HomeMy WebLinkAbout16175 � i
_�`_ CITY()F DIAMdND BAIt
t DEPARTMENT pF COMMUNITY&DEVELOPMENT SERVICBS
� 2266�E.Copiey Ihive Suite 190
�t � (909)86Cl-3195 Faz(909)$61-3117 PRESS
�"�%^"' BUiLDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION PERMIT P/G
a AQDftESS z�72{} CBtIYOt'1 Visfia C4Ut't pq;� Z��If�I NUMBER 1�17� #
g — — ISSUE TYPE OGG
-- APN l.QT 87 TRACT DATE CONST. GROUP
p OWNER pult@ �"�ORIES
p ADDRESS i8401 Von Karman ZONING SETBACKS
� ClTY rvine ZIP 926i2r��. 9�9797R400 REA�RT _ Rw i ❑
APPLICANT _ TEL. — ��
� SIDE/SIDE STREET RW ❑�
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� C]6ASOWNEROFTHF�PRQPER7Y,ORMYEMPl.OYEE&WITNWAGESRSTHEfRSOLEWMPENSATX.iM, � �OlTfinetCia3
Yflll D6 7HE WORK,AND TNE STAUCTURE i6 NOT IMEt1DE6 OR OFFEqED FOR SALE(SEC.70M,BUSI• �..
� NESS AN�PqOFESSION5<%1DE:T1E CONTMCTORS LICENSE IAw DOES NOT APPLV Tp AN pWryER QF �
PHOPEfRY VhK)BUIlD50F;MAPqOVES TNERE�N,AND WriO OOES SUCH WORK H!MSECF OR HERSELF�R
tC TNROUCiNHi60RNEHOWNEMPIOVE£S,PROYIDEDTHATSUCHIMPRQyEMENT5ARENOTINTEN4EOOR �
� OFFEREDF6RS/LEIF,FIGWEVEI;TIIEBUILDIN60RIMPRQVEMENTISSOIDVJI7MINONEYFAROFCqMPLE-
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IMPR4VE FOR TNE PURPOSE OF SALE).
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[� TO tSJNSTRUCT T}iE�RQ7ECT iSEC.70�t.BUSINE5R AMi PROKE65IIXJ5 CQClE:TME WtJTRACTOflS U- ValUeti0ll ADJ.ARER
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� WFIOGONTAACTSFORSUCHPROJECTSWtTHACIXITRACTOR{S)i.iCENSEDAURSUPNTt4THECQNTRAG QUANT7TY dESCRSPTION FEE
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d 9iCOM4ENCMO WiTH SEC�'iON 7Doo)OF DIV15roN J OF7Mf.eU51NE55AND PROFESSIONS CODE,AND Z
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�j�i HAYE M1D WtLL MAIN7AIN WORKER5'COMpEN5A710N INSl1RANCE.AS REOUIRE�BV SECTION
� 3700 OF THE I.ABCA COUE.FOR THE PEflFbNMANCE OF TNE WORK F6R 4VHICH Ttti.^+P�31MiT 35
ISSUE6.MV WORKEitS'GYJMPENSATKiN�NSll"�ANCf C�RPIER ANO i'OL�CY NUMBEfl ARE'. CONSTRUCTION
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SC SNAlLNO7FMP.OV.WYpEHSONWANYMANNER90ASTOBEGOMESUBJEGTTOTHE
� WOflKERS'COMAEk::ATqNUW50FCPLit4RNiA,ANGMiREETHATlFt$HOUIDBEGGME INSPECTIONFEE
SUBJEC7TOTHE WORKERS'WMPEN5AiIGN PRGVISIONSOF SECTiON 3700 pF THE INBOR �S' '��—�
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� SUBJECTAN EMPLOYER TO CRIMINAL CpNALTIES ANtl CIVLL FlNES U7 TO ONE NUNDRED THOUSAND ENERGY PERMIT
r OCiLARS{it9d.0oo},iNADDfSiON7�THEGOS70�C4MPENSATION,DAMAGE5A5PROYiDEOFOfl{N '" ' ""-�t. '
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J� BECTION 370t1 Of?HE LA00F COfJE INTEREST,AND ATTORNEV'S FEES. � ., ,. - -�� - - -
RETENTION FEE: � � �
� CONSTV7UCTtON LENDiNG AGENCY PRE-ALT FEE:
� INERE9YFSFIRMUNDENPENAITYDFpFft,tUftYTt1ATTti_ftEiSACQNSiRUCiIONlEN6INGAGENCY ` __
�OR TNE PEPFORMANCE l3f"HE WORK FOR WHICH iH15 pERMIT IS ISSUEO(SEC.3�&7,C;V.C.). �
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F l£NDER'SADDNESS �
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� t CERTIFY FHAT i HAVE READ':HIS A4'PUCATIONAHQ STATE TFtAT 7NE A80YE MFL7RMATqN iS COftRECT. TU�A�FEES (I�) � ��
U"� I AGRE6 TO COMPLY N7TH ALL CITY ANp COUN7Y O%61NANCES AN�STATE LAWS RELATING TO 6UILD�NG t
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� CONSTRUCTIbN,qNbHEqEB!'AUTHOFIZEREPRESENTATNESOFTHISCOUNTYTOENTERUPONTHE
A80VE�MENTKNtEO PROPERTY FOA�NSP-CTION AVRP4SES. COMMENTS
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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
PRESS
FIRMLY
JOBSITE
ADDRESS 23720 Canyon Vista Court
APN LOT 87 TRACT
OWNER Pulte Homes
ADDRESS 18401 Von Karman
CITY Irvine zip 92612FEL. 9497974400
APPLICANT_TEL.
CONTRACTOR Pulte Homes
ADDRESSSame
CITY ZIP TEL.
ARCFUENG/
DESIGNER MaRK Gros&Associates
ADDRESS 1551 usttn
CITY Santa Ana ZIP 91705EL. 7149909777
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS I.I.
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 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL 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).
^ 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 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
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
LICENSE CLASS
LIC. N0.
DATE 2 X21 O1 CONTRACTOR-. PUIte Homes
WORKERS'COMPENSATION DECLARATION
II H AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS.
1 NAVE AND WILL MA NTAIN 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 WORKEfIJ COMPENSATION INSU LANCE CARRIER AND POLICY NUMBER ARE:
CARRIER-Pacific Employee Ins.Co._
POLICY NUMBER 1 1 8/A
(TH6 SECTlON NEED NTT BE COMPLETED OFT)E PERMIT IS FOR ONE HAIRED DOLUJSS($100)OR LESS}
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I
SHALL NOT EMPLOY SITY 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,ISHAtFgjor COMPLY WITHJOu)tPROV o 1.511 mes
//
DATE:
APPLICANT:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS 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. 3067,CIV.C.).
LENDER'S NAME None(Pulte Homes Corp)
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ-i HIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 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 INSP-CTION PURPOSES.
PERMITTEE NAME(PRIN
SIGN E OF PERMITT DATE
APPLICATION
PERMIT
P/C
2/21/O1
1617 5
DATE
NUMBER#
ISSUE TYPE OCC
DATE CONST.GROUP
ZONING SETBACKS
FRONT RW^
REAR^
SIDE/SIDE STREET RW^
SIDE^
PROPOSED USEI w2
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
W Garage/Carport
LU Patio/Deck
LL Poo)/Spa
C)
Re-Roof
Z
Commercial
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
Q
U
Ix
U
W
LU
0
z
z
z
u
w
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C��--
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES
COMMENTS
RECPT. N0. PAID BY VALIDATION
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