HomeMy WebLinkAbout16171 (9) ' r
_1� CITY OF DIAMOND BAB � `���,
� DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES �
21660 E.Copley Drive Suite 190
(909)86(�3195 Fax(909)861-3117 PRESS
�'^��'� BUII.DING PERMIT APPLICATION FIRMLY
y JOBSITE APPLICATION PERMIT P/C
o ADDRESS 23770 Canyon VIStB COUYt DATE Zf21��� NUMBER 16��� #
� APN LOT 83 ISSUE TYPE OCC
TRACT DATE CONST. GROUP
p OWNER Pulte-l-Tomes
p ADDRESS 18401 Von Karman ZONING SETBACKS
� cirr rvine ziP 92612 re�. 94979744Q0 REART Rw o
� APPLICANT _ TEL.
SIDE/SIDE STREET RW ❑
CONTRACTOR_ PUIt@ Homes SIDE ❑
ADDRESS _ amP
� CITY ZIP TEL. PROPOSED USE �
� ARCH/ENG/
� DESIGNER Mark Gross � Associates
ADDRESS_155� UStil'1 NO.DWEL. NO. NO.
� C�7y S8f1 a na ZIP T�5 TEL. T�09�7 UNITS STORIES BEDFi00M5
�
a� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV�FFlRM UlIDER PENALiY OF PERJURV THAT I AM E%EMPT FROM THE CONTRAC7oRS LI� Gara e/Ca rt
W CENSE UW FOi1THE FOLIOWING RFASON(SEC.7031.5 BUSMESSANO PHOFESSIONS CODE:ANV CITV OR [n 9 �
C.7 COUNT'INM1i1CHREIXIIRE!iAPERMRTOCONSTRUCT,ALTER,IMPqOVE,DEMOLISH,ORREPAIRANVSTFUC-
Z NRE,PRpH TO ITS ISSUANCE,ALSO REW IfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W P3110/D@Ck
� STATEMENi THAT ME OR SHE IS LICENSED PURSUANT TO THE PROYISIONS OF THE CONTRACiORS LI� �
� CENSE LAW(GIAPTER V(�^..OMMENCINO WITH$ECTION 70D0)OF DIVISqN 30F THE BUSINE55 AND PRO� POOUSPa
FESSqHSCODEJOFTMA1HEOfl5HEI5E%EMPTTMEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
TIDN.ANYVKKATIONOFSECTION7031.SBVANYRPPLIGANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z' RB-ROOf
� ACML PENHLTY OF NOT AIOFE THAN FNE HUNDFED DOLURS(f5o0).):
� ❑I,ASOMMEROFTHEPROPERTV,ONMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � Commercial
N7LL DO THE WOF11(,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE�SEC.7oba,BUSI. J
� NESS AND PiiOFE5S10NS COOE:THE CONTRACTORS LICENSE lAW DOES N7T APPLY TO AN OWNER OF
PiqPERTYW1108ULLDSORNAPROYESTHEREON,ANDWHODOESSUCHWOFKNIIASELFORHERSELFOR �
� THRIXIOH MIS OH HEfl OWN EhAPLOYEES,VROVIOED THAT SUCH IMPROVEMENTS ARE NOT INTEN�EO OR m
Q OFFEREDFORSALEIF,HOWEVER7I�EBUILUINGORIMPROVEMENTISSOL�WITHINONEYEAROFCOMPLE�
Z TION,THE OWNER-BUIIDF:fl WILL HAVE THE BVRDEN OF PROVING THAT HE OF SHE DID NOT BUILD Ofl
� IMPROVE FOFl TME PURPCSE OF SALE).
w ❑1,ASONTIER OF TrIE PROPEfiTV,AM E%CLUSIVELY CONTRACTINO WfTH UCENSED CONTRACTORS
Q TO CONSTRUCT THE PRQIECT�SEC.7011,BUSINESS AND PROFESSIONS�DE'THE CANTRACTORS ll� V81U8fI0n ADJ.AREA
W CENSEUWDOESNO7APPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7MEREON.AN� —
� WFiOCONfRACTSFOqSUCHPRO.IECTSWITHAWNTRACTOH(SIUCENSEDPURSUAN7TOTHECONTRAG QUANTITY DESCRIPTION
Y TORSLICENSEIAW.). FEE
Q J
O ❑I AM EXEMPT VNDI:R SEC. __ B.8 P.C.FOR THIS REASON Q
7� U
� �
DATE OVJNER F-
Z — -- (�
O W
F, UCENSED CONTRACTORS DECLARATIqN -�
� W _
I HEREBV AFFIRM IINDER VENALTV OF PF.RIURV TNAT I AM LICENSED IIN�GR PROVISIONS OF CHAPTER �
d Y(COMMENCINO WITH SEC710N]o0oi OF DIV1510N 3 0F TNE BUSINESS AND PROFESSIONS COOE,AM1D Z
�L; MV UCENSE IS M FVII FORCE nND EFFECT. m
� LICENSE CLASS�f_A�17 ���.No. 517 5 93 � -
V DATE 2 G� 1J1 _ CONTRACTOR Puite Homes d
W
� NIORKFf�S'CpMPENSATION DECLAf�ATION Q
� 1 HER� AfFlRM UNDER I�ENqLfY OF PERJl1RY ONE OF THE FOLLOWIN�DECURATIONS: Z
� I HAVE AND WILL AUWTAIN A CERTIFICATE OF CONSENTTO SELF-INSUHE FOR WORKEHS' _
COMPENSATION,AS PPOVI�E�J 9V SECTION 3]Oo OF THE LABOR CO�E.FOR THE GERFORMANCE U
p /�//OF THE W04K FOq WNICH iH�S PER611T IS ISSVED. �
w �1I7.._I MAVE AhO WILL MAINTAIN WORKEflS'CAMPENuqTION INSURANCE,AS REOUIFiED BY SECTION
Q �� 37000F THE LAFinq�E,FOR THE PERFORMANCE OF THF.WORK FOR WHICH T�',IS PEflM1T IS
,. � ISSUED.MV WOFtM:ERS'COMPENSRCI'ION INSURANCE CARRIEFAN�POLICY Nl1M8ERARE� CONSTRUCTION
� CARRIER__P�C I f I�m�IO_�ee '�S• CO. PLAN REVIEW _
ZPO�ICY NUMBFR. ___. �'�J O•I�U 7 A ELECTFiIC _
� � C— _.'_
� (IHISSECIICN^�Ek�)NDTBEQJIrPLETIDOFTFicPERMfTISfORIXvEFR1NXitDOIX.lAfiS�§tOD)ORLESS). PLUMBING _ _ J �.'
Z I CEiiTIF"THRT IN THE PERFORAIANCE OF THE WORIf FOR WHICN fH15 PERAAIT IS ISSUED,I MECHANICAL
(} SHALL NOT ENGL()V ANV VERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE
y WORKER$'CpAIP�_NSATKIN l.hWSOF CAIIGGRNIA,AND AGRcE THAT IF 1 SHOULD BECOME INSPECTION FEE _
SU&IECT TO THE'NORNCRS'WMPENSATION PROVISYJNS Of SECTION 3]CG OF THE LABOR <
� CODE,I SHALL FORTNWI7H f.OMP�V WITHTHOSF PROVISIONS. �SSUANCE �� �U
a exp 5/1��� Pulte Homes sM,P
p DATF: __ L CANT. _ __.___ .. __
J WMNING FAIWRETO SECURE VJORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C ' -
� SUBJECTANEMPLOVEPTOCRIMINALPLNAL7IESAN�CNILFMLSUPTOONEHUNDflEDTHOUSAND ENERGYPERMIT
DOLLARS(5100.000�.IN AODITION TO 7HE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN �
� SEGTION 3�OB OFTIE UFOfl CD�E,INiEREST,AN0 ATTOqNEY'S FEES. RETENTION FEE: '
OCONSTFUCTION LENDING AGENCY PRE-ALT FEE�.
� IHEHEBVAFFlRMUNDER?ENALTVOfPERJUflVTHATTHERE15ACONSTRUCTIONLENDINGAGENCY �
�- FOR THE P[RFORM�HCE OF THE WORK FOR WHICH THIS PERMIT IS ISS�ED(SEC.3o5!,CIV C.). -----
Z
"' None (Pulte Homes Corp)
� IENDER'S NAAIE _
1'- LENDEF'SAD�flE55
� TOTAL FEES �� � �
� I CERTIFV THAT I HAVE RE4D THISAPPLICATION AN�STATE THAT THE A90VE INFORMATION IS CORFECT.
w I AGREE TO COMFL�WIT PLL CITY ANO COUNTY OPDINANCES AND STATE UWS RELATINO TO BUILDING �
2
� CANSTRUCTION,/WD FIEBYAUTFIORIZEREPRESENTATIVESOFTHISCOUNTYTOENTEHUPONTHE
Z ABOVE-MENTIONE oERTY FOR INSPECTION PURPOSES. COMMENTS
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4
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 23770 Canyon Vista Court
APN LOT 83 TRACT
OWNER Pulte-Homes
ADDRESS 18401 Von Karman
CITY Irvine zip 92612 TEL.9497974400
APPLICANT_TEL.
CONTRACTOR_Pulte Homes
ADDRESSSame
CITY ZIP TEL.
ARCH/ENG/
Mark Gross&Associates
DESIGNER
ADDRESS 551 ustin
CITY Santa na ZIP 1705 TEL. 71 55U9III
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 PERMrTTO 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 Y(,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 FORA PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(11500).):
^ 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 CR 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 OFCOMPLE-
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 CONSTRUCTTHE 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
Y(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 LIC. N0. 517593
Pulte Homes
DATE 2 U
NTR
C
1
LO 1
0
ACTOR
WORKERS'COMPENSATION DECLARATION
I HERE AFFIRM UNDER NALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
4
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.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION
3700 OF THE LAPCR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WOlIl ERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER--Pacific Employee Ins. C0.
7
9
TT7
x
LR
_,I;433
O1
-L07A
Y
POLICY NUMBER Y
(THIS SECTION NET)NOT BE OOMPLETEDOF THE PEFRAT IS FOR ONE HUNDRED DOLLARS(5100)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'NORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE,I SHALL FORTHWITH
COMPLY WITH THOSE PROVISIONS.
((��
Pulte Homes
exp 5/1
I
DATE
APPL
CANT
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?ENALTY 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 Corp)
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WIT ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTlON.AND FIEBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTI NE PERTY FOR INSPECTION PURPOSES.
PE EE E(PRINT)
SIGNAT OF PERMITTEE DATE
APPLICATION 2/21/O1 PERMIT 16171 P/C
DATE NUMBER #
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ^
REAR ^
SIDE/SIDE STREET RW ^
SIDE ^
PROPOSED USE
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
Garage/Carport
W Patio/Deck
LL
Pool/Spa
0
Z Re-Roof
Commercial
In
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
0
W
LU
Z
CL
Z
2
U
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
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GRE N-Applicant's Copy