HomeMy WebLinkAbout16118 (9) -�__ �
' ----j�� CITY t?F DIAMONI?BAR �� i�
DEPARTMENT OP COMMUNITY 6t DEVELOPMENT SERVICES
�, 21b6U�.Copley Drive Suite 190
� �so9�asa�l�s F����a��-sl�� PRESS
'�" BUQ,DING PERMIT APPLICATION C LASS I C� PLA�V 2 B FIRMLY
y JOBSITE APPLICATION �_ 1 �`,J'� PERMIT ` P/C i �
o ADpRESS 2��2d CaT't t�OC; �j1Sta pATE � NUMBER 1� # ��-'��
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p dWNER PUIt� H4t'T1E$ Car� DATE CONST. � GROUP
p ADDRESS_ �$4O� VOYI Karman ZONING SETBACKS
� cirY trvir�e zip_ 9261$E�. 94979744t16 aEART Rw �_�
APPIICAhIT 81T]@ TEL. SIDE/S1DE STREET RW ❑
� GOIVTRACT(SR Sc3t7tL aS a�3flVG' SIDE ❑
Q ADDRESS PFtQPOSED USE_ N S F R
CITY Zlp TEL.
w ARCHtENGi
z DESIGNER Mark Grass � Associates NO.DWEL NO. NO.
� ADDRESS 55 US Itl V2.
� CITY Santa tl8 ziP�9270�E�.94 5519�J UNITS STORIES BEDROOMS
rn QESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
OWNEF-BUILDER 6EGtARATiQP1 Sf WApDtREM
0 4�489 96.30 432 290.70
i t1ERE8Y AFFtf1AA ilNDER PENJU.7Y OF PEAJURY TFtAT I pM EXEMPT FfiOM TNE q7NTMCTOflS LI- GaB9f3/(�`dipOrt O Z 7�'!V L 2 .7 3 2�U U
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W NRE,PRK7R TQ ITS 155UAhICE,AL$Q pELkJ�pES THE APPLICAN7 FOR SUCH PE}�,ilT T4 FlLE A SFGNED �
� STATEMENT TNAT HE 6F SHE I5 LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRAQTOHS LI� �
� CCi+.ISE lAW�CHAV�TER p(COMMENCINO WITH SECTION 7oao)OF DIY1910N 9 OF THE BUSINESS AND PRO- POOUSpe
FE93pN5 CObEj O#i THA7 HE OR SHE IS E%EMPTTHEREFROM ANOTHE 8ASI5 FO�THE AtLEGED fX£MP- (�'J
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� A CMl PEN�L7Y pF NUT MOflE THAN FIVE HUNDREO W4.lARS(SSoO).):
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WILI OO7HE WORI(,AND TH6 STRUCTUfiE IS N4f INTENOEp OR OFFEflEp FOR SALE(3EC.7D41,BUSI- �
RifcSS M#7 Pfl�ESS1IXIS CQOE:TNE CONTMCTOflS UCENSE LRW UQES N9F APPtY 70 Ati OWNEft OF /� �}
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G�i,fS OWh1ER OF THE Pp6PERTY,Ai.t EXCLt�tVE4Y CANTfl,ICTiNG WtT}i LICENS£E}C�FtTpACS4R5
Q TO CONSTRUCT 7ME pR0.1EGT(SEG.7oH,9USINE55 AND PRQFESSIONS CODE:THE CONTRACTORS LI- VBIUellbfl 4 S 6_8 G A_�O ,.�ADJ.AREA
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Y TORS LICENSE I.AW.�.
Q ❑IAME%EMPTUNOERSEC. ___._ B.3P.C.FpfiTM5REA50N d C,enerai Etectric 3{}V.(/�
3 DATE ^.--... OwtaER_ � O �C� g 1l Fr J �{Q.�I O
� LICENSEd CONTRACTqRS DEC44RATION W �� Pa nel
� I HEREBYAFFIRM UNDEA PENALTY OF AEiL1URY THAT i AM LICENSED UNDER PflOWSiON3 OF CHAPTER p
d Y�GOMMENCIN(#WITHSECTNJN70p0�OFbIVISIpN30FTHEBU5INESSAND?ROF�SSIONSCODE,ANp � �iU �IX�UYP.�'J'
X LiY UCENSE IS IN Ft0.{.FbRCE tND EFFECT. �
«� m 6 Gas 4utlest 254.40
� ucENs�c�ass A ���.No. 517 5 9 3 � 1 W/Fi
� onre_.. 1 /04/Oi cor,YpncroR PU(t� i-iotlleS c
� 3 Vent Fans 31,80
� WOqKERS'CpMPENSATIONDECLARATION ¢ 13 RE isters
� I HEREBV AFFIRM UND6R PENALTV QF GERJURY fNJE OFTHE FOLLOWING ptCLAFATIONS�. � Re u r n � 43�J O
� �[XMAPENSATtKMA,�S pROVIpED BYi5EGTION 37(OFE ME ABOR CWE,FOR TNE�PERFbRMANCE CJ � B T U °i O V V V �O.V O
Q 4F iHE WC}RK FOR WH!GH T4115 PERMiT IS 455UE0. � _
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� �INAVEANUWILLMAINTAINWONNERS'COMPENS�TIONINSUqANCE,ASREOUIflED8Y3ECTION
Q87Q0 OF THE t.ABOR COdE,FOR TNE aER�6flMANCE LSF TH6 WOflK F4R WNICH TH{5 RERMIT IS �y
� ISSUED.MY WORKERS'COMVENSAi10N INSURANCE CARRIER AND POIICY NUM9ER ARE: GONSTRUCTION _ 2�3 7�.R U
> e,�,RR��R_PaC[fi�a Employee Ins. Co. PIANREVtEW 2,020.28
� MJLtCYMlMBER WORC 43011 87A ELECTRlC �, ZF)3.5Q � 375.43
o m+sseenor+Nemrro�eEa».�.�rEooFn��arrcr�s�c�e�Entbu���.smwf«a�cssA PLUMBING �S��7.S 254.40
w p (�(� � (�
Z I CEflTIFY TMAT M THE PEFFORMANCE l]F THE WORK FOR WHICH THIS PEpMIT IS ISSUFO,1 MECHANIGAL q�.U V ��� .3 V
C} SNAiINOT EMPtOY ANY PERSIXtl IN ANV MANNER Sp AS TO BECpME SU&lECT TO THE � 1
(p WORKEAS'CQMPENSATIONUWSOFCALIFORNIA,ANOAGREETMATIFlSMOULpeEWME �NSPEC7IONFEE _ t
__.__ _ w
SU0JEC7TOTHEW(7RKER5'COMPENSATIONPROVISIONSpFSECTION3�ooOFTMELABOR � ,
� t;ODE,i SHAt,C FORTHYflTH fAMPLY WITIi iHOSE PROYISIQNS. ISSUANCE �Q��_Q_ l
aonre:_ '� 4 01 nPt�icnwr PUIt@ F9ome COi"�_____ SMia (y l}�,,6$ {j.
� WARNING�FA4URE TQ SECURE WURKERS'COMPENSATION COVEHpGE 13 UNUWFUL,AND SHALL BE ENERGY P!C i 2 d Z•V Z C.,,i
SU8!£CT AN E61Pl4YFR TO CRtMiNAL PENAIT7ES ht�CNiL fiNES UP TO(?,YE MUN6ftE0 T+fOUSANO �j y c �
� DqIURS(S1o0,qo0).IN ADDITION TOTHE COST Of C�MPENSATION,DAMAGES AS PROVIUED FOH IN ENERGY PERt�dIT �J d.�7� �r-'
� SECTpN 37ae OF TN6 LABOq CODE,MTEREST.AND ATTORNEV'S FEES. — �
tt RETENTIOtJ FEE'
� CONSTRUGTION LENDING AGENCY ppE-AlT FEE: _ __ tJ
CC I HE0.EBV AFFIqM 11N0ER VENl�TV OF PERJURV THAT THERE IS A CANSiF1UGTiON IENOMG AGENCY -�.�-'�-�-�--.�-
d F4R TNE PERF{1HMANCE OF THE WORK FOR WHICH THIS PERA�IT IS ISSUECI(SEG.308�,pV.C.J. � y/� /;6 7 2.�6
W u �
� LENDER'SNAAIE_ �On� (Pulte flpme �Orb,_�, 1_, —'
1-� LEN�ER'SADDRESS_,_„„ _ _
W ICEATIFVTHATIHAYERERpiHiSAPPI�CATfONANOSTATETMATTHEAeOVE�NFORMhiIONiSCORRECT. TUTA�FEES 3�5UL.2g
� I AGREE'fOCAMPLV WITH AI_L CITV AN�COUN7V ORdINANCES ANO STATE IAWS REUTING 70 BUILpING
� CONSTiiUCTiON,AND NEREBY AUTHOfliZE ftEPRESEMTAiiVE5 4F THIS CqUN7Y 74 ENfER UPON THE
ABOVE-MENTqNEO PROVERTY FOR INSPECTIGN PURPOSES. COMMENTS
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� PERMMEE NAME{PfttNT}
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� SIGNAiUREOFYERMi iEE 6AT� ������� � —
= RECPT.NQ. PAID BY _, r�_VALIDATION_
~ WHITE-Pepa�tment Copy,YELLOW-F'mance Copy,PINK-Assessor C
opy.GOLDENR�ie Copy,GREEN-Rpplicani's Copy
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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 2B
PRESS
FIRMLY
+J
APPLICATION -0
���
NUMBER #
1
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBAC KS
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.AREANALUATION
SFR/ADD/REM 4489 96.30 432 290.70
U) Garage/Carport 780 29.40 22 932.00
W Patio/Deck
�- Pool/Spa
Re-Roof
Commercial
Deck 112 14.70 1 ,646.40
M
Valuation 456 ,869.1 0 ADJ.AREA
QUANTITY DESCRIPTION FEE
a General Electric 366.03
a 8 Garage 0&S 10.40
I- Main Panel
Lu Sub Panel
Z 18 Fixtures
rn 6 Gas Outlest 254.40
1 W/H
a 3 Vent Fans 31.80
13 Registers
2 Returns 43.50
c=, 1 BTU-48,000 18.00
1 BTU-60,00 18.00
CONSTRUCTION 21376.80
PLAN REVIEW 2,020.28
ELECTRIC 263.50 376.43
PLUMBING 101.76 254.40
MECHANICAL 85.00 111.30
INSPECTION FEE
ISSUANCE 100-00
SMIP 45.68
ENERGYP/C 202.02
ENERGY PERMIT 237.68
RETENTION FEE:
PRE-ALT FEE:
P/C 2,67.56
TOTAL FEES 3,502.29
COMMENTS
RECPT N0. PAID BY� 1
VALIDATION
JOBSITE
ADDRESS 23620 Canyon Vista
APN LOT 92-00 TRACT 52267
OWNER Pulte Homes Corp
ADDRESS 18401 Von Karman
CITY Irvine zip 9261'EL. 9497974400
APPLICANT Same TEL.
CONTRACTOR Same as above
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER Mark Gross&Associates
ADDRESS 1551 Tustin ve .
CITY Santa Ana zip 92705EL.9495519777
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 PERMTTTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIRANY 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 9(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 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
^ 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).
^ I.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 UCENSE 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
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
517593
A
LIC. N0.
LICENSE CLASS
Pulte Homes
1/04/O 1
CONTRACTOR
DATE
WORKERS'COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTYOF PERJURY ONE OF THE FOLLOWING DECLARATIONS.
-1 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 WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
Pacifica Employee Ins. Co.
CARRIER
0
0
A
C
43
11 87
POLICY NUMBER W
R
(THISSECrKS4 NEED NOT BE COMPLETED 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.
Pulte Home Corp
114/O1
T
APPLICAN
DATE: -
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.
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 Home Corp)
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
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy