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Home My WebLink About17334 / ��. _ .��,. CTTY OF DIAMOND BAR �x W� DEPARTMENT OF COMMt.)NTI1'8c DEVELOPMENT SERVICES 21$25 E.Capi�y Ihive (909)860.3195 Fax(909)861-3117 � PRESS `�w��' BUILDING PERMIT APPLICA'FION FIRMLY � JOB5ITE /'� � �ry Y ��L n APPLICATION � � ,,,,'�,� PERMIT �_ '_t��'_ PIC � ADDRESS_ 1�� {�� DATE NUMBERY � # � ^ ISSUE TYPE OCC APN �OT "�.! TRACT. .�3�;._�____ DATE CdNST._ GFt4t7P c, owNER Pulte Homes p ADDRESS 18401 Von Karman Ste 200 zorowG SET'BACKS s CITY__(_�'Vip� 2IP�.�2fEL �!{g7�']!}t{a� FRC7NT RW ❑ � APPIICANT TEL. REAR ❑ � SkDEtS1DE STREET RW O Q C4NTRACTOR__�AM� SIpE �7 ADDRESS /► �-: a CITY ZIP TEL. � PROPOSEpUSE �la.� {�-. � ARCHlENG! z DESiGNER HOV!' D�5igi'1 .,___ w NQ.DWEL. NO. NO. � AQDfiESS �-4�-R@WS3Qt"—t C.enterZ�r. u> UNITS STORiEB EiEDR4(}MS � C�Tv v N��ri- Rt�P ._92fi6.OTE�. 9497600812 - us DESCRIPTIC7N S4.Ff. FAGTOR FSF ADJ.AREANALUATIQN � OWNER-BUILDEFi DECLARATION � 9FR1ADplflEM [� I NEREBY AFFIRM UNDER PENALTY OF PER.It1RV THAT I AM E%EMVT FROM THE CONTRAG7qq5�I� G0I'8J8/CBfPOR W CEtJSEtAWF6RTFiEFIXtOW6JGREASON(SEC.7C31.58USINESSANQPflOFESSION5C06EANYGiTYOR {f) C.) COUNTVWHICHREOUIRESAPERMITTOCANSTRUCTALTER.IMPRqVE.DEMOLISH,ORREPAIftANVSTRUC� W TURE,PRIOq TO ITu ISSUANCE,ALSO REDUIRES THE APpLICANT FOR SUCH PERMIT TO FILE A SIGNED W PeI10/DBCk � STATEMENT THAT HE OR SME IS 4IGENSE4 PURSUAM TO THE PRONSIQVS QF THE CONTflACTt3R3 tI- � CEN56 LAW(CHAPTEP 9(GqMMENCINQ WRH SECTION]000)OF DIVISION 3 OF THE 9USINF5S A40 PRO� pO0USP2 � FESSIQNSCOOE}OFiTHATNEDRSHEISE%EMPTTHEflEFAqMANDTHc9ASISFORTNEALIEGEDE%EMp� � � T10N.ANVVIOLATI�AIO�SECTIONJ03t.5BYANYAPPItGANTF4RpPERMITSUBJEGTSTHEAPPLiCANTTC z Re-Roof r, A CIV0.7ENAl.TV OF NOT MORE TNAN FryE NUN�RELI DOlLARS(;500).�: a �I,ASbWNEF�THEPAOPERTY,ORMYEMPIOYEESWkTHWAGESASTHE�fi50lECAMPENSA710N. � �ommeroiai � WILI DO THE WOAK,AN�7HE 57RUCTItRE IS NOT M7eNDED OR OFiERED FpR SALE iSEC�vaa,BU51� J � NESS AND PROFES910NS CADE:THE C6NTRACTORS LICENSE LAW DOES NOT APPIY TO AN OWNER OF � PROP[flTY WH4 BUiIDS OR IMPAOVES TH£PEC�N,ANO WHOIXlE5 SUCH W6RK HIMSEIFOFt tiEPSELF OA [C THHOIIGH HI9 OR HEH OWN EMPIOYEfiS,PROVIDEp THAT SUfH IMPRDVEMENTS ARE NOT INTENDED OR m W pFFEftEDFORSALE.IF,NOWEYER,THEOUILDINGOFIMPROVEMEN715SQI.DWITHINONEYEAROFCOMPLE� � T%7N,TNE OWNEft�BNIDER Wit�NAVE T4E 9URDEN OF PR6VINC`i TiiAT HE OR SiiE DiD NOF BUtt,6�R ' 'Z IMPROVE FOR THE PUflPOSE oF SALE). � DI,ASOYMEflOFTHEPROPEFlTY,AMEXCLU5IVELYCONTRACTINCiWITHUC[NSE�CANTRACTORS W [C TO CANSTRUCT TNE PROJECT(SEC.70sa,BUSiNESS AND FAOFESSIONS COpE:iHE GUNTftACTORS Li- V0IU8tiOn ADJ.AFIEA W CENSEIAWpOESNOTAPPLYTOANOWNERpFAPROPEFTVWHOBU14D50RIMPFpVESTNEREON,ANp —" — - � WHOCONTpACTSFORStlCHPftpJECTSWtTHACONTRACTOR(S}tiGENSEDPUftSUAN7TOTHEGOMftAG {,�(J}\(�'(}'('y pESCR4PS14N � FEE � TORS UCENSE LAW). 4 O{AAi EXEMPT UNpER SEC._ ,_ 8.&PG.FOR TH1S RfASON Q '�,+ U � — .....V..—.. � PATE�_�____ OWNER� �. U � ... �` W � UCENSED CONTRACT6R$DECIAFiATi6N W �[ � i HEA68Y AFFIRAi UNOE({PENAt.TY 6F PERJURY THAi iAM I.tCENSEO UNDEFt FftaVi810NS QF GHAPT£R �, p,. 9(COMMENCING WITH SFCTION l000�OF DIVISION J OF THE BUSIN'e5S AND PROFE5SION9 CODE,AND Z � MY LICEHSE I$IN fUIL FORCE AND EFFECT. � �� t�� LICENSECLASS_�_._.._t ._ ��o.Na. �17593 _� � �� bATE v�„�„ 9 I�EI 7 O.� CONTRACTOR �Il('�Q , a W � WORKER5 C6MPENSATION DECLARATION Q � i MEREBY AFfiRM UN6ER PENA�TY OF p�AJURY ONE OFTH6 FQI.�OWING D£CtAftATbNS: Z � � ,___IHAVEANOWILLMAINTAINACEftTiFiCATEOFCONSENTTOSEI�-iNSUREFORWORI(EftS' _ ,� CAMPENSATION.ASPROVIDEDBVSECTION37ooOFTHELABOFtCOOE,FORTHEPERFOPMANCE U � OF THE WORK FOR WHICN THIS PF.RMIT IS ISSUED. � � I HAVE ANG WILL MAWTAIN WOflKER5'COMFENSATION INSURANCE,AS REQUIREp 6V SECTION Q �37400fTHEL480RCDDE,fORTHEPERfURMANCE4FTHEWORKFORN'HICHTHISPERMITIS ISSUED.MY WORKERS'C.00MPENSATIQN INSURANCE CARRIEIR�AN�PO'_iGY NUMBE9 ARE. CONSTRUGTI{JN j cnRpiErt..,,,_ ��C,��rII� Emr�1 /�, tnns./� 4�. _ PLANREVIEW ' . _ � POLICV NUMBER,_YY O R LH 3{/��0 7/1___ ELECTRIC ,. 4 l�t /� � (iHISs'EGTM)NNEE7?No7gECDMRE�EdCFT11EPERhUTISFf7RaJEHUhVREDOCY.LARS(Eim)CN3LES5). PLUMBING _ `f t.��7 � i cERTIFV TNAT IN THE PERFORMANGe OF TNE WURK tOR wnICH iHiS PERMI7 IS i53UED,� MECHANICA� ____,,, (� SHALLNOTEMPI..OVANVPERSONINANYMANNERSOAST09ECOMESUBJECiTOTHE Uj ri'ORiCERS'COMPEttSATiONi.AW50!'CAIiF{?ftNiA.AN0A6REETHATIf7SHQULOBEGQME �NSPECTIONFEE . � SUpJECTTO THE WORNERS'COMP�NSATION PROVISIONS OF SECTON 37o00FTHE LABOF � COpE,1 SHALL FfJFTHWITH CpMPLY WITH THOSE PROVISIONS. ISSUANG`E � oATE:.__ 5-10—(�,'6P��.�,T: �1te Homes snn�P _.. . - � WARNING:FAILURETO SECURE VJ()FKERS'COMPENSAiION COVERAGE U'UNLAWFUL,ANU SHA4LBc �NERGX PIC � SU&IECTANEMPI.OYERTOCRIMINALPENAI..TIESANDCIVILFlNESUPTpONEHUNDREDTHOU5AN0 ENERGYPERMIT OOLtAFiS{T�o6,6a0}.IN A6oi710N TO THE CO5T�F CO+AF£NSATIQN,OAMAGES AS PROVIDED F4R IN � SEGTION 3�UB OF THE LA90R CO�E,INTEREGT,ANUATTOFINEV'S FEES. RETENTION FEE: OCQNSTRUCiION IENDWG AGHNCY PRE-ALT FEE: _, _ ^_ � �}{EREBYAfPRMUliDEROENA�TYOF'PERJtiRYThATSHEREISAC6N$TftUCTiON{.ENQtNGAGENCY _^ FOF TNE PEFFORMANCE OFTHEwoRK FeP WHICH THIS PERMIT IS ISSUED(SEC.9097,CIV,C.). Z W -.. � LEN06R'SNAME NO�IP.__�.Pll�tP� �-� t— IENUERSAUDRE55__� _, � � TOTAL FEES L � i GEFTIFY TkAT i NAVE READ TNtS APP�7CATION AND STATE 7HA7 TME ABQYE INFOPMATION IS G4RRECT. �iJ�SO � I AGREE TO COMPLV WI7N ALL GTV ANO Cc)l1NTV ORDINANCES pND STATE UWS RFLATING TO BUIL�ING � CONS'RUCTION,ANDHFREBYAUTHDRIZEHEPRESENTATIVES(7FTHISCAUNTYTOENTERUPONTHE z A80YE-MENTIONE6 PFlOPERTY FOq INSPECTi6t0 RURPCSES. o COMMEN75_.., _,.,� _ � �...... ._ ._ � ��... ... .. � _ . . m PERMITTEE NAME 4PAINT) ,Q �.—....... .. C/J � +� - � SIGNATUftE OF P�f;,71TTEE pATE (l = RECPT.RO. I � PAtd BY VAU�ATION�� ~ WHiTE—Department C opy,YELL4W—Fina�ce Gapy.PINK—Assessor Copy,GOLdENRpp— ile Copy,GREEN—ApplicanCs Copy � u �� ,��.�� '� - � .��;�� .� �� r _ , i � �� _ _ _ , _ r� , 1�a=,.r'�. � �e�++ Y 4 r : Y A m�y i% A�� I � .. . .. . . . . .... .. _ .. . ... . . ,i�-0(G �f ��"�• � i4�(,kw��' .__. ..... _... .. . � � N h ^( � � y x r �. 9�!"� .i 6'a . .. .. . . . .... . . .. >_ . �: , , . .. .. .... . ...... . ._ _. _... . . �_ e , ... _... �� d :, C � � — — _ _ = ��a� i,�� .�� a> r � �� - - .., i �+m4 =�,. ��. - x `,�a ,�,.. � . ... .. . . � �,e . � ..-; . , . . .. . . ... . . .. ... ... . ��. ' 7�_ � ��, . . . .. . . .. .. . ._ r ,� r._ c;.i._.. - �� . .. . . . . .. .. .. . . .. . . .. .. . . .. .. _� '�.,�. - _. _ � i_ ,n .� . . t ._ . .... .. JOBSITE j"M ADDRESS�•�• 4 APN LOT�J TRACT OWNER Pulte Homes ADDRESS 18401 von Karman Ste 200 CITY Irvine zip 9261 2rEL.9497974400 APPLICANT TEL. CONTRACTOR SAME ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER Hove Design ADDRESS ewport enter r. CITY Newport RQtQ 97660TEL.9497600812 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(BESS),I: 0 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). 0 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 ACONTRACTOR(S) LICENSED PURSUANTTO 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. LICENSE CLASS A LIC. N0. 517593 DATE Exp 9/x/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 CARRIER Pacific Emp Ins. Co. POLICY NUMBER WOR L43011R7A (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)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,: SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: 5-1 0-041PLICANT: Pulte 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($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 READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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 INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE U) 0 IY 0 LL 0 w 0 U) U) C/) 0 in all U W 0 U U) L.1-. LU W 0 I- U w U) C) C) W C) W LU 2 0 r I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION PERMIT P/C Iy DATE NUMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBAC KS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE //-- .A-. N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PooLSpa Z Re-Roof Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U cc: I- U W J W CD Z 41.50 Z W CONSTRUCTION PLAN REVIEW ELECTRIC 41 50 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