER O[THE PRpPERTY.AM EXCLUSNSLY CQNTFACTtN6 WITN ltfEYStTS CONFRA4TOft5 [L TO CQNSTpUCT'(7iE PR0.7'cCT(SEC.�OM,BUSiNESS AND PROFCSSIpNS COpc:THE CONTRAC70R$LI� �/a��0I10� ADJ.AREA W CENS@UWpOESNOTApP�ViqANONMERqFApqDPEFlTVWH08UIlD50RIMPiiC1VESTNEREON.AND � "—'—"— — WFfO CONTRACTS F�H StICN PR6.IECTS Wtn1 A COFlTRACTpft{Sj UGENSED PliF15UANT W�HE CQFITRAG- FEE iatsuca�ssuw.}. � t}UANTITY DESCRiPT10N � O t AM EXEfAPT tNlOER SEG ,,,__. __,9.&PC.K3R'HIS pEA50N � Q V . LL OATE �� ._OWNEft__„ �..—. , � �+ � .... ...._..� ..... ±� I.iCENSED CONTHACTORS DECLARATION w �� {� i H£flEBYAFfiPA1 UNDEp PENAL7Y Of PEAfUAY THRTlAM LICENSEQ UNDEfl P(�YISIONS QF CHAFI'Eft � �Ti p(COMMENCM�U WITH SECT70N'ioaD)O�DIVISION H OF?HE HUSINESS AND PROF�SS�ONS CO�E,AND Z i`� MY LICENSE IS IN FULL FpRr_t/�.�0 EFFECl. � LICENSE CIASS ��._ tiC.No.__ ___ j�� dATE_ J _. „__ CGNTRACTOR��,,,,_„�,..___ d — � WORK£FS COMPENSATION DECLARATION a � � i HEREBY AFF�RMi UNOER PENALTY OF PERNiRYC7NE 6`�THE FIX.I6WING OEC;.ARAT10N5: Z � „f_IHAVE}NDWILIMA"N7AINACEPTtFICATEdFCON5EN7T0'sELFtNSURE�Ofl4V4RKEH5' ¢ �� COMiMN3�tT10N,AS PRWiOE(3 Bv SECTION 3�0o Of THE 4ABOR CODE,FOR TNE PERFORMANCE U � OFiHE W4flK FOp WHICH TNIS PERMi715IS5UE0. � � �„I HAYE�ND WILL MAINTAIN WORKEAi'COMPENSATION INSURnNCF,AS qE�UIREO 3Y SECTION � 9700 Qf THE lABO!1 4JOE,FOR i'HE PERFOfiMANCEOF tHE WbRN 6"�R WHIGH THt5 PEP,MIT IS � ISSUEO.MYWORKERS'C6MPF.NSATHNJINSURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTlON T �__ �. caaa�En--------,- — -...---- alnN F1EVIEw 2 aoucv Nuueea_- ---- ----_`.__ ELECTRfC __ � ._ � - s� � (iN65EC1YJNNEHINJTBEOJM�1.FfEDf�hEPER1KT6WRONEI�0.MJREpU0l,l.AfiS(5100)OpLESS} PLUMBING _ � �CERTIfY THAT iN TNE PERFOflMANCE OF iHF WC�RK FOR WHICN TNIS PERMIT I5:5SUE0,l MECHANICAL _ SHA4L NOT EMPL4Y ANV pER50N IN ANY MANNER 60 qS TO BECOME SUBJECT TO TNE (,j) WORKERS'COMPENSATION[AWS Oi CALiKN?NIA,ANDAGREE TNA71F I SHIXJIO BEC�N,E INSPECTIOIJ FEE _,,, SLJBJ[CT Tp 7H'c VKJqKERS'Gti.1MPEN5ATiON PROVISION$OF:ECTION 370o OF THE LABOp v .—` � CODE,I SHpLL FOflTNWtTN COM7LY WITH TFIpSE PROVISIONS_ �$SUl�FJC..E i�-�T;^':' �. �e Q '��. . ��. —.__.. [] DATE:�-. .._�. APPIICANT: �i,. _ SMIP .__ � ' ..._ � ENERGY P!C ` ' � _ WARNING:FAIWflETOSEGUHEWOFiKERS'CUMPENSATIONCOVERAGEI$UNLAWFIIL,ANDaHALLBE --�•+�+-�� y� $U&IECTANEMPLOYERTOCRIMINALP�NALTIESANOqVILfINESUPTbaNEHUNOFEOTHOUSAND EFIERGYPERMIT �'• y OOLURS(i�OO,000�,M ADDITFON TO TNE C4S70F COMPENSATION.OAMAGES AS PqOY16ED FOR IN -' "�.'.,.' � ' � ._. ,_ , SECTIqN 3�oe OF THE LABfJR COpE,INTERE57,AND ATiOANEv'S FEES. � �-� � '. � RETENTIQN FEE: ___� W ....— —^_ ... 4 ..� 4 �CONSTRUCTION LENDtNG AGENCV PRE-ALT FEE: � ......__. ...-- yC� 1 NE�BYAF�iRAt UNflER P�NAITY OF PEft1URY TMAi'TH�ftE i5 ACONSTFt7CTIUN LENDING AGENCY , «- FOF THF nERFORMANCE OF l'ME WORK FOR WIi1CH THIS PERM.71S ISSUED(SEC.3091.CIV C.�. —� � W —._T_ � LEND6R'S NAME .�_,_ `_..'____ .i Fi- 4ENQER'SADURE3S�_. ......i _ . . � ICER7tFY7HATtHtWEqEAb11NSAFP��ATFpNPNOSTATETHdT7HEABt}VEINFORMATKKhISCARRECT. 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GROUP 0 ow��-R�ulte�flomes d ADDRESS 18401 Van Karman ZONING SETBACKS � cirv 1 rvine ziP 92612r��. 949797440Q FRONr Rw ❑ APPIICAh1T � TE�,. REAR ❑ SIOE(SIDE STREET RW_ ❑ � CONTRACTdR__, 58111G' SIDE O_.__ � ADDRESS PROPOSEDUSE P2tI0 �OVG'P � CITY ZIP TEL. � AACH/ENG! _ DESlGNER Frank Radmacher � Assaciates NO.DWEL NQ. NO. � ADDRESS.�„�. Oi' c� {}NITS STOF2lES BEDftOOMS � cirv Tusfi�n ziP 927 OTE�. 77�F8�21774 � DESCRtPT10N 8t�.FT. FACTOR P5F ADJ.AREANALUATIDN rn � OWMER-BUIIDER DEGLAflAT10N SFRlADDlREM � _ , � I HEpE9V AFFIHM UNDER P9�lALTY 4F PEHJURY THA7 1 MI EXEMpT FR9M THE CAM'RaC70fl5 U- � �aragelCarqoR LLt CENSEUWFOR7HEFOLL6WWOREA50N(SEC.7o31.5BU81NE55ANDGROFESSIDNSCOOE:ANVCITV�R C� (X%,XiTYWHtp{flEtY1q2E5APERMRTOCOn15TRUCT,AtTER,BAPRWE.DEMOLISH,ORREPAIRANVSTqUC- (L p�t�p�k 238 W741NE.RFiION TO fTS ISSUANCE,AL9Q REOUIflES iME APPt�AMT Ft?R SUCN FERMIT To FtLE A StGNED W .� &TITEMENT TNAT HE OR$HE IS IJCENSE�PURSUANT TO THE PR01��SIONS OF THE CON7MCTOftS LI- pOoUS e � CFNSE UW(CHAPTER Y�CxJMMENCINa WITN SECTION 7W0�OF pIVISION 9 OF THE BUSINESS ANO PPO� U' P fE63NN75 CODE)ORTHATHE OR SHE IS EXEMPT TNEREFR6Li AND THE BASIS i0i'�THE ALLEOED EXEMP� TqN.ANYVKJLA710NOF51:CT10N7471.68YANYAPPL4CAHTGORAPERMiTSVBIECTS7NEAPPIiGANTT6 Z Re-Roai � ACIVIL PENN.N OF NO7 A14flE THAN FIVE HUNOFiEp DQLLARS(l5o0j.): � ❑I,ASOWNEROFTNEPROPEpN.ORMVEMPLOVEESWITHWARE$ASTHEIRSpLECAMPENSAiION, Q GOR7rt18lCidl q��pq 1}{E WpRK.AN6 TtiE STiBJCTURE IS N07INSENOEO OR OFFERED KJR SN,E tSEC.76d4,BUSI- _7 � NESS AND PRQFESSIONS C%717E:THE CONTMCTORS UCENSE i.AW UOES N(7T APPLY TO AN OWNER Or' _ pppGEpTVN1iOBUROSOHIMPROYESTMEfiEON,ANDYINpWESSUCHWbRKHiMSEIFORHEPSELFOR m � TriHOi.idHN�SORNEROWNEMPLOYEES,PRCYVIOEDTHATSUCNIMVROVEMEN7SARENC77MTENDEDOR �Ff6tED WN SKE 1F,�10WEYEfl,7HE 6iNLDiNG QRIM{PFqVEMENT i5 fiO4D WtTFRN OtdEYEAROFCAMi'LE � 710N,TME OWNER-0UILOEF VALL HAYE THE BUR�EN OF PR04WG THAT HF OR SHE OH>NOT�UlID OR � IMVRDVEFOqTMEPURPOSE4FSALE), „_, � ❑I.k56WNENdFTHfPi�PERIY,UJfEXCLUSiVEtYC6NTRACTMGWiTNUCEN9EpIX3NiRACTORS �'L�Qp� qDJ.AREA._ (y TO GONSTRUCT F}1E PftAlEGT ti$EG.7A14.eU5tNE55 AND PRQfESS10N5 C07E�.THE COtiTFAG70R5 LI� VBIUefiqn 41 C:ENSEUWDOESNOTAPPI_YTOANOVMEROFAPFOPERIVN?H?BUILDSORMAPA4YE5iNEREON.AND �� Z VhiDCX3NTRACTSFQRSUCNPROJEC75WITNACONTRRCTOR(S�LICENSEDPUFSUAN7T7THEfANTRAG QUANTITY OESCRIPTSON FEE Y TORS LICENSE IAW.i. � � ❑1 AM EXEMPT UNDEFI SEC. _.__._..-....8.&P C.FOP THIS REASON � _, "y -_. __ — "_ � V' DATE__..- __�...O'NMER�_ ...� V —•. . �' � W Q U(;ENSED CQNTRACTORS DECIARATiON -� i W � 1 HEHEBY AFFIRMi UNOER PENALTV OF pERJUqV TNAf I AM LICENSED UN�EH PROVISIqNS OF CFiApTEFt � � DjCOMi.iE/iCi1WWtTHSECTKNJ7oo9)OFD�ViSiON30FiHEBUSINESSANDPAOFE5510NSCO0F,AND Z AAY UCENS£IS 1N FULL fOftCE AND EFfECT. m a ucENse cuss T j A ��c.r+o.. 517593u _ � _ V DA1E�._��._^+O D�_._ CONTRACTOA Pulte (IOTT��S a- W � WGFiKERS'COMFEt35ATiUN 6ECLAFiAT1{7N Q � � � I HEHEBY AFr`IRM VNDER PENALIY OF FEAJUPY pNE OF THc FQLLAWING DECLAFIATIDNS: Z Q C} ___�IHhVEM10WILt.MAIWTAINACERTIFiCATEOKWN5EN'TOSELF�INSUpEFORWCIRKEHS Z Q cXYMPEMSATKX�i,ASPHOViDfDHYSECTffN3'ToodFTnELaBCJRCppE,�pRTHEPENFOAMANCE W UF?NE WQfM fGFl WF{��;f{TNlS 4�RMIT!S ISSUED. r�, d � ��IIIAYEANOWILLMRIN7AWWOp1(ERS'COMPENSATIONINSUPANCE,ASREQUIREPEYSEGTION Q 37(W bF THE IPbOR CADE.FOR TNF PERFORMANC6 OF THE WOflK FOR WNICH TMIS PERMIT IS ' (y ISSUEO.MY W(SRKEFS'Q7FiVENSATION iNSURANCE CRRRIEfl hND POUCY NUMBEfl ARE: CONSTHUCTION ��V y PaCifiC ES1�I I e_�_..-.�_— auw�ewew 5Q.00 -�- GRHIEp_ --q��, -T� � � aatcv NuuaEa� YM U R1- �}3 V 1 g7 .,--.. .— ELECTNIC ... .— -. Q � (IFIISSECIIWN��NO78EC�4.E�IFDOFT}E�EFb�fit4FOqoNE�N/n[)!?EDDa.I.AFiS,{E±oo)IX1LE55} PLUMBING . ...�..,�_ - � I CEAT7FY THAT N+TNf'?£RFQAMANCE OI'7HE WORK FOA WHICH TNIS PERMIT�5 ISSUE6,� MECHANICAL _„_ __ .__ (� SNAll.Nf1T EMpLOY ANY PEft59N M ANY MANNER 5o AS 70 9EGGME SUEJEC7 TO THE � WQRKERS'CaAPENSAT�ON LAWS QF Cn4iFOPNIA ANp AGFEE TNAT IF 1 SHOUL�BECAME 1NSPECTION FEE ({ � SU&IECi TO TNE.WUiiNERS'CAMPEN5FTION PqOVISICJNS OF SECTION 37Do OF THE LABOR �SSUANCE �TC.� .LL_--. Q?DE,tSHALIF�iMWRHt.UMpLYWiTHTH45EPqOVISI6NS. �� ' � )�y-�)/y _P.1�ItP Homes sMip __.�5.11— n bATE:_,�.(�_L1_Sl.� APPLICANT _ ---" w ENERGY PIC _w.;�,.,�.y.��_ _-- J WAFtNiNG.FAILUp[t0 SECURE VJORKERS'COMPENSATiON WVERpC+E IS UNIAWFUL.ANC SHAI,L BE � SUB.tECTANEMPtOYERTOGf116/1NRLAENAL71E5ANDC:Yi�FMESUPT06NEttUNOREDTNQUSAND ENERGYPERM �Y,ii .... . DOLUHS{S1QO.DOQ),iN ADDITh�N TO THE C(75T OF COMPENSATION,DAMAC,ESAS PPOVlREO FOft tN /��y J SEC71oN 3)o80F TNE UBOH iADE,INTER[57,ANDATTORNEYS FEES. RETENTION FE�: .,_._ �•V v t� - W CONSTRUCTtON LENDINC�AGENGY PRE•ALT FEE: --""' � ��.-.. � ::.r�.__ � - � 1 HEFIEBV AFFIHM VN�Eft PENhLTY OF pERJURY THAT THERE IS A GONSTHUCTION I ENOING AGENCY _,_ � �! n- FOR TNE PERFqRMANCE OF THE WORK�oR WFiICbI THIS PERMIT IS ISSUED(S�C.309'1,CIV.CJ. — / W N��e c��t�) — � I ENpEp`S NAME__. . _..� ---- -�-- f- IENDER'SAD4RE55_,,,_,__�.._. - � j� t�/'� � ICERTIFVTHATINAVEREADTHISAPPLICATIONANOSTFTETHATTHEABC7YEINFOflMATION�5CORRECT TC?TALFEES ��Y.YV W 1 AGREE T6 CQMPLY N'17H ALL CITY AND COUNTY IJRpINANCESAND 57AiE LAWS RELATING TO BUILDINC � CONSTRVC7lON,AND HfiREeV Al7Tri()R[ZE REPRESENTATNES Oi Tli�S COUNTV TO ENTFR UpOW THE � ABOYEMENTKMEP PRpPERTY FOR INSPECTION PUHP65E5. COMMENTS� __ �- � � � Jerr� Haines m PERMtTfEE NAME(PRiNT} -. -... Q C/� _,_ _ � SIGNATUREOFPERMITTEE � d/TE t AECP7 NO.� " PAID BY _ .. 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M . . _ . .� .. : . .�.. ...�.: _.._.,._,..__..._ ..,_..... ......... . ....... . ...._. .... ..... ...... ..... ....... .. .... ... ... .. . . � �....«...e.�..W.,�,.a.,.........,�««�—�......._..V...,�...,�».....,�.,..... ....> ...........,.,_.._,.,.__,�...__ ...m.,...�.,. .., �,:a.......�.�..�.......a....p,a. .._., _..._,... ..._ .,.,._ .... ...w,..: . ,.,e-. ..,. . .._._., MUMMIM JOBSITE LZ . L ADDRESS J# 1 S G APN LOT TRAQT J,_Z 2�� 7 OWNER�IJ ADDRESS_£j' CITY 7, !11°-ZIP 924,L TEL4'5V 7t/7 APPLICANT_TEL. CONTRACTOR ADDRESS CITY ZIP_TEL. ARCH/ENG/ DESIGNER ADDRESS_/Q CITY r"-ZIR! TEL OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT.ALTER. IMPROVE. DEMOLISH,OR REPAIR ANY STRUC. TURE. PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 0(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500(.): ^ 1,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUSI. 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 FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE. TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D 1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY 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 I AM EXEMPT UNDEFI SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CUSS LIC. N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HERER AFFIRM UNDER PENALTY OF PERJURY ONE CF THE FOLLOWING DECORATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION i 700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY KER5'COMPENSATION INSURANCE C RRIER AND POLICY NUMBER ARE' CARRIER-( POLICY NUMBER (THIS SECTIDN NEED NOT BE CO PLETEDOF THE PERMITIS FOR ONE HUNDRED DOLLARS($100)OR LESS). 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 CODE,I SHALL FORTHWITH COMPLY WITH//77��HOSE PPROVISIONS. /��Y r•/�;?� DATE: :y!.._�APPLICANT: 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 TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE RK FOR WHICH THIS P RMIT IS ISSUED(SEC. 3087.CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY NTH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE SE S. ABOVE-MENTIONED PROPERTY FOR INSPECT?N PURPPO OS A PERMITTEE NAME(PRINT) SIGN LIRE OF PERMIT E DATE CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION r V L� �_,PERMIT P/C DATE NUMBER# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORI BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM CO Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W w z Fn a- Q z u w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL 115 GY P/C ENERGY PERMIT ETENTION FEE: PR-FEE: TOTAL FEES Z� I'c Cl COMMENTS RECPT N0. PAID BY�'-VALIDATION If WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES�� ids S(C S�� 21660 E.Copley Drive Suite 190 B (909)860-3195 Fax(MI 861-3117 PRESS BUILDING PERMIT APPLICATION P1 ! FIRMLY JOBSITE ADDRESS t,mJ V1457 X-erA APN LOT TRACT 5 2-Z OWNER U ADDRESS 2-5 t S CITY j f t Z j fo TEL.9o?-9B/8u APPLICANT H*1 064 TEL. CONTRACTOR u I-r:- ADDRESS_18401 lf o0 7g7�� CITY ZIP 1 Z 2TEL� ESI NE A D G �� b DIGNER R ES ADDRESS f�-7"')fL/ CITY 4/f_,q'4 4 ZIP g2b6 0 TEL� R 7('0 O8/ OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT.ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW)CHAPTER A(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031,5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(3500).): C3 1,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7064,BUSI. 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 FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE• TIO N.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ 1,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE._OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT AN {- 5 73 LIC. N0. v LICENSE CLASS ASS_ -� DATE CONTRACTOR U .� e-� COMPENSATION DECLARATION WORKERS I HERE Y AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE 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 KERS'COMPfNSA7 CARRIER AND POLICY NUMBER A� CARRIER"!f! � /^' POLICY NUMBER OO G,,,�D 1J 0 Z F 5-o/ HERO NOT BE IX*A'ErED OFTHE PERMIT IS FOR ONE HIXOREDLXXANS($100)OR LESS). (INS 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 CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: ZZ-'t DO APPLICANT: 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 TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR RICH THIS PERMIT IS ISS ED(SEC. 3087,Y.C.). LENDER'S NAME v/ LENDER'S ADDRESS 1 CERTIFY THAT I HAVE 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 N PURPOSES. ABOVE--MENTIONED PROPERTY FOR INSPECTION IO / ^'1�� / FERMITTEE NAME(PRINT) � 12.-/-po SIG UREOFPER TTEE DATE P/C APPLICATION/� s 7 PERMIT qi 3D DATE NUMBERI #t�(_ ISSUE TYPE OCC DATE CONST- GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0, FT FACTOR PSF DJ.A EANALUA ION SFR/ADD/REM ri) Garage/Carport W Patio/Deck t 0 0 It- Pool/Spa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DE CRIPTION FEE J I- U W J W Z a 4 U Z S U ' �� 1 -3 CONSTRUCTION 1 PLAN REVIEW ELECTRIC 00 PLUMBING - MECHANICAL � 00- INSPECTION FEE ISSUANCE SHIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES - 42q _ , COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy.-GOLDENROD-File Copy,GREEN-Applicants Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suitc 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION "Classics" Plan 1 Model CR PRESS FIRMLY DATE CATION I, � .. (J I NUMBER�J� � �#/C ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ SEWER LATERAL PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck W W PooUSpa Z Re-Roof � Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U F- U W J W C.� z m ) 0 ) Q U 2 6 S U W CONSTRUCTION_ PLAN REVIEW ELECTRIC PLUMBING "+ MECHANICAL INSPECTION FEE� .1C ISSUANCE-J b� � SMIP' ENERGY P/C _iv, ENERGY PERMIT. ��; �- , .. >.. RETENTION FEE: �-� PRE-ALT FEE: TOTAL FEES�Ct� • �� COMMENTS s RECPT N0. PAID BV VALIDATION WHITE--Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy II1.1�111JU It,IN CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION�� C I�S�C.� �� — PRESS FIRMLY JOBSITE ADDRESS 13ri51 ranTOn Vigtg CnVi�# APN LOT TRACT J�� OWNER�Ulte omes ADDRESS 18401 Von Karman cITY Irvine zIP 92612fEL.9497974400 APPLICANT TEL. CONTRACTOR-Same ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER Frank Radmacher S Associates ADDRESS Ora CITY Tustin zIP 92780TEL. 7148321774 OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REWIRESA PERMfT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY 57RUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE UW(CHAPTER Y(COMMENCING WITH SECTK)N 7000)OF DIVISK)N 3 OF THE BUSINESS AND PRO- FESSKNVS CODE)OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TKXV.ANY VIOLATNXV OFSECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).): ^ 1,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7041,BUSI- NESS AND PROFESSIgJS CODE: THE CONTRACTORS LICENSE UW 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 FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TpN,THE OWNER-BUIIDEH WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^I.AS OWNER OF THE PROPEm-YAM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 701a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE UW DOES NOT APPLY 70 AN OWNER OF A PROPERIY YVHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITHAC(NITRACTOR(S)LICENSED PURSUANT TO THEIXINTRAG TORS UCENSE UW.). ^ 1 AM EXEMPT UNDER SEC._,_B. 8 P.C. FOR THIS REASON DATE_,_OWNER�__ LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0(COMMENCING WITH SECTKNJ 7000)OF DIVISKJN 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. A LICENSE CLASS LIC.N0. 517593 30 81 DATE EXp 9 CONTRACTOR Pulte Homes WORKERS'COMFENSATIUN DECLARATION I HEREBY AFFIRM UNDER PEfJALTV OF PERJURY ONE OF TH'c FOLLOWING DECORATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATKI,AS PROVIDED BY SECTION 37000F'THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FGR WHICH THIS PERMIT IS ISSUED. �I NAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION 37 n00F THE IABOR CX)DE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPE NSATION INSURANCE CARRIER AND POLICY NUMBER ARE: t II C I C' EI .yaIns. Co . CARRIER P�a� � �7 /^' B POLICY NUMBER-YY I/R� �QLiS7A (n11S SECTION NEONOT BE aI+PI.EfFD OFTNE PERMfT IS FUR ONE HUAORED DCLLAFiS(5100)OR LESS} I CERTIFY THAT IN THE'?ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS 70 BECOME SUBJECT TO THE WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE VJiIF1KERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR CODE, 1 SHALL FO THWITH COMPLY WITH THOSE PROVISIONS. FI 9 DATE:_�/V 1 APPLICANT: �IIItP_Hnmpg WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFIJL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLURS(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE UBOR CODE,INTEREST,AND ATTORNEY'S FEES. <:ONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.CJ. LENDER'S NAME None(Pulte) LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE INFORMATgN IS CORRECT. I AGREE TO COMPLY WITH ALL f.IN AND COUNTY ORDINANCES AND STATE OWS REUTING TO BUILDING CONSTRUCTION,AND HEREBY,4UTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. JerrX Haines PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy