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Home My WebLink About17333 (10) /_��`z CITY OF DIAMOND BAR � ' 1��- �*'�� ', DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVIC �w�\�� 21825 E.Copley Drive �� (909)8603195 Fax(909)861-3117 7 �� PR SS � BUILDINGPERMITAPPLICATION /G �--/ �,�G- MLY � JOBSITE �� DATE_ '\ �� NUMBER - ¢ ��,� �,� APPLICATION PERMIT o ADDRESS__ -� r � /C ^° APN LOT TRACT j 1 ISSUE TYPE OCC p OWNER�1te Of17@S — DATE CONST. GROUP o ADDRESS �s�0� 011 arman t@ ZONING SETBACKS ociTv I rvine ziP 92612re�. 949797 00 FRONT RW � p APPLICANT _ TEL. REAR � Z SIDE/SIDE STREET RW ❑ Q CONTRACTOR_ SAME SIDE � � ADDRESS � ��T�' ZIP__ TEL. PROPOSED USE �.. , ,(' 0 w ARCH/ENG/ z DESIGNER HOV@ Design � ADDRESS 2�L�-NeW OY' �enter Ui. NO.DWEL. NO. NO. � CITY �@W O�P't BC�IP 92660Te�._94976 0 2 UNITS_ STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION O SFR/ADD/REM p I HEFEBV AFFIRM UNJEfl PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS L6 G8f8 B/C2f W CENSEIAWFORTHEFOLLOWWGqEA50N(SEC.7C31.58USINESSANDPROFESSIONSCODE:ANVqTYOR (n 9 P�� U COUNTVWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IAAPROVE,DEMOLISH,ORREPAIRANYSTRUC- py�i0/DeCk W TURE.PRIOR TO ITS ISSIIANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT 70 FlLE A SIGNED w � STATEMENT THAT NE OR SHE IS LICENSED PURSUANT TO TNE PROVISIONS OF THE CONTRAGTORS LI� O CENSE LAW(CHAPTER 9(GOMMENCING WITH SECTION]ao0;OF DIVISION 3 OF THE BUSINE55 ANO PRO- � POOVS�J2 FESSIONSCO�E)ORTHATHEORSHEISEXEMPTT4EREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (� U TION.ANVVIOLqTIONOFSf:CTION]o31.5BYANYqGPLICANTFORAPERMIT5U9JECT5THEAPPLICANTTO Z Re-Root � ACIVILPENAITVOFNOTMJRETHANFIVEHUNDRE000LLAR5(SSOOj.): � GI,ASOWNEROFTHEPqOPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z WILI DO THE WOfU(,AND THE STRUCTUflE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.�oda,BUSI- J � NESS AND PROFESSIONS CODE THE CON'RACTORS LICENSE I.AW DOES NOT APPLV TO AN OWNEq OF j PROPERTY WHO BUILOS Ofi IMPflOVES THERFnN,AND WHO DOES SUCH WORK HIMSELF OR HERSE�F OR Q THROUGH HIS OR HEROWN EMPLOVEES.FROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDEDOF m OOFFEREDFORSALE.IF,HOWEVER,7HEBUILDMGORIMPROVEMENTISSOLDWITHINONEVEAFOFCOMPLE- Z TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 010 NOT BUILD Uft � IAAPROVEFORTHEPURPOSEOFSA�E). w ❑I,AS OWNER OFTHE:PFOPERTY,AM EXGLUSNELV GONTRAGiING WITH LICENSFD CONTRACTORS � TO CANSTRUGT THE PROJF_CT(SEG.]044,BUSINESS AND PflOFE5510N5 CODE:THE CONTRACTOflS LI- V8I118I1011 ADJ.AREA = CENSELAWDOESNOTAPPLYTOANOWNEROFAPRD7ERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTFACTSFORSUCHPROJECTSWI7HACONTRACTOR�S)LICENSEDPUPSUANTTOTHFCONTRAG QUANTITY DESCRIPTION � TORSLICENSELAW.). FEE I Y � ❑I AM E%EMPT uNDER SEG J Q B.8 P.G FOR THIS REASON Q � - U LL DATE OWNER F-�- U � LICENSED CONTRACTORS DECLARATION � Q w � I HERE6Y AFFIRM UNDER PLNALTV OF PEFJURV THAT I AM IICENSED UN�ER PROVISIONS OF CHAPTER � d 9�COMMENCWGWITHSEC'"ION7000)OFDIVISION30FTHFBl151NESSANDP90FESSIONSCOD_,ANO Z �X MY UCENSE IS IN FULL FORCE AND FFFECT .� � LICENSE CLASS!°► 1 �,o.No. 517593 � V DA7E Exp 9 30 �1 CONTRACTOR PUIte d W � WORKERS'COMPENSATION OECLARATION J � Q � I HEREBV AFFIRM UN�ER Pf:NALTV OF FERJURV ONEOFTHE FOLLOWING DECLARATIONS�, U � Z � I HAVE AND WILL MP.MTAIN A CERTIFICATE OF GONSENT TO SELF-WSURE FOR WORKERS' ¢ Z = Q COMPENSATION,AS PROVIDED BY SECTION 37a00F THE LABOR CODE.FOR THE 7ERFORIAANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W , 0 � w _I HAVE AND WILL MPINTAIN WORKERS'COMPENSATION INSURRNCE.AS REOl11qE0 BV SECTION � 3�00 OF THE LABOq CODE,FOR THE PERFOqMANCE OF THE WOqK FOR WNICH THIS PERMIT IS ISSUED.MY WOPKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE� CONSTRUCTION � PaCifiC Em Ins. Co. p�qNREVIEW CqRRIER 7�p�1�1� � Poucr nurneEa W v R L'i O� 7 ELECTRIC Z - — ._ Q - Q (1HISSEC110NNEmNDTBECOMPLEfEDOFTNE�EHMITISFORONEHUMRED00.LqRS(bloo)ORLE55). PLUMBING • W - Z I CERTIFV THAT IN TIiE PERFORMANCe OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.I MECHANICAL CJ SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SOAS TO 6ECOME SUBJECT TO THF (Jj WORKERS'COMPE�SATION LAWS OF CALIFORNIA.AN�AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SUBJECT70 THE WORKER5 COMPENSATION PROVISIONS OF SECTION 3]OOOFTIIE LABOR � COOE,1 SHALL FORI'HWITH COMPIV WRH THOSE PROVISIONS. ISSUANCE p DATE: �-�O-y��pLICANT Pulte Homes SMIP � W � WARNING FAILURE TO SECURE WORNERS'COMPENSATION COVERAGE IS uNLAWFUL,AN�SHALLBE ENERGY P/C J � SUBJECTANEMPLOVERTOCFIMINALPENALTIFSANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100,�0�),IN AODITION TO THE COST OF COMPENSATION,DAMAGES AS PROV IDED FOR IN J SECTION3]OBOFTHELAB09CO�E,INTEREST.ANDATTORNEY'SFEES. RETENTIONFEE: 2 W � CONSTAUGTION LENDING AGENCY PqE-ALT FEE: � 1HERE6VAFFIf1MUNDERPENALTVOFPERJURVTHATTHEREISACONSTRUCTIONLENDMGAGENCV FOR THE PERFORMANCE Of THE WOHK FOR WHICHTHIS PERMIT IS ISSUED(SEC.3o9],CIV.C.�. ---- Z �"' �lone (Pulte) - LENDER'S NAME . � f-- IENDER'SADDRESS � W I CERTIFY THAT I HAVE REAC THISAPPLICATION AND STATE THAT THE ABOVF INFORMATION IS CORFECT. TOTAL FEES 6'6.CJ O � 1 AGREE TD COMPLY WITH ALL CITY AND COUNTV OR�INANf,ES AN�STATE L4W5 RELATING TO BUILOING � CONSTRUCTION,ANDHEREI3VALITHORREREPRESENTATIVESOFTHISCOUNTVTOENTERUPONTHE Z ABOVE�MENTIONF[]GROPEFITY FOR INSPECTION PLRPOSES. � COMMENTS J -- � m PERMITTEE NAME(PRINT� Q � _. _ � SIGNATVREOFPERMITTEE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy 1 �� -�� " � � " �' ,°��=��n'��.�� . � � � � _ . ��,��_.�,.��__ � � _ _ __ _ . k. �', 4 " ; ... .. .... . .... .. e.i � fiW: � E 3 �3 H p , ..., .. ... . ... ._... .... .. ..... � �� ,� d � , . .. . . . .. . . . . . p ��y�8i�r�4� �X� �, C �S� � x � ��a�>��4 d€�:4i-d—�`. $ "'- .. � � „�� r,� � t _:i a d .._ . .. . _. . . .. .. . . .. . . . . ..... ._ .. . ._. .__..... ,'��. �n_ � . E �' i + . .. . . . . . .. . . . . . ... ..... ... _.... . , :' e : Y �� ',. • _" 'n�..� r tr��"�" „i�k��k ,� .. . . � . ._. ,, � ... _. . . . ,, i; ,�, n 3', ... _ .. . � ..v i�. v,�j u � � a . , � n� a ir�. . " " . . . . . . .. ... . . ... .. . ... . .... .. . . '!. t i ( .. . . . . . ' k , _: .—, _ . . . � ` . .. .. .. -- , �� . lae ,: . . . . . — CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVIC, 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION t, JOBSITE Q S I 1 r �,�,rI ADDRESS- )Y APN LOT TRACT OWNERlte omes ADDRESS 18401 Von Karman to CITY Irvine zip 92612TEL.949797 4400 APPLICANT TEL. CONTRACTOR_SAME ADDRESS CITY ZIP TEL. i De n /H 9 ove s DESIGNER ADDRESS2'Iflr eW or Center Dr. CITY New port Bch 92660TEL._94976 0 2 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 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 SEC--ION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. 517593 A LICENSE CLASS L)C. N0. DATE ExD 9/30/O1 CONTRACTOR Pulte WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 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 LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: Em Ins.Co. CARRIER Pacific cE W o K L4301 1 8/A POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 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 WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. T Pu 1 to Homes 5- 10-a'APPLICA DAT E: N 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) LENDER'S ADDRESS I CERTIFY THAT I HAVE REAL THIS 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 PROPEFTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE 71- PERMIT /C APPLICATION�, DATE NUMBER 1 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 S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PooVSpa 0 Re-Root Z Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U I- U w w 0 Z ED .5 a Q U Z 2 U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 66.50 COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy