HomeMy WebLinkAbout16173 (9) _`�_ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117 � PRESS
'�^' BOILDING PERMIT APPLICATION l'/�J� "�'�� FIRMLY
¢ DDRIESS 2'3750 Canyon VIStB COUYt APPLICATION 2�21�Q�- PERMIT 16�73 P/C
p DATE NUMBER #
� ISSUE TYPE OCC
� APN LOT $5 TRACT DATE CONST. GROUP
p OWNER 18401 Von Karman
o ADDRESS Pulte Homes ZONING SETBACKS
� CITY IYVICI@ ZIP 9261 TEL. O FRONT RW ❑
APPLICANT _ TEL. REAR ❑
� SIDE/SIQE STREET RW ❑
CONTRACTOR_ PUIt@ HOtll@S SIDE ❑
p� ADDRESS Same
� CITY ZIP TEL. PROPOSED USE
oARCH/ENG/
DESIGNER Mark Gross � Associates
ADDRESS �ri5� N_ Tustin NO.DWEL. NO. NO.
� CITY Santa Ana ZIP�1705TEL.��R$SO97�� UNITS STORIES BEDROOMS
[n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDEA DECL4RATION SFR/ADD/REM
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I HEREBY AFFIRM UNDEH PENALTY OF PERIURY 7HAT I MI E%EMP7 FROM TNE CONTRAC70R5 LI- Garege/CefpOrt
W CENSEUWF01iTHEFOLLOWINGREA50N(SEC.7031.SBUSINESSANDPROFESSIONSCODEANVCITVOR (n
C7 ('bUNfYNM1IN`,HREWIRESA7ERMRTOCONSTRUCT,ALTER,IMPROVE,DEIAOLISH,ORPEPAIRANYSTRUC.
Z TURE,PRIDR TO ITS ISSUANCE,PLSO REOUIPES TNE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED W P8I10/DBCk
� STATEMENT iHAT HE OR SHE IS LIC[NSED%1RSUAM TO hiE PROVISIONS OF THE CONTMCTORS LI�
CENSE UW(CFIAPTER 9(I:OMMENCINO WITH SECTION�ao0)OF OIVISION 3 DF THE BVSINE55 AND PRD- LL POOUSPB
FESSqNSCODEjORT11ATHEOR5HEI5EXEMPTTHEREFROMANOTMEeA515FORTHERLIEGEDE%EMP� C7
TIDN.MIVVKKATIONOFSECTION7031.56VANVAPPLICANTFORAPERMIiSUBJECTSTHEAPPLICRNTTO Z Re-Root
� A CMl PENALTY OF NOT MORE THAN FIVE HUNORED DOLIARS(f50o).�:
� ❑I,ASONMEROFTHEPROPERTY,OflMVEMPLDVEESWITHWAGESASTHEIR50lECOMPENSATION, ❑ CORIrt10fClel
YALL DO THE WORK,hND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.704�,BUSI� J
� NESS IWO�ROFESSIONS iX/DE'TME CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WViO BUILDS OR IMPROVES 7HEREON,ANO NMOOOES SUCH WORK HIMSELF OR HEFSELF OR
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� OFFEPEDibRSALEiF,HOWEVERTMEBUIL�INOORIMPROVEMENTI550LDWITHINONEVEAflOfCOMPIE-
Z TqN.THE OWNER-BUILDEfl WILL HAVE THE BVROEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
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LL' DATE __—._—.___. OWNER____.-___ ¢r�
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� LICENSED CONTRACTORS DECLARATION W _
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� I HEREBY AFFIRM UNDER PENALTY OF PERJl1RY THAT I AM L'CENSED UNC[R PROVISIONS OF CHAPTER �� /J
d Y(dJ1AMENCINO WITH SECTION 70cp)OF�IVISION 3 0F 7HF BUSWESS AN�PPOFESSIONS CADE.AN� Z '� `I �—
X MY LICENSE IS IN FULL FCaCE AND EFFECT. m
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V DATE �/���Q� CONTRACTOR�U 1 t� f7 V�IeS d
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U� N'OFiKEFl:i COMPENSATION DECl,4RAT10N �
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� I HERE �FFIRM UNOER PEMALTV Of PERIURV ONE OF THE FOLLOWING DECLAM?IONS: Z
d �MAVE AND WILI MAINTAIN A CERTIFICATE OF CONSENT TO SFLF-INSURE FOR WDRNEflS' =I
Q ��COMPENSATION.J�.S PHOVIOED BV SECTION 3T10 Of THE UBGH CODE.FOft THE PERFORMANCE w
O OF THE WORK FOIi WHICN THIS FEAMIT IS I55UED. �
� I HAVE MID WILL MAINTAIN WORNERS'COMPEN5ATION INSURANCF,AS RE�UIRED BY SECTION
Q 37000FTHE LAk7GR CO�C,FOfl THE PERFORMANCE GF TNE WOFK FOR WHICH�HIS PERMIT IS
ISSUED.MV WORNEFiS'COMPENS�110N INSURANrE CARPIERAND POLICY NUMBERARE: CONSTRUCTION
_ __ —_
> �ApR�Eq__Pa'"7c�ific Em lo e�e �Ins. Co. PI_ANREVIEW _ __
Z POLICYNUMBER__ YY_LIC � O� H/f1 ELECTRIC _ _
� (RYSSEG'110NYE91NOTBEQNrri*_ETEDOFT£PEWAITI,SFOROFiEMN�OfiEDDOLIMS(S1ooJORLESSF PLUMBIfJG , � �
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Z �CEHTIFY THAT IN THE VEFFORMANC[OF THE WOP.K FOH WHICH THIS PEFMIT IS ISSUEO,1 MECHANIGAL
�!} SHALL NOT EMPLOV ANY 7ERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO TH[
� WORKERS'COM7[NSATIONLAWSOFCALIFONNIA.AN�ACHEFTHATIFISHOl1L�8FCOME INSPECTIONFEE
= SU&lEC f TO THE�NORKERS'C01A7ENSATION PROVISVJNS OF SECTION 37oa OF THE LABOR
CODE,I SNALL FORTNWII N COMPLY WITH THUSE PFlOVISIONS. �SSUANCE � �I
� ex 5/1 /0 Pulte �iomes SMIP
p DATE:_�__.__ A�PLICANT: _ - . ,.���'� I
J WARNING FAIWRETO SECl1HE WORKERS'COAIP'cNSAT10N CAVERAGE IS 11NLAWFUI,AND SHALLBE ENEFGY P!C ;
SVBJECTAN EAIPLOVEN TO CRIMINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED THOUSANO � n
� DOLLARS(5100.000�.IN AODITION TO THE COST OF COMPENSATION.DAMAGES AS PHOVIDED FOR IN ENERGY PERMIT ��.__J .� i I ��
J SECTION 3�oe OF THE LAFOfl COOE,INTEREST,AN0 ATTORNEV'S FEES. RETENTION FEE:
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d CONS7RUCTION LENDING AGENCY PFIE-ALT FEE:
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� I HEREBV AfFIRM UNDER oENALTV OF PERJURV THATTHERE ISACON57RUCTION LENDING AGENCV _ '
FOR THE PERFOPAIANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUEO(SEC.3oSt,CIV.C.).
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� LENDER'SNAME____Nnne �U�te Homes l.�rR, _
H LENOER'S ADDRE55_
� I CERTIFV THAT I HAVE READ THIS APPLICATION AN�STATE TNAT THE ABOVE WFORMATION IS CARRECT TOTAL FE ES � ,�' v
W I AGREE TO CIJIAPLY WI7N ALL CITV ANO COl1NTV DR�INANCES ANO STATE LAWS REIATMIG TO BUILDING
�
� CONSTRUCTION,ANO MEqEBY AUTHORIZE REPRESENTATNES OF THIS COUNTyTO ENTER UPON THE
Z ABOVEMENTIONED PROPERiV FOR INSPECTION PUAPOSES. COMMENTS
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U1,INIISU U,11C
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117
BUILDING PERMIT APPLICATION
PRESS
FIRMLY
JOBSITE
ADDRESS 23750 Canyon Vlsta COUrt
APN LOT$5 TRACT
OWNER 1 $401 VOn Karman
ADDRESS Pulte Homes
cITY I rv�ne ziP 9261 TEL. �
APPLICANT_TEL.
CONTRACTOR- PUIte HOmeS
ADDRESSSame
CITY ZIP TEL.
ARCWENG!
DESIGNER Mark Gross�Associates
ADDRESS� 551 N Tustin
CITY Santa Ana zIP�1705TEL.7145509777
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSELAW FOFi THE FOLLOW ING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR
COUNTY WHK:F1 REQUIRES A PERMRTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRK1R 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 IAW(CHAPTER 9((XIMMENCING WITH SECTION 7000)OF OIVISK)N 3 OF THE BUSINESS AND PRO-
FESSIONS CODE] ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED EXEMP-
TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f50o).):
^ I,AS OWNER OF THE PROPERTY,OR MV 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 ix1DE:THE CONTRACTORS LICENSE IAW 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 IMPROYEMENTS ARE NOT INTENDED OR
OFFERET! FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TqN,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 PRQIECT(SEC. 7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI-
CENSE IAW DOES NOT APNLV TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WFq CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR{5)LICENSED PURSUANT TO THE CONTRAG
TORS LICENSE UW.).
^ I AM EXEMPT UNDER SEC. ,__B.8 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
0 (COMMENCING WITH SECTKNi 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MV LICENSE IS IN FULL FCRCE AND EFFECT.
517593
A
LIC. N0.
LICENSE CLASS-T
u to mes
2�21 (u1
CONTRACTOR
DATE
WORKERS'COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PEMALN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
w
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F/,Y•
r
I NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'
Y
COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABGR CODE, FOR THE PERFORMANCE
OF THE WORK FOIi WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
3700 OF THE LAdCR CODE, FOR THE PERFORMANCE GF THE WORK FOR WHICH THIS PERMIT IS
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CARRIER_haCIfIC ECM
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POLICY NUMBER_.___
(fFY55ECT10N NEH7 NOT dE CCAAA_E7ED OF THE PERMT 0: FOFi ONE HLNDHED DOLLARS(SI WJ OR LESSF
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
�iUBJECf TG THE WORKERS'(XIMPENSATION PROVISIONS OF SECTK7N 3700 OF THE LABOR
CODE,I SHALL FORTHWIT
H COMPLY WITH THGSE PROVISIONS.
�E
DATE:exp 5/1/QAPPLICANT: PUItP. Homes
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIGN COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTK)N 3708 OF THE LABOR C00 E,INTEREST,AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER�ENALN OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3057,CIV.C.).
NOnE jPUlte Homes Cori)_
LENDER'S NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATK)N AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES ANO STATE LAWS REUTING TO BUILDING
CONSTRUCTION,ANO HEFIEBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
D PROP ERN FOR INSPECTION PURPOSES.
ABOVE-M
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PERMITTEE E(PRINY,
SIGNATU OF PERMITTE DATE
WHITE-Department Copy,YELLOW--FinarECe Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy