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Home My WebLink About16151 (9) , . r r / CITY OF DIAMOND BAR / /`'�� { `�J� ,' t - -��""-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SBRVICES � 2156U E.Copiey I?rive Suite Y90 (904)86b-3195 Fa�c(909)861-3117 c-- -�.�� PRESS � "9^"� BUILDING PER.MTT APPLICATION �_� ; � �.-�`--��IRMLY } JOBStTE r ��`�,j r i �7 APPLICATION PERMIT + ` P�C r �^��- + o ADDRESS �O �l l `-�'�--�-T ��r f.-'.•�aI �i t--i t}ATE �` �.o`!�,_NUMBER I I� � # ��I - �J�11f� � APN LO TRACT 4 DA E� � ONST. GROUP p OWNER �� ^ o ADORES �Ir'l!r j�� ZONING SET6ACKS W FRdNT � APPLIGANT��_ ZfP TE �^ pEAR — RW ❑ TEL �• �� Q SIDEtSIDE STREET RW ❑ � CONTRACTOR yV�.�.'� SIDE p� ADRRESS ,j�,?_�"�._�,AI��:, � � � CITY'�� __ ZIP�,�.�,�TEI�'-e�:�,,,,� PROPOSER USE_ w ARCWENGI z aEStGNER_ l�.r�{ ,.. ��"�� - NO.qWEL. Np. Nq_ � ADDRE �a �� - �7'g STORtES BEDROOMS_„ � CPTY ZI TEL L'`% - � DESCRIPT�ON SQ.F(T. FAGTOR PSF ADJ.AFIEAN LUATION � OWNER-BUILDER 6ECLARATION SFRJAQDIREM X `�' a •_'L I I NEHEBY AFFIRM UNDER PENPLTY OF PERJURV THAT I AM EXEMPT FiiOM TI{E C6NTRAC70R5 U� � Gurage/Garyort ' � �^ f'\ 1 W CENSEIAWFORTHELOLLOWINCiqEASON(SEC.1W1.58U&NESSNlqPftOF�5S10N5CODE:ANYGiTYQR , t,f . �.� Wt7NTfWHK7tREWIpESAPERMiTTOCONSTRUC7,Ali[R,IMPROVE,DEMOLISH,pRHEPAiRANYSTRUG � NpE,PFqFi TO ITS ISSUANCE,N.SQ REOUIFES THE APPUCANT Fdfl SUCH PEpMIT TO FILE A 51GNED W Pflf10/�BCk � '�} � STATEMENT THAT HE OR SNE IS LtOEMSED�VR5UANT TO TlfE PPAYtSIONS OF 7HE CONTRAC70AS�i- '!� CENSE UW+CttMTER 0 i�MMENCiNG WITM SEG'iION 7p00)OF DIVISION 3 OF THE BUSINESS AND PRO- V' PpOUSpa - FESSIONSCOOE)URTHATHEORSNEISE%EMPT7HEREFROMANDTHEBASISFORTHEA�LEGEOEXEMP- (� . � TpN.ANYV10LAtiOttOPS£CTItlN763t.58VPd1YA5'R�3�qP17F{NiAPEftMiT5U8.1ECTS7HEAPpItCANTTO z RB-ROOf � ACML PENALTV 4F NOT MORE TNAN FIVE HUNDRED�bI,I,ARS�SSao)J� � ❑I,ASONMEHOFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIftSOLECAMPEN5AT10N, (,`pmm61'G8I M7lt 0�7ME WbAK,At�THE STRi7C7URE IS NOT INTEt�ED{7R OFFERED FOR SAIE(SEC.70M,6USI� � � NESS AND PROFESSIONS G17DE:THE CANTqACTORS LIGENSE IAW DpES NOT APPLY TO RN OWNER pF PROPEpTVWFqBUILDSOFifGPROVESTHEFlEok,ANDWHODO£55UCNWORKHIMSEIFQRHERSEIFOR � – � � j . �f Q T}iR4tX3MMI56pNEROWNENPtAY£ES,PROViDEDTHA7SUCN�MPROVEMENiSARENOTINT`cMDEDbR m � � p OFFEREDFORSAI.EIF,FMSWEVERTNBBUILbINOORIMPqOVEMENTI550LOWITHINQNEYEAROFCOM%.E- ! i TION,THE OWNER�BUMLpER Wltt NAYE THE BURDEN dr PfiOY�JG THAi HE QR SNE 6ID N6T 8Ut[D OR R � . ^ �_ _ . \ � IMPROVE FOR THE PURPQSE OF SALE). �\ . , p I,AS OVMER OF THE PRUPEflTI;AM E%CLUSIVELV CANTRACTING WITN LICENSEO OC)NTpACTORS J (� 74 60NSTFWCT TrtE PFlpJECT i5tG.70U,BUS%�7£SS ANQ RROFESSIONS C04E:TNE CONTftACTOflS 4�� Wa�uyfi0l7 AD,I.AREA tl! CEN9@LAWDOESNOTAPPLYTOANONMEftOFAPROPERTYWHO&JN.OSORIMPROVE."..TMEREpN,qNp — � WIiOCOMMCTSFORSUCHGR0.IECTSM/ITHACCNTMCTOR(S)IICEMSE0PUfl5UANTTO7HECONTRAC� �UANTITY DESCRtPTi6N � TORs uc�risE t,�w.}. FEE ❑I AM EXEMPT UNbER SEC. e.d F.C.F6R TH75 REASCN Q 3 ___ � � oATe owNea v � t -�1 G� � _ ---- w .�% � F - i . � IiCENSED GONTRAG70R8 DECLARATtQN w � �,�� .�� \�: IMERE9YAFFIRNUNDERPENALTYOfPERlURY7HATIAMLIGENSEDGNDERPflQYISbNSOFGHAPLEq � [� 9{COMMENC�70WtTFiSECTiON7d00jOF01VISiON36FTHE8USiNESSfWOPROFE5510Ns"GODE,ANO z ',, �._� `L� MY LICENSE IS IN NLL FORCEANO EGFECT. m / � LICENSE C4ASS__,,, � ___„ LIL".NO,_,_ 5 1 75 J 3 � �� r l �-- oA�E 9f 31 Q1 Pulte �omes � �''`� . � ....__ � CpNTRACiOR „ — G � t, � WORKERS'CflMPENSATIQN 6EClARATtON Q ,, ' � 1 HEREBY Ff1AM UNCER PE4ALTY OF PER�Up"OME OF Tt�fOt�OWiNc�DECtARATiONS: U � N' Z f � H�VE ANp WILL MAINTAiN ACERTIFICA7E QF CANSEN7 TO SEIF-INSI:RE FpR WORKERS' _ '?,�' GOMf@iSATiQN,AS PP7VIDED 9Y SEC710N 3t�Q�THE tA�q CODE,Fofl THE 7ER'roRMANGE U �,,,,__ � � � �GF THE W4RK FOq WHICH THIS vERMiT IS ISSUED. � w �� 7 HAVE M"p WILL MA�NTAiN WpRKER>'COMPENSAIION MSURANCE.AS REQUIRED BV SECTION //��++``rrr��7� `,, �� t/'�� ,~d,� 3loq OF TIE IABOR CO�E�OR'ME PERFORMANCE OF Th1E WORK FOfi WHiCN THIS PEHMITlS �� /!h � {y(t� ISSUEO.t#Y WORKEftS'S:UMPf:N.`,AtKK�iNSURANCL-CARfliER AND➢L%.iCY NUMBER kqE: CONSTRUCTIf'N x ry 'CC.y_L`4__ � C�qRIER�r'a�C��{I�(��IG` Em (O e� �i"1�. CO. PLANftEViEW � POIICYNUM9EH` ••��__"'—"_� ELEC?RIC y �� d __��-----=. � � (nussEcnc�wEmnorsEmnanF-soc�n�r�anar�scc.�auEra�r�rxtEo�.l.a�s�sim)oaGEss). PLUMBING _ t ��"�� (. � i GER'StFYTMAT W THE pERFOpMANCE OFTHE VKriiK GOq WHICH THIS PERMlT IS�SSUEp,I MECHA1dICAL , �-.?��_ � I��` SHALL NOT EMPLOV ANY PERSCNJ IN pN'/MANNEp 50 aS To BECOME 9UBJECT lC TME � ((j WORKEflS'I:�MP[NSATM]NLAWSOFCALIFORNIA,ANDAGAEETNATtfiSHQUIOBEC S� TI` FEE � St/B,IECT i0 THE W6AKFR5'C0IAPEFISATIpN PitOYI5ION5OF S£CTION 3]00 C?f TME U t � ` "– ' � CADE,I SHAI..L FORfNWIi'H COMPIV WITH THOSE PROY1510N5. ISSUANCE � 4 S � � n _._� __ � __—l_� • __Pulte H,rLm,�s _ � �M�� i�Q� "3 , DATE__ �I� �7 PPUvANT _ _ � � W ENEAGY PfC � WARNING:FAItURE TU SECURE WORKFAS'CCM,fPENSATIDN COVERAGE IS JNIAWFlJL,ANp SHA 8E f �'_...._. .____...._ _ � SUBJEC7ANEMPLOYEHTUCRIMINALPENAL7IESANDCIVILfINE5UPTOONEMUNDflE�TMOUS Nn � ENERGYPERMIT ��L_ � OOLUftS(il W.WO�.!N AD�ITION S07H�COST Qf qOMPENSATipN,OAMAGES AS PflpV10EQ F6 C � SECTiON 37UeOF T}iE IABOR COpE,INTEfiEST,AND ATTORNEY'S FEES. � CClNSTRUCTION t.ENQtNG AGENCY PRE-ALT FEE � �� 0. I HEREBY AFFIRM UNDER PENALTY oF oEAJVAY THAT THERE 15 ACQNSTNVCTION LEN0INGA�ENCY ^ Ft'�qTHE PERFORMXNCE C�F THF WaRK G6R WHICN TktS PGRMIT IS iSSUEO(SEC.3VB7,CIV.C.). ��. – � W ( (� (�,,.,y'}�} —� � IENOFA'StlAME ._�--l.�U�t� !7{�m�'� .].�V.^'-P"-i--....__ _. 4 i`-��`� � � IENDER'SACpRESS_.� _ � � ICEHTIFYTNATIHAVEREAUTHISAPPI.ICAT�ONAUDS7ATETNAT'FMLABOVElNFORMAT�ti1SCOAHECT. lOTAL��ES . 1 ___•�� j W IA6REE T4 GOAi%.Y WS7N ACL dTV AND COUNTV OROINANC[5 FNO STATE lAWS RELATING T9 BUILUING J� a' CONSTRUCTIpN.ANG HFRFBY AUTHORIZE REPRESENTATIVES OF TNis WUNrYlO ENTER UPON THE � Z A80Y£�MEMIONED PqOPEHTY f1?R tNEPGC ON PUP.P45ES. G'.1 �� COMMENTS O�D �� / _ . .. . a PEflM TEE NAME(PRINT� _ .r�f-�..� I �/j SIONATI� PEOF RMITTEE(/ � ��~��"....' QATE ��— – � � RECPT.N0. � PAID BY ��,VALIpATIQN WHI7E--0epartment Copy,YELL4W-�--�ina�ue Copy,PiNK—Assessor Co{y;GOt.DENRQCt—File C�py,CaREEN—App7icanYs Copy �,v��4 �„��~ ��s� a�� =� ��b��''�"�� a�� q��w, �� .� �� .� e � M �w ��, �. r � � . ,� �� ; ., �g�� „ �� .s�. .� . r � x � �w�t �� . �� '�'�`� , �. � 3, , n , � . __ _ __ . � � , . �_�� _ � _ _ - _ _ , ��r .r�: � _ ,: _ _ . 3 � . f � � � � fr��-� . . � � . . _ . �_ =�,-.�' _ _ � � , . �. _ _ .�� ,� . � _ � _ �. �� — ' - __ _ � _ �. � .,. . � �. �.� a �r _ _ � � .t � � � _ _ _ _ . � _ _ � � � — �� . _ �W - � � � , � �w—�� _ . � ___._.—. � , �. ��. . �. � _ � �� _ _ � __ �___ . _ � , _ _ _ ��. �� .�_ . _� f �: . _ _ _ � _ � . _ _ _ _ ___ ______. �_ _r _ _ __ __ _ � � �,.,, _, ,, _ __ ,._ _ , . ,. _ __.� __ _ ___ _ . �,� t, ,. . __ . _ _ _ _ , t _ _ _ _ __ __ . __ __._ _ � � ; � t:�� _ _. __ _ ___ _. �._ .,_. _.. �.,_ __ � ,. � �^ .� � s.,r � � .,, __ _. . _ _ �<.+. _ :�,/�`'�._ �. . _ _ _ _ __ � _ __ _ _ �"2,)w� � ' � . . � _ �. _ _ _ e _ _.Ir� _. _ � _ _. _ _ �_ _ _ .. . _ � � _ " � `� � + � � ��.`� �� _ �_ � �� o��< �a�, . � ��...� _._ _ _ _. _ _ _ _ _ _ . . __ _. _ _ _ _. _ t � � ` z �� . � » �`r ,, .. ... .... .... ... ..... .. . .. . . . ;�� ,�'�k^h ��i_ _ _ "� �"� ' � �. �� _ _ � ��, fi �.n{ e n.a� Pt£ .. ._.. .,._., _ _... .. _ ^ c �n� '�T ��d F �S t� . . . ._ ._ _.. _... ...... ... . � � , a�g � ' °�� n�� . ,.�� t� ��;?'�� _ �.. _._ . ... . ..... , _ .. .. .. . . . . . .. z i� ��, `� • � �� , �� r � a��x ,� � �. _ _ ,�� ' �� #f 5� �"'� �" _ �' � '��'^,�`��''��qm�� _ _ s��s.k�� '�` ��'�r�"�'t i�'3 '�',� .. , e�.�..�—A�,� .: . . 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 JOBSITE�j CCU-( e iz ADDRESS . � 1 Ji APN LO TRACT 4- OWNER ADDRES CITY L 1 r Vl W; 7 TE APPLICANT TEL. ' CONTRACTOR ADDRESS CITY'S�ZI j 'LTEL ARCWENG/ A C DESIGNER P -Y I ADDRE,5f, CITY c > r ZIFf- 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:ANYCITY 0 R COUNTY WHICH REQUIRESA 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 EXEMPTTHEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ 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 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 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 (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. A IC S 517593 L EN E CLASS _LIC. N0. DATE 9/3/O1_CONTRACTOR Pulte Homes WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: HAVE AND LL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' WI ��COMPSAT EN ION,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 TABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER Pacific Employee '7 Ins. Co. POLICY NUMBER•• LR8/ !9 (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE"INURED DOLLARS(6100)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 50 AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECO E SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTlON 3700 OF THE LA CODE,I SHALL FOR; HWITH COMPLY WITH THOSE PROVISIONS. / 11/OI T Pu I to Homes kPPLICANT: DA E: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHIN L BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUS D DOLLARS(6100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FO�(T SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. ,[y 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 Homes Corp) LENDER'S ADDRESS 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 FOR INSPEC ION PURPOSES PERM EE NAME(PRINT)-�� SIGNA PERMITTEE DATE APPLICATION L PERMIT P"7)„ Ji I ( I /C DATE NU BER # L TYPE OCC �a�� ISSUE(A/7 fi DATE V CONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. ITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAN LUATION SFR/ADD/REM I, U) Garage/Carport (OM Y) I 0 AG W Patio/Deck ,-7 1 LL Pool/Spa 55 Re-Roof Z Commercial e „J Valuation ADJ.AR =A QUANTITY DESCRIPTION FEE Q LLI W t U ti Z 0. 'I� L Q Q 13 ) C W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL C, L� U� (I irr SP TIO FEE ISSUANCE lr B �Mley Q O1 ENERGY P/C ENERGY PERMIT (�•- ��[1? PRE-ALT FEE: I C1, TOTAL FEES COMMENTS RECPT. N0. PAID BY 2S 1'VALIDATION 4 WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy PRESS �A IRM Y C)