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� _�,,,�� CITY OF DIAMOND BAx � �!
DEPARTMENT OF COMMUNITY 8c DEVBLQPMENT SERVICES ����
x 2166Q E.Capley Drivo Suite 190 __..._-
(909)860-3195 Faa(909)861-311? PR�7�$
�"�' Bi.JILUING PERMIT APPLICATION C LA S S I C� P L A N 3 C Ff RMLY
y JOBSfTE APPUCATION PERMI7 i PiG r , �"(
� ApDRESS� 236�� Car1}r(JC1 vIStB dAT� ' NUMBER Y �
'�-1�- �1 I� �� �l�.�� _.
� APN �OT �3'O Q TRACT �Z Z 6�J �SSUE 7ypE ��
p OWNER Pulte Home COP . DATE CONST. GROUP
o ADDRESS 1g�rd� OPl arman ZONING SETBACKS
� CtTY Irvine ZIP �2�7Z TEL.���7�7� FRONT _ RW �
APPLICANT 8�-��'i�� TEL. REAR ��
� SIdE/S�dE STREET Ryy �
CONTRACTO�j Pulte Homes Corp sioe �,
� ADDRESS ($� Otl arman
���r t rv�ne Z�p � p PROPOSED USE N S F R
� ARCH/ENG!
�z dESIGNER Mark Gross � Associates NO.DWEL. NQ. Na.
� ADDRE5 _ L!S ICl Y
� CiTY ��ni� Hn� ZIP �����55T9�777 �1NiTS STORIES BEpROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIQN
� qWNER-6UILDERDECLARATION SFR1ADpiREM 1j3�� 9�.3d L}2d,6�8,1EO
1 HEREBY�FFIRM 11NDER PENAI.TV OF PERX.IqV THAT 1 AM EXEMPT FpOM THE CONTRACTORS 41� G8(8g8IG8tT,70tf 1�/� /��}t� (�
� CENSE UW KOR7HE Fq,�OWIN6 REp$�M(gEC.703t.5 BUS WESSAND Pf�FESSIOMS{�j[}E�ANV qryOR � 5 93 ��.Y V 17�Y.7 Y.2 V
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TUHE,PRqR TO ITS t53UANCE,AL50 REOUIRES THE APPLICANi FOR SUpi PERMIT TO FILE A SIGNEO �
.� STATfiMENT 7TiAT!iE OR SME IS UCENSED PURSUAR7 TO THE pFM}VISIONS OF THE CONTRACTORS li-
� CENSE tAW(Gi�PTER Y(COMMENCIN�WITH SECTION 7tlp0)OF DIVISION 3 DF THE 9USINESS AND PRp• � PODUSPB
FES3qN5CODE)OflTW1THEORSHEISEXEMPTtHEAEFR�AIANDFHEBASISFORTHEAILEGEDEXEhW- (�
� 7pN.ANYVpLAjAINOFSECTION70.31.3$YANYAPPLlCAN7FOqAPERMiTSU6JECT57NEpPPLICANTTO Z Re-Rool
� �CIVIL VENAI.TV OF NO7 MORE THAN FIVE NUNDRED DIX.I,ARS(f5oo).J;
� OI,ASOWNEROFTHEPPQPERTf,OqIdYEMPLDYEE3Wi�MWAGESASTl�IRSOCECQMPENSATION. Ll Commercial
NflLI Q�THE WORK.AND tHE STRUCTURE IS NJT�NTENDED OR oFfERED fOR SALE(SEC.7D44,9US6 J
� NESS AND PIiOFE$SbN3 CWE:THE GON7MGTORS LICENSE U1W DOES NOT MPLV TO AN OWNEA OF �
PpOVfiHfY WNU BUIIDS OR IMPAfWE3 THEflEOti,ANDMkiQ D6E5 SUCN NiORK Mi1,SElF QR HER3QF 6R
� 7HROUGHHiSORHEROKNEMPLOYEES,FpqVIDEQTHATSUCHIMPRCIVEMENTSARENOTINTENDEDOR m ' ..
OFFEREU FOR SN,E IF,NOWEyER TME 9UILDWG OR IMPPpVEA1ENTISSCND WITHIN ONEYFAROF COMPI.E
TpM,TNE OWNEfl��DER 4t161 HAVE THE BUROEN OF pROViNG THAT NE OR SHE 6ID NOT BUILD�i
NIPqpVE FORTNE PURPqSE OF SALE).
❑�.AS OWNER OF?HE PROPER7Y,AH EXCAUSlvELY CON7RACTMp ri17H LICENSEp CXJNiRACT0f65 ,1^
� FO G<INSTRGCTTNE AROJECT(SEC.7N4,FX,lSINESS AND PROFESSVpNS CODE:THE CONTMCTOflS U• y�}����__ADJ.AREA___
I W CENSELAWpOESNOTAPPLYTdANONMERQFAPROPERTVWF�IOBUIIDSORIMPROVESTHEPE4N,ANp ValUetion
t�- wHOCo�nFl,�cTs�onsucHvawEcrswin�ncorrrnnota�s}ucavsEOPut�su,witotrtEt�Ta�c. QUANTITY DESCRIPTfON FEE
�oas ucErrsE ixw y.
� ❑FMl6XEMP7UNDERSEG �� p.8P.C.FOPTHiSflEASpN � Genera( Etec#ric �����{�
�= OATE _. oWNER i � " G+�+Y�t� � iLI S V JWIIGti i�.'YV
� V � SU�J 8Ci@� —
�( IFCENSED C�ITRACTORS DECLARATION W � M�1�„r 21�1e�
(.'C 4 HEflEBY AFFIRAR 4WDER PENALtt�f AERIURY THA7 i AM UGENSED UNDER PRDVlSIONS 4F CHAP7Efi � t �/� "- --
� 9j{AMMENCINO WITH SECTION 7000)tSF DIV�SKKJ 3 OF TME BUSINE55 AND PROFESSIONS CODE,AND Z _�
MY LICENSE 16 IN GULL FORCE AND EFFECT.
A 517593 � .—.� Gas
4 410ENSE CLASS �, IIC.No. -`—�-� �y
�,�j DATE 1104/Oi CONiRAGTOR Pufte.,,,_Homes a 16 F�Xt�.7��'$ _ 2`���8�
"' R turns - -- - -- --
� W6RKERS'COMPENSAT(ON DECLARpTION Q 4.9�
� t MEREBY AFFIFiM UtiOER PENALTY dF PERJUflY OM60FTHE FOI.t�WN1G OECtARATtONS U /�
� = 2.4U
� �IHAYEANDWILI.MAINTAINACENTIF'CATEOFCONSENTTOSELf-0NSUpf�ORWOqKERS' _ "' �o,�o
�� COMpENSAT�OM1I.AS GRGVIDER 8V S[CTION 3'/00 OFTME f,ABOR CODE,FOF tHE P�RFOpMANCE U p
OF THE WORK FOq WHICN THI9 PERMI7IS ISSUED. W
�n � TZj_ f0
„_I HAVE M/D WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,A9 PEOUIRED 9Y SECTION
Q 3700 aF THE Lq60R CODE.FCA 7HE pER�ORMANCE OF TNE LYpR!(FOfl W}tiCN TNIS PEAMIT IS
�SSUED.MYWORKFRS`CpMPENSATIaF1iNSUqANCECARpiERAN�VOLICYNUMBERARE: CONSTRUCTION __�.Y q '�Q_
'y c,wa�ER P3C1'fiCs�y�q��(� �.�._��S►_a—. PLANREVIEW _..—f—+l�J . 4
� POIiCV NUMBER__Wo r ,�_yt�„�]__$.71:�__ EIECTftIC Z rJ 7.4� 3�7.8�
a mussEc:��r,�e�wrseao�.�moFn�aea�.rr�s�oo-�eHuwa�ooa.�nns�s�ro�oa�essF PLUMBING �i 9p3c.9� 2�4.83 �
�W � 135.30 �f�
I CERTIF1';HAT IN THE PERFORMANCE OF THE WONK FOR WHICM THIS PERMIT IS ISSUED.I MECHANICAL O J.O O
� SHALI.NOT EMPLOY ANY PERSON IN ANY MANNER 50 FS TO BECOME SU&IECT TO THE �
WORKEAS'CflMPENSATtOM UWS OF CAtlF4HN7A,ANQAGREE tHAT IF i�iOUI�BECAME INSPECTION FEE
SUBJECT Tp TNE WORKERS'COMPENSATqN PROVISKKJS OF SECTION 31a0�F THE IABOH �� � � ���y� �
� CODE.I SHr,ALLJ tFlOFTHW1iMCOMPLI'WITH THOSE PROVISICNJS 7SSUANC� _,.,
p DATE:�i ��T!V� ApPLICANT: �U�te HORI�S SMIP �,.___�� p� �
— Q
� ENERGYP/C ___�(.�����a
� WARNiNG iAiLUqE TO SECURE WOflKERS'GbMPENSATION COVERAGE IS UNLAWFUL,AND SHALL 6E ,�,_„ '�
W SU&IECTAN EMPLOYER TO CRIMINAL 7ENALTIES ANO CIVIL FMES UP TO QNE Hl1NORE0 T4qU5AND ENERGY PERMIT _ ����5 1^
C%71t.1�FfSiS�o9.OWj.tNADblT(qiT07t#ECOSTOFCOMPEN5ATlQN.6AMAGESASPROVpEOFORM ..... �. ...�,..
J SECTION3]oEOFTI{ELABORCODE,INTERE57,ANDATTORNEY'SF6E5.
� PETENTION FEE:
— .._...—...
a CpNSTflUCTI6N LENDING AGENGY PRE-ALT FEE: __
� fHEREBYAFflfiMUNOERPEN.4UYOFPERIUAYTNATTHERE45ACON5TRUCTlbNtEh'09JC�AGEh7CY
FOA THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3091,CIV.C.J. ^�� � S��'��
z 1� ._
� NOtl@ �(�Ult��.�[Il�.��
tEN6EP'S NAME
t-- LEtAER'5ADbF�55
� __
Wi GERTIfY TMAT 1 HqYE REAIJ 7tiIS APPLICATKKi ANO�ATE TNAT TNE ABOVE NJFOftFAATDH IS CORRECT. TVTA� �E E�.7 �!�O�'`��
� i AGfiEE i0 Ci}MPLV WITH AI.L CITY AND C'AUNT'Y ORDINANCES ANp STAiE LAWS REUTING Tp BUILDING
� CONSTRVCTI4N,PNOHEREBVAUTHORIZEHEPPESENTATNESOFTHISCOUNTYTOENTERUFONTHE
Z. ABOYE-MENTIQMEDPROPER'iYFORiNSPECTKNiPUftP0.SES. COMMENTS
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� PERMIT7EE NAME(PHINi�
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� SIGNATUfiEOf PERM177EE DA7E +'-y��,��—.��—�
� RECPT.NO. � PAID BY VALIDATION� `—�
WNlTE—Pepartment Copy,YEtL6W--Finar�ce Copy,PINK—Assessor Copy,GOLDENF106—Fie Copy,GREEN—AppiicanYs Copy
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5
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
CLASSICS PLAN 3C
PRESS
FIRMLY
JOBSITE
ADDRESS 23610 Canyon Vista
APN LOT 93-00 TRACT 52267
OWNER Pulte Home Corp.
ADDRESS 18401 Von Karman
CITY Irvine ZIP 92612 TEL.9497974400
APPLICANT Same TEL.
CONTRACTOR Pulte Homes Corp
ADDRESS 1844 on arman
CITY Irvine ZIP TEL. .�2 612
ARCH/ENG/
DESIGNER Mark Gross&Associates
ADDRE 1551 Tustin y
S
Jan a Ana ZIP 7 EUS+ L�JS5I9777
CITY
OWNER-BUILDER DECLARATION
1 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 REQLNRESA PERMI TTO 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 I (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 CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).):
^ I,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).
^ 1,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 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.).
^ 1 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
I (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS A_LIO. N0. 517593
DATE 1/04/O1 CONTRACTOR Pulte Homes
WORKERS'COMPENSATION DECLARATION
I HEREBY 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.
-1 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 WORKERS'COMPENSATIIN
SURAANCE CARRIER AND POLICY NUMBER ARE:
CARRIER Pac
ic
NS
i
e Ins Co.
mIal e
A'^
/L
rc
V
POLICY NUMBER__7Y 1(Z
j^'
(HER SECTION NEED NOT BE OOMPLETED OF THE PERMIT IS 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 THOSE PROVISIONS.
DATE: 1/4/O1 APPLICANT: Pulte HOmes
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 15 UNLAWFUL,AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.).
LENDER'S NAME-None(Pulte Homes)
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
PERMITTEE NAME(PRINT)
SIGNATURE OF PERMITTEE DATE
APPLI
PERMIT
DATE CATION NUMBER�r 1 1 #/C f 31- [_I
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW^
REAR ^
SIDE/SIDE STREET RW^
SIDE ^
PROPOSED USE NSF R
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION
SFR/ADD/REM 4366 96.30 420,638.40
U) Garage/Carport 593 29.40 17,434.20
W Patio/Deck
L Pool/Spa
Z Re-Roof
0 Commercial
Valuation 43$ 1172_60 ADJ.AREA
QUANTITY DESCRIPTION FEE
a General Electric 357
42
8 Garage plugs& Switch 10.40
w 1 Sub panel
1 Main panel
1 W/H _-
6 Ga
a 1 Fixtures 234.83
Returns
19 Reqisters 60.90
Z 4 ventfans 42.40
1 Btu-48,000 18.00
W
CONSTRUCTION 2_295.10
PLAN REVIEW 1,950.84
ELECTRIC 257.47 367.82
PLUMBING 93.93 234.83
MECHANICAL 85.00 135.30
INSPECTION FEE
ISSUANCE 100.00
SMIP 43-80
ENERGY P/C 195.08
ENERGY PERMIT 229.51
RETENTION FEE:
PRE-ALT FEE:
P/C 2,582.32
TOTAL FEES 3,406.36
COMMENTS
RECPT N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy