HomeMy WebLinkAbout16172 �� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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21660 E.Copley Drive Suite 190 � �-�r r l� PRESS
�"����+w' BUII.DING PERMIT APPLICATION �~ FIRMLY
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� JOBSITE APPLICATION PERMIT P/C
o ADDRESS��76O Cany9n VISt� COUt't DATE Z�Z���� NUMBER 16�72 �
� ISSUE TYPE OCC
APN I.OT S4 TRACT DATE CONST. GROUP
p OWNER �Ite �"�OIY1P5
o ADDRESS 1R$�11 �/nll Karman ZONING SETBACKS
w CITY Irvine ziP�1�e�.9497974400 FRONT RW ❑
� APPLICANT __ TEL. REAR O_
SIDElSIDE STAEET RW ❑_
� CONTRACTOR SIDE ❑
� ADDRESS PROPOSED USE
CITY ZIP TEL.
o ARCH/ENG/
� DESIGNER Mark Gross & Associates NO.DWEL. NO. NO.
ADDRESS 1�i51 N T�stin UNITS STORIES BEDROOMS
� ciTv�� Ana ziP__21Z05Te�. 7145509777
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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� OWNER-BUIIDER DECLARATION SFR/A�D/REM
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� 1 HER�V AFFlRM UNDER PENALTY OF PERJLIRY THAT I AM EXEMPT FROM THE CANTRACTORS LI- GefeCJB/CelpOlt
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANVCITYOR (J)
C.� �OUMYWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORPEPAIRANVSTRUC� W pg[i0/D9Ck
WTURE.VRIOR i0 ITS ISSU�WCE,ALSO REQUIRES THE APPLICANT FOR SUCN PERMIT TO FILE A SIGNED w
� SU7EMENT THAT HE OR SME IS LIGENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOR6 LI- LL POOVS
� CENSE UW(W�PTER B S��MENCINO WI7H SEGTION 1000)OF DIYISION 3 OF THE BUSINESS AND PRO- ,R Pa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROMAND THE BA515 FOR TME ALLEGED EXEMP� v
TKKJ.M1V VKK.ATqN OF SECTION 7031.5 BV AHV APPLICANT FOR A PENMI7 SU&lEGTS THEAPPLIGANT TO Z Re-Rool
� A CIViI GENALTY OF NOT MOFE THAN FIVE HUNDRED DOLURS(5500).�:
� ❑I,ASOWNfROFTHEPROPERN,ORMVEMPLOYEESWITHWAGESASTHEiRSOLECOMPENSATION, � COmmefCiel
VALL DO THE WORK,AND THE STRVCTURE IS NOT MTfNDED GP OFFERED FOfi SALE(SEC.lOdd,BU51� J
� NESS AN�PROFESSIONS CODE:THE CANTRACTOPS LICENSE LAW DOES N�T APPLV TO AN OWNER OF �
PROPERTY WFiO BUqDS OR IMPROVES THEREON,AND WHO DOES SJCH WORK HIMSELF OR HERSELF OP
[[ TMRIXIOH MIS OR MEN ONTI EMPLOVEES,PROVIDED TH�T SUCH IMPROVEMENTS ARE NOT INTENOED OR m
QOFFEflEDFORSALE.iF,F10WEVERTHEBUILDINGORIMPROVEMINTI550LDWITFIINONEVEAROFCAMPLE-
Z TION,THE OWNERAUR�I:R WILL H�VE THE BUFDEN OF PROVING THAT HE OP SHE DID NOT BUILD OR
� IMVROVE FOR TME PURFOSE OF SALE).
W CI.ASOWNEflOFTHEPROPERiV.NAE%CLUSIVEI�CONTpACTINGWITHLIGENSEDCONTFiAGTORS
� TO CONSTRUCT THE PROJECT(SEC.)Oa�,BUSINE55 AND PHOFESSIONS CODE�.TF1E CONTRAGTOPS U� V81U8110f1 ADJ.AREA
W CENSE LAW OOES NOT RPPLv TO AN OWNER OF APROPERTY 14H0 BUILDS OR IMPPOVES THEREON,AND
� NM1qCONTMCTSFORSUCHPPOJECTSWIiHACONTRACTCR(S)LICENSE�PURSUANTTDTHECANTRAC- QUANTITY DESCFIPTION FEE
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I_ICENSED CONTRACTORS DECLARATIGN -�
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1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM uCENSED UNO[R PFOVISIONS OF CHAPTER �
p� Y(COMMENCINO WITH FECTION 7000)OF DIVIS�ON 3 OFTHF BUSMESS AND GROF[SSIONS CODE.AIJ� Z _
MY LICENSE IS IN FULL FOFGE AND EFfECT. m
� LICENSE CLASS__"' LiC.NQ_ .S�7 S 9� j L�.% y__ ���
V DATE 2 2� L0� ._ CON7RACTOR Pulte._..Ho�mes a � '
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� �S'ORKERS'COMPENSATION DEGLAFATION �
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N I HERE AFFIRM UNDER PENAL7V OF PEHJUitY ONE OF TNE FOLLOWING DECLARATIONS: U
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� IHAVEANOWI�LMRINTP�INACERTIFICATEOFCONSEN7iOSCLFINSUREFORWORKERS' _
COMPENSATION,45 oROVIDEO BY SFC710N 3]oa OF TH[LABOR COOE.FOR THE PERPoRMANCE W
OF THE\VORK FOR WHICH THIS PERMIT IS ISSV fU. �
�
W IHAVEMID WILLMAMTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION
4 97o00FTHFLAP�FGOOE,FORThEPERWRMANCEOFTHEWORKWRWHICHTMISPEHMIT15
� ISSUEJ.MY`NOPKERS'CbMPFNSATION INSURpNCE CARR'�.ER AND POLICV NUMBERHRE: CONSTRUCTION _
� ��Rq,Eq_Pacific Employee Ins. Co. , P�,r,REv�ew
� POLICVNUMBEP_]�1[.I R . 4�(11 1 R7A...— —_.— e�ecTaic
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a missECiqwNri�noreEa�.ErmoFnfff:w�nrr�swaonEMxnaEomuaasryioo'�oa�Essx PLUMBING __ 7
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W I CERTIFY THA7 IN TNE PFRFORMANCE OF iHE WORK fOR WH�CH THIS PEFlMIT IS ISSUED,I MECHANICAL
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� SHALLNOTEMPLOVANYAERSONINANYMANNERSOASTOBECAMESU&IECTTOTHE INSPECTIONFEE
� WORKERS'COMPENSATiON IAWS OF CPLtFORNIA,AND AGREF THAT IF I SH(%1LD BECOMF
� SU&IFCTTOTHEWOFKEiiS'GbMPENSATIONPROVI510NSOF5ECTION3]DOOFTHFlA90R �SSUANCE _ ��-J �
� WL'E,I SNALL FOflTHWITM COMPIV WIiHTHOSE PROVISIONS. �„ . .
� Ex 5/1 (� Pulte Homes sM�P —_
p DATE:�____ �PPL�CANT: .
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J W�RNING�.FA4VRETOSECVPEWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL.ANDSHALLBE . .�_ . '� ° -
� SU&IECTANEMPLOVEPTOCflIMINALPENALTIESANDCIVILFMESUP(OONEHUN�RE�THOUSAND ENERGYPERMIT
DOLURS(f1 W.o00),IN/iDDIT10N TO THE COST OF COMPLNSATION,�AMAGES AS PFOVIDE�FOR IN
J 5[CTION370BOFTMELr\EOHCOOE,INTEREST,ANDNTTORNEY'SFEES. RETENTIONFEE:
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� IHEREBVAFFIqMUNDENPENALTYOFPERJUHVTHATTHENEISACONSTRUCTIONLEN�INGAGENCY
d FOR THE PERFORMANCk'DF THE WORK FOR WHICN THIS PERMIT IS ISSVED(SEC.3oH].CIV.C.�.
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11' None Pulte Homes Corp)__
� LENOER'SNAME_,_
F— LENDER'SADDflESS__ —
� ICERTIFVTHATIHAVEREADTHISAPPUCFTIONAN�STATETHATTHEA90VEINFORMATIONISCORRECT. TOTAL FEES
� I AGREE 70 COM7LV WIlH ALL CITV AND CWNTV OFOINANCES AND STATE LAM'S RELATING TO BULDING
G(NJSTRUCTION,AND HEflEBY AUTFIOR2E R[PflESENTATNES OF THIS COUNT`I TO ENTER 11PON THE
ZNBOYE�MENTIONED PRI)VERTV F INSPECTION PURf'OSES. COMMENTS
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117
BUII.DING PERMIT APPLICATION
PRESS
FIRMLY
JOBSITE
ADDRESS��7G0 Can�gn Vista COUrt
APN L.OT H 4 TRACT
OWNER Pulte Homes
ADDRESS 1841 Von Karman
cITY Irvine zIP 9261�EL.9497974400
APPLICANT TEL.
CONTRACTOR_PUIte Homes
ADDRESS 5
CITY ZIP TEL.
ARCH/ENG/
DESIGNER Mark Gross�Associates
ADDRESS 1551 N.Tustin
CITY Santa Ana zIP 91705TEL. 7145509777
OWNER-BUILDER DECLARATION
1 HEREBY AFFRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSKNS CODE:ANV CITY OR
CWNTY WHK:H REWIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRIOR TO ITS ISSU,WCE,ALSO REWIRES 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 B Sr:OMMENCWG 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-
TKKJ.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
^ 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.Todd,BU51-
NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUBDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THRW(iFi HIS OR HER ONM EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE. IF,HO WEVER THE BUILDING OR IMPROVEMENT IS SIXD WITHIN ONE YEAR OF COMPLE-
TION,THE OWNERAUILDF:R WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID N07 BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
C I,AS OWNER OF THE PROPERTY.AM EXCLUSI�JEI�CONTRACTING WITH LICENSEU CONTRACTORS
70 CONSTRUCT THE PROJECT(SEC. 70N, BUSWESS 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. � .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 SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FOFCE AND EFFECT.
5 �7593
A
LiC. N0.
LICENSE CLASS
CONTRACTOR Pulte Homes
DATE 2 21 O1
Vr'ORKERS'COMPENSATION DECLARATION
E�AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLAP,ATK)NS:
I
H
ER
/
'�j�_ 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT i0 SCLF-INSURE FOR WORKERS'
V�1� �COMPENSATONI,AS PROVIDED BY SECTION 370a OF THE LABOR COOE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUEU.
I HAVE MID WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOIJIRED BV SECTION
37000E THE IABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WOPKERS'WMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
GARRIER_Pacific Emp oXee Ins. Co.
POLICY NUMBER_]L)[ L R C 4�0 1 18 7 A_,_
(THLS SECTION NNE NOT BE OCMPI.ETEDOF TFIE. ff:FfMT IS FOR ONE FO.lt-DRED DOLLARS(5100)ORLESS}
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFIMIT IS ISSUED,I
SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATKNI IAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE: WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABCIR
OMPLY WITH THOSE PROVISIONS.
CODE,I SHALL F
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TH
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C
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DATE: E x�5� 1 APPLICANT: PU Ite Homes
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(f 100.000),IN J,UDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDEU FOR IN
SECTION 3708 OF THE Lr\BOR CODE,INTEREST,AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THENE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.).
LENDER'S NAME,None Pulte Homes Corp)_
LENDER'S ADDRESS
I I CERTIFY THAT I HAVE READ THIS APPLICATION ANU STATE THAT THE ABOVE INFORMATK)N IS CORRECT.
I AGREE TO COMPLY WrrH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
�CONSTRUCTlON,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTKHIED PROPERTY F INSPECTK)N PURPOSES.
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PERMITTEE NAME(INT)
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DATE
7 SIGN R OF PERM�1 E
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TOTAL FEES
COMMENTS
RECPT N0. PAID BY
WHITE-Department Copy,YELLOW--Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREE