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CITY OF DIAMOND EtAR '� �,� � r`i'
. - -�'� - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� � ''�
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� SU&IECT TO THE M/ORKERS'COMPENSA710N PqOVI510NS OF SECTION 370G OF TME LABOR �� !�'r1"y f� \
� `.%JCE,ISHALiF'ORTMNRTHCOMP(.YWiTNTtWSEPflOViSIONS �SSUANCrc �_ _ _ ! UV '�.J�.J .J
� 5/1 /01 Pulte Homes sM�P _ "�.'� :=� t�_ �
a OATE:__�_._ APPIlCANT: _ ...�_ { �
J WMNING:fAILI;RETO'iECUHEVlORKERS'CAMpENSATIONGC'1VERAGEISUNLAWWL,ANOSHpLLBE ENERGYP/C �_-1�� /. I / ��('
� SUt3.JECTAN EMPI.OYEft TQ CRIMCNAt FENALTiESAND CIV4L FINES llP744NE HUP1S}RED THOUSAND `
u- ENERGV PERMIT ���e�,t� y
Dq,LARS(51ao.oUo�.INAD�ITIONTpTHEGOSTQFCOMPENSATION,pAMAGESASPROV@EDFORIN ���- –
J SECTION 3706 Of THE tA80fl l,'OOE.MTEflEST,ANO ATTOflNEY'S FEES. �+�
� RETENTION FEE: . ,,.,.�,_ ,_.^ �
d CONSTHUCTION LEND�NG AGENCY PpE-ALT FEE:
O
� I MEREBY AFFI%M UNOi:P PENALTY 4F PERJURY THAT TNERE IS ACONSTRUCTION LENOMG AGENCY ,�
fOH THE PERFOflMANCE OF TNE WORK FOR Wii'�CH TNIS PEqM1T IS ISSUED(SEC.309�,CIV C,). _____.,4���.�'+�r���� _._'__
W A1 p y. {J � '—'
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F- LEN�ER'SADDflESS_ ... ,
W IGERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOftMAT10NISCOFRECT. TV�A���ES T�� � ^ ���� , ,�� �
d 1 AC:REE Tp GOMPLY WITH Al.l CITY AND COUNTV OR�INANCFS ANO STATE UWS RELATING Tp BUILDING �" *� �
� CANS7RUCTIQN,AND HEflE6YAUT4�iORiZE REPAESENTATIVES OF T};�S COUNTY TO EMERU�N THE
z A&")VE-MENTIONE�PHOPERTYF fliNSPECTIONPURPpSES.
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES Uj
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS
FIRMLY
JOBSITE
ADDRESS C./"'7��d LAW
APN OT TRACT 77 67
OWNER/u
ADDRESS S7 ZNU
CITY= '4-ZIP-TEL. 7'7Wj i
APPLICANT TEL.
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER J
ADDRESS
WIT-
� ���
CITY ZIP 11-2.70 TEL.
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 REQUIRESA PERMITTO 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 14E 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 CNIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(8500).):
^ LAS 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 OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(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 SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE D EFFECT.
T3
LICENSE CLASS LIC. N0.-
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I HERE 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 ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
3700 OF THE LABOR C00 E. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WOPKF�S'COMPENSATION INSURANCE CARR RAND POLICY NUMBER ARE:
CARRIER -� t i f I-V'�-I
POLICY NUMBER
(THIS SECTION NE:03 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 EMP:-OY 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 TH PROVISIONS.
DATE:J !! APPLICANT:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYEE.TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(8100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 37080F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHI THIS PERMIT IISISSU (SEC. 3097.CIV.C.).
LENDER'S NAME li
LENDER'S ADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION,AND HEREBY AUTHORIZE REPRE ENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECT URPOSES.
] PERMITTEE NAME(PRINT)
r�SIGNATU PERMI'REE DATE
APPLICATION/ ' PERMIT I y-. 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.AREANALUATION
SFR/ADD/REM
CI) Garage/Carport
W Patio/Deck
LL Pool/Spa
Z Re-Root
0 Commercial
M
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
cc
I-
U
W
J
LU
0
Z
Fn
2
J
0
J
U
Z
W
N ��N'
CONSTRUCTION 7�,,,�
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
7 TE
D)
TOTAL FEES - z)
��
B
COMMENTS .L
RECPT. N0. PAID BY VALIDATION C
WHITE--Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy
i
I I'VIO%D BAR
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--JLI �al��i V-V)
9
��
APN OT j TRACT Z(a T
OWNER
ADDRESS D G Y1
CITY V tojL--ZIP E. �4
APPLICANT TEL.
CONTRACTO c-
ADDRESS'
CITY'n Lil.%I-ZIP aTE
ARCH/G/
DESIGNER
ADDRESS
CITY ZIP EL.
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 B (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
ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
^ 1,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 014 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 PRO.IECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI-
CENSE LAW DOES NOT AP:'LY 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 SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
517593
A
LIC, NO
LICENSE CLASS
DATE 913/CONTRACTOR PUI tP Homes_
WORKERS'COMPENSATION DECLARATION
I HER Y 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.
1 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__P A3L ifC Employee-Ins.Co.
POLICY NUMBEF WLRC 43(111 187A
(IHIS SECTlON NEEDNOT BE IXAE&ETEDOF THE PERMIT IS FOR ONE I-IU DRED DOLLARS(XI 00)OR LESS).
I CERTIFY THAT IN THE PERFORMANCE OF 1HE 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
CCD E.I SHALL I'ORTH W TH COMPLY WITH THOSE PROVISIONS.
Pulte Homes
5/ 1/O1
APPLICANT:
DATE:
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 UNOF:R PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.).
None(Pulte Home Corp)
LENDER'SNAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I 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 F R INSPECTION PURPOSES.
] RIV)" '
AM RI )
L I el
SIG R OF PERM'DATE
L)
M APPLICATION R'I #/C of-OL.
DATE NUMB
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 1 3- !j it
Garage/Carport /L i
W Patio/Deck
IL PooVSpa
0
Re-Roof
Z
Commercial
Valuation E ADJ.AREA
QUANTITY DESCRIPTION FEE
Q �
U
W iNt'i f- L
Z /Ltr�'1
e" Q
<
L
1��
U I bi
LLl �1 v J
D 1 r\
CONSTRUCTION ,
PLAN REVIEW
ELECTRIC
PLUMBING f
ITL
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP .
ENERGY P/C
ENERGY PERMIT ��
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES
7 001
COMMENTS
RECPT. N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-Applicant's Copy