Loading...
HomeMy WebLinkAbout16162 •x 1� CITY OF DIAMOND BAR � DEPARTMENT t�F COMMUNITY 6t DEVELOPMENT SERVICfiS � W 21660 E.Copley Drivc Suitc 190 , (909)860-3195 Fax(909)861-3117 PRESS � `������ BUII.DING PERMIT APPLICATION �,�5���(�� �� � FIRMLY o ADDR'ESS �a. 'l�/ �1f'��� ll��W � pAT��ATtON�l� Jl NUMBER���7t �� '�I�JIIfS >.. ; PERMIT P/C � APN LO TRACT��- �SSUE 7YpE pCC �� DATE CONST. GROUP p OWNER "' ADDRESS ZONING 5EfRACKS W CITY �J�l�n,�: ZIP � FRONT qyy`_ p i � REAR ^ p APPLICANT TEI. StDE/SIQE STREET' Ryy__ p � CONTRACTOR 11V�L SIDE ` p � ADDRESS PROPOSED USE CI7Y ZIP TEL. � ARCH/ENG! � �,� �' DESIGNEA NO.DWEL. NO, n�0. ADDRESS � �� UNITS STORIES E�EDROOMS yCITY ZI TEL.' v� DESCRIPTION SQ.F7: ACTOR PSF t,DJ.AR AIUATION Q OWNER-BUItDER DECLARATIDN SFR/ADD/REM '' 'j� O • p 1 HEPEBY AFFlPoA UNGER PEtULT/OF PEiWHY THAT I AM E%EMPT FHOM 7HE CONTAACTORS tl. G8�8ge/C8lPoA •� ` ' W CENSEUWFORTHEFOLLOWINCiPEA"AN(SEC.7W76BUSWESSANOPROFESSpNSCOD6ANYCITYOR (n ZCqXfTYWF11CF1qEd11qESl.vFRMRTOCONSTitUCf,ALTER�FiOVE.DEMOU�.OFREONRANYSTRUG W PatiW�eck �L 7UAE.PRIOR i0 R9 ISSUMlCE,A150 REOUIRES TNE MPUGNT FOR SUCH PERMIT TO FIIE A SIfiNED � � STATEMENT hfAT HE OR SME IS LICENSED PUNSUMIT TO THE PRDYISIONS OF THE CONTFqGTOR3 U• � CENSE lwW�CHMT£R 9(C9MMENCWO WITH SECTqN 7000)Of DIV1510N]OF THE BUSINESS AND 7Ro- LL FooUSpa FE58qN5CODEjORTHA7HEDRSNEISE%B.IAT7HEREFROM,WD7NEeA515FOH7HEALLEOEDEXEMP• � TION.ANYYIOI/�TIONOFSEGTION70.71.SBYANYAPPL�CANTFOHlIPERMIT5U8JECT5THEAPPLIGNt10 Z q�q�� f,., A CIV1l PEFMUY OF NOT MIK1ETiAN FIVE MUNDqEU DOLLARS(lSoo)J: O �4�30YYNEAOFiF1EPROPERT:ORMYEMPLOYEE511n7HWAOESASTHEIRSOLE00MPEHSATqN, � CafllmBfCiai Z Wlll�O TNE WOAK AND THE STRUC7URE IS NOT INLBIDW OR OfFEREO FOq SFLE�SEC.7�N,6U56 J � NESS NA DAOFESS�ONS C9D&TNE C0117RACTORS UCENSE UW OOES NOt 4PP�Y TO!J!pYMER OF � � ✓f r PpppFJ;fY WFp BURpS Op IMPROVESTHEflC-0N,ANO VNIOOOES SUCM WOFlK HIAISELF Op HEA50.F OR �/C! � TXA(%JfiNFI150RHERONT7E�MPWNEES,VAOV10ED7MAT5UGHlMPROVEMEMSAqEMOTIME�EDOR m � O OFFEPFDFORSAIEIF.NOVlEVER1MEBLMLOM�ObRMAPROVEYENTISSOLDVAiNINONEYEAROFWM0.E. Z TqN,7HE OYMER�BURDER WILL MAVE TME BURDEN OF PqOVIN6 THAT HE OR SHE�ID NOT BURD OR � pAPipVEWf17HEPUfiPD:'EOFSKEJ. W OI.ASDNMEAOFINEPRpPEHTY.AIAEXCLI15NElYOONTMCTNOWITHIICENSEDCONiMCTORS � TOOONSTFNGT THE PRO.fECT�6EC.10H.BUSINESS ANO PROFESSIONS CODE�THE WNTMGTORS LI- V21U0I1011 ADJ.AqEA W C@15EUWWESNOT/Wi'LYTOM/]WNEAOFIIPROPERttWH00UttD5OHNAPqpVES*NEflEOf7,Ff10 F WIqCpMRACTeFOqSU(sIPRD.IECTSN7TiA00NTRAC70A(SS��ENSEDPUPSUANfTOIHEGONiMG q�qN7�Ty DESCRiPT10N FEE � toasue¢nseuw>. O O t AM IXFd1Pf tM10ER SfG 8 d P.0 FOR 7HIS REASOM Q A Y1 U � `_' ! 3 , .S..L�d'�X_ r � � ►� ��.� DATE OWNER U �+� LAGENSED CONTRACTORS DECIANATION W �ti ��� � L'G IMEAEBYAFi7flMWN1EpPENALn'OFiEqJURYTHATIAMLICENSEDUNDERPRON510NSOFCHqPTER � � 0(MIIYENCWO WRN SECTION 7000)OF D��ISION 7 0F THf BU51NES5 AND PPOFE551pNS GWE.ANp Z `�I X�� MY LICENSE IS R!FlJI.I FOHCF AND EFFfiCT � uc�vse cuss_A ��c.rio. 5.3 75 93 � . w �►.rE 9 3 O1 cor+rancma Pulte Homes a �,�} `'"� � YlOFiKERS'COMPENSATION DECLARATiON -� �`• ( � V � � 1 HERES AFflifM UNDEA PENAITY OF PEAJURY ONE OF THE FOLtOWING DEC�ARATIONS: Z Y4 K !�1 �,/� .1 � /_J/�IHIWEANDVALLM/.MiNNAC'cRTIFICATEQFCDNSENTTOSELF-�NSUNEFORWDRNERS Y � �{'' A � .�` �F�� Cy]MPENSlRION,'15PROV10EOBYSEGTION37000FiHELA�RCODE,FORTHfPERfOqMM/CE W 1 ��1 J pX 71{E WpW(FC.R NM1IICH THIS PERMR IS ISSUED. � 1` O V �1{AVE/Wp Wll�IMINfMN NqRKER5 f17M7EN5AT10N iNSUIUNCE,AS HEOUIRED BY SECTION r� ^ O 370oOFTHEWY'JRCD�E,FOR7HEPERFORMANCEOFTHEWORKFORWHICf(THISPEHMITIS � +,.y � (� ` � ��� .�� ISSUFD.YY NOPKERS'COWPENSATION 7NSURANCE CMRIER ANO POIICY NUMBERAflE. CONSTRUCT�ON �x o �J T � �,��� Pacific Empl�ee Ins. Ca. PIANREVIEW � POLICVNUMBER YYLR . 4�61187�_ ELECTRIC _1 _ � ) . � p (IIASSEC7CNNF�HDTBEOObFIEfEDOFiTEPEi'MiI6fORONEM1N7FifDOC/.1AR5RIm10NlE5Sl PLUMBING 1�p� •� ` ,Z 1 CEATIFY THAT IN TNE 7ERFORMANCE OF THE WORK FOH WHICH iH15 PERMIT IS ISSUED,1 MECHANICAL �]�_U�.� 1 1 L� (7 SHACLNOTEMPLOYM�'PERSONMRNY�ANNERS�AStUBECOME5UBIECTTOTHE WSAECTIONFEE � WORKERS'COM�ENSATKIN UWS OF CAL�FORNIti AND A6REE THh(IF I SHOULO BECOME S St18JECT TO THI:WOFNERS'COMPENSATION PADVIS10N50F SECTIDN 37�0 OF T1fE U80A +h/� /� CODE,ISHALLFORTNW�TICOMPLVWf(nTN�SEPROY1S�15. ISSUANCE I`J`J_�iJ � n' SMIP p DATE:�v� APPIICANT. __,P�A�te H om e s /� � �� � WAANIN4FAILUHE70SECUNEYfOPoCERS'CAMOENSRTqNCAVERAGEISUNUWFUI,�NDSHN.LBE ENERGV P!C ��.�L :J –�—�� ��—�/--�{ �y SUBJECTANEMPLOYEPTOCRIMWAIPENALTtESANDCIVILFINESUPTOONEINNDREDiMDUSPlA EN�RGYPERMIT 1 '�!11� OO�URS�{lao,0ao�IN nDDIT10NT0 TNE CDSTOF COMPENSIRIOfJ.DAMA6E5 AS VqOWDEO FOR IN � SECTIONI�oeOFT1tEL�BORD�OE,MiEREST.ANDATTOFWEY'SFEES. RETENTIONFEE: p�„ CONSTRUCTION LENDING AGENCY pRE•ALT FEE: � IHEFtEBYliFFlFlFlMUNOEHPENpLiYOFPEF[IU7iYTNATiNERE15ACONSiRUCiqfVLENDINGAGENCY � � S FORT/EPENFOPAMNCEOFTXEWORKFORWMICHTHISPENMITISiSSUEOlSEC3oB7,GVC.). • � LENDER'SW4AE_i1.I1S� (Pulte HQme l.�r�� �_ 7 � y � t_– LFNDERSADONESS_ �,�, - � TOTAL FEES ± `�•"`'..%�� `"�7" 'j� I CEi7T!iY THAT 1 HAVE�EAD T/US APPLICATpN ANU STATE THAT THE AB04E WFORMATqN IS CORRECT r"'�' � � � � � I�CiHEE TOCOMPLY WITH ALL CfTY I�ND COUNTY OflDINIWGES MID ST�TE UWS REUTMlGTo BU0.DING � CONATRUCTION,M101IEREBYFIffHOq1ZE NESENiATNE50FTM5COUNTYTOEHiFRUPONTHE � A80VE-MEM71ONEDPROPERTYFOAINSPE IONPUFPOSES COMMENTS '^ � � � ; , �r r ' m PERMRiEENAME�PHiHT) � '--'� 'fJ' -�G �-�-�- � SIGNATU OFP E , DATE ' � = RECPT.NO. PAI�BY ` VALIDATION ~ WHITF_ryepartment CoW,YELLOW--FV1enCB Applicant's Copy Copy,PMK—Assessor Copy,GOLOENROO--Fil9 Copy,GREEN— �.:.��'"�' ��' ��r������i� �.�°a� i��6a�'��`�"�t°"'P� ��:��"J��k a� _� • �'� A � O ' " ! / � ' '�"'� ��` _ � __ �..�'.4� , � { F1;��.��5 i.i ' '�" A _- ' --• - - --- - - ------• -- ---- - --- ----- -• ---- - - --._,_.. -- -- - ��----� ' ---�--�-- - - ' r'T�c rr-,-��,;.•14:">�`-.i_ ' ' ;:i-;� '-,`;�'',..t;'_ �+ , , ,.. . - � � - � t _L��,J!t..�i';r?4._'i ti` _ _' .." "'_ ' _'�"" _ _ ' """""_ ". ..._�i i Lif.�Lr`h�5 � V�'r't !i�iGr.�,_._ "_ �I'_ ' " __.. '"" "' _ _ _ � ;. . , _ � . . � � 'J ' � i.._,.._� ...__'' '' '__''a_' ' _ _ . _ • _." " "._�...�' _: � � .��_�._......- .."" "...__....__ ,.-..' ' '.,t'__ ""' " '._._..___.�_. ' i ... . .. ... , . . � , :��F�'i;.��i'' ;�'� i,:.��"• .•f, �}rii1�'�� �:(.��it�11:i��:�!I�T � _ "_ . . _ ' _ � i ' i� .' _' _ '." _ ' _'_ . . _ ..__. .�' _" '_'_._.__. __�_'.' __"1"_ '_..-�_._._.. _ ._,._' '_ " '_ ' _"'. _ _r'__ . ) ..__"_ _ " __ � :t ?:t�i��;"1:?� f � i'�i�t.��.��i� ''�JE J��.'�T���'� ` r- -� - - - -- - -- - - '---- -� ----- - ---- - -------- - --- --...---- -- - - - - - - -._�_ -- ,.� ...�� _. : � . . , .. . , !.r,w", '.°a�''F.7: � t' �..t�i`::' ;i;i�'�i�!_F A:�" � . ...-_- _- -- - - - ...__ _..-- - ---__.-- ---' - - ��F-- -_-- - ---- I . ._�_--- -.._�._____----- - - .. .. - - - - ; . --� . ..,, ,, , '�{.'iitL`F.;.�r�`I�;.�;'_ � I i.r ti?' "�_f�'���' �.:L.�''?'.i � i __ . ___' _ '_ _,.__.._�" ' _ '_"�_ '_"_" . ' _' "'__._"..._ __'. _' "'_'.._ .. ... _ . _ „_.. , � .._' " ..._._._ " ' " .. .-a,. , ��� c.r�„�,, .-r�-r'�;�:, ... ' � .=t'F3 �tS,L 5 ' , • • ; C . EAM ' � � __ _. --• - •---- - - -- �- � - �— -=--�--��--- -- -- ------- --._ _--- - --- - -- - - - - - - ... . � . ,. , f `"'. ' ' - �a.e�?;x��.,ii?r'`t hi a�'�j''�!�i���+ �::/i�,l�'�i)�'�il O=�`'� _ _ ___.__ �.- 2t-v : _rv._..1..,. : _ _ _ _ ._ ._ --- -- - - -� --�--�--- - ---�____------ ' - -- -_ - �------------ - --- - - - - - - . _ _. - - ! _ .._ . _,. � . � - , �/ . � �'t.'�. ; , �!'.:�.: ` - - — `, f"I-�%_-�ar-�F��Ji^,i�----•�- -- � - -- - " - - -- -_. _- '- - -- - - --- - -- --- - --- -_ -- - ------ - -� ------ ---�- - j ��(:� .-� ,-'_;'`'."�; : 6�I�tC:Fiit:•::� �_ , . . . • :•�, ° ' ' � - ---------._�:__-___. ___ . - - -------•._- - - -- - ----- - ------ -- --— --- --.__-- --- -- ------ -- - - ="�' = _"_ : �` I'V''= i � ���f�� �1� ?�`�}€! ��'��_i .f , . C:.. � '�� � _. .___"__ ._""."'___, . � _ _" ' _".'_'__ _ _-_'_" ' '_ _' .'__ , _ __-.." i .. __._._' "_ _ _..__. .-.,C_ „ , L-., � ,�xy�- .. �� , }"t.�i_'i.S, " ' , � _ �� _. �,. . . ., . ,,� . , {.,vtd,it�J�; • . -i ;�; ,,,..,�, ; � , ; . L t , - � , � t., . � �-- --. .. ..._- � --- - -_,._..� --- _-- - --------- - - --`"-- -- - -- —__�-_____ • -- -- ---- -- -------�------� - _ , 'Ci;/`'� . ,'I._I�-r`�c,,-�" ; . � � i-i� i! r=� F�'i'I r?'� `''- �,. .- - ti . � .. - - - - �-___. ---- - ----- ..-..--- ---"'--__.__.__.-"'--- = -�J - - -�"`--' '_ --..._.__._,_ -_..-- '--- - --' .------- � - ,„ " _' • ' ,^�, . ,�:.s -.4,'15h.i�, • ''E -`F C.,1 � : r. . ._ „_, _ ..t i P,� r - - - - �-- - - - . .,.___ -- - - ._ — _ '_._. {=- --���.i_..._----- ----------._—.____.---�- ----- •------ . ..s ,�.,. � ,-� - - �- - — ' ' ,,,, , --- -- , . :..• , ���f'_'_i,'1�`J.II:�,...1 � F I 1'�lJl�l °�Ih�,�t!_ � I - -' - - ._�._�- .- . - -. __ _ ...._ . __...__... .__ _.___.�._.(_ --- - - ---'----------- ---"-- --�-----" --'-� --'-.__—.�.___ ._ �k _ . .,_, .,.... „ ..� A-<{r.ti: "c� , r� �r� � � , .,_ .�-• - � � � ,.,��-�,4..2_ . , � , �i e ,,ii,� ,.�.t,r ,. - - -- --- -- - - ._...�_�-r - ----- ----_ __.._..--� ---- --- — � ---� -- - -- -- --- - � -- - --- - - - -- . .h::' � l�, l' r Y(� ' , . . _- r _ ..�.. . ,. � i � { L�r..,,'�'...,-;'���F'�fJ t i, , . , .i �.- . '___'"'_ "« '__�_.�_"'_•_' "__L_.' ' ' _' `""".-. �...� _ _' 'r - " ' "_"'" '" _' ' -_...._ .._.._..��.. "_ '.., '_"" " ' _'_ ' ' "'"_ " ._.' _ - ._ � . A F4� v. � ` . �. . ,-. _.... . �. . ... ._ .__ ..,__'.____ _ "_t___._._`_'. .__�._.._.""`_`"_�._"_.__{- .__ __'___ "' -- '_"__ "___ ._.,�_..._.-L"__'__ '_ "_ i_ " _" __' '_ '_ '_ f S'r y."r,t;Y . - ' -i-, ,r.,�'.._ � V r � ;.r'i°�:,�.�.r`i�t-,}�?;�s l. - '- --- -- ._.' -"-. - __'�--�.--�'�-'_. '--_-'-'.^.v..---'-' -''-�- -- � '--- -- ' --- -- -- -- -._-_.___..� .�.._., _""' .'- .- - . � _ , . '-� _,-� _ +�y'(rz : :. : -. _ ' ,_� _�, , i - - - - - -' .__ ._. -'-'--•'-.,_._w._- - - ---..__._.._u.._.,.-----�-�...- -- --' - �- -- --�---`--_ ........_ ___ . .____...- -- - - _ , _r . ' -.�•^�t. ._1-}_..n){� -'- .,_ . . .- .__ ..__' '. _'__' ...' ""�. .'_'w"n"_`_".,.�_..._._._-�.' __ ' '_ _ _ . _ ._ __._ __ _... _ ' _ -_ _ ..� _ . , �.- ,_ - ` . ,�'�rti- ' , .. _. _ . ._- - --- ...---- - - �`- - -�- -'-'- -- - - -- ' - --'- ��- -` - - - �- .- . r:r�- � - - - _ . � - ' ,. . . ... ,tv .. .� . , . . - �- - - - •- '� - - - - - ------ --- - - - ' - - � - ' - -'- --•---� � - � - - - e.. � , .,.__ ." Y , ��1 , " ' . : • ..:'' ' � - . r ' - , . : : - � , .. ',. . , � F� � - _-' ' - '- - - --._ . . -- -.,.._.,. _ �_W,---._.._ ..... _ . _- - -� - - - - -- � ' - - --- -` "--�- - .' kc '� � "- � . i �.-. . . _ � � _. ._""'_ " "' " _ _�_ ' ",__.!'__" '_""' ' "_ ""__ "^�_'" i ' ' '""""'"�"-.' " _'_.i.--.�-..�_ .."""_._.. .." ' ' � " ' . _ .` .._ __. _ . �'4 r �.. .. • �n �.. - . .. . .. . _ �1?'.a� . y _. ..w��,�.,�... � "" . '. :. i ,v . • . � + _ .:__ a wN:..ri�.Y� .I.r1�.S1�"'.Y.:S"�:tJ;i','�,a�'.rG ."7"�y . " i" .5�.Em" . " '"_ " ___.. ..... ' '_"_"'_'_'_' "__ ""_" "' ' _' " '" ' '" ' " " _'_""'"."'" '_' _�. _' _ _ " _ ' ' i _.�.' " '_ "' _ __ '"_ "" _"_ "_____.... . ..'"' _ ' "_"_"'�.._"__.'__'""�__ "� _ _ _�'�.'._"'�__ '_ _ _ ._ .._..._�. _ `_'"�'.. '_""_..._''.__' '_ " � -'�-c."F � ,- x.,�. - --' '__'_ ' -'-- '.. . ._ _ - :,�"' +. , . '. .. - .._ . . .- - . ' -.. .. _. .- ' - - -__'-.-.'-_._ _- � - - - . ' - . ' __s'-�';- ., - t�_ - '.__ - _ ' _ ' ; r[vvs._.,:�x.�...,".r`.,.,,,,.����q'.; ... ._._..__ ' . ' ' _ _ .. ._ . j i.. ;+., ' _ "' xLSt .N!'�f 'Y'e'..i�tx,.:'.94'�aa. - .' " . - . . . . . � ��i1 �i'�y�i tA��'�,'t� ra �^i�' A•.�-��`C rx r Y�ti�' ,�4''��i�*'����F.� - ---"----' -` -... - '--'- -._. .. _._ _'.. ' - '- -'. . _ . _. . - _ ' - ; ��� ,�:.; � ' ------- -- - --- --- - - - - - ---- - - -- � �,�� „ � _ . --_.---- � � t' ��ry ::r. ss ..�i S', +, `� . .;:���^�,:��� .. ._,,.. . _..__,_ .--- - - . � -- - - -- - .-- -- - - - , . . �.. � .� �, ,�... _;,,.�: .., � ;'� � , .� .�j ,a%� � ,, : � �f., � . . .__ _.___. - - -- - - -.. . .!� �i'��,�r,�t' ��"'q,'�+%�� i ;�-�- $s:,r'r� :;; �:s.�� IwM;�k,.;+ _,__-- •--.....,_._ -- � - --- - ---�� - - � - - �'j =T'C a`;'.vu'Y...L ' �wi, .�e.A���`"'t.�..p�5�;�� .::.;� ,:+. . �,;'4 .r!' -. •P�:�iti;yr a i ii'"3f';,�� '�,,. .°��Y„ni'^."'7'�d.r^ . _'.. _' "._ .. _. _ . ._ ' _ _ _ . - - .. .. •a K�:f:��'F. ''o• NII-LITF—haoartmera CODY,YELLOW—Finance Copy, PINK—Assessor y,GREEN—Applicant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 909 860-3195 F 909 861 311'7) ax ) - BUILDING PERMIT APPLICATION FS-7-11(F,' ZONING SETBACKS FRONT RW o REAR 0 SIDE/SIDE STREET F1W 0 SIDE 0 S0. Ff DESCRIPTION PERMIT NUMBER Lstl),47 O1-apc TYPE OCC CONST. GROUP PROPOSED USE NO. BEDROOMS SFFVADD/REM Garage/Carport Valuation QUANTITY DESCRIPTION -J 0 Ltl -J UI ID CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: 17.7-: 331/.31 COMMENTS ij 2001 RECPT. N0. PAID BY VALJDATIONC !map IIAtIi! Aka-04 JOBSITE -3, 62_ ADDRESS t 0.1.00 C-AreSt LA em..) APN LO TRACT - Uri-- la OWNER zirl ADDRESS II r_l.11l,l%.A_ - .. ii ir CITY-r...arii brat- ZIP ... TE 1 utre APPLICANT TEL CONTRACTOR P.Alke kik/Jo-Les:3 ADDRESS 5I CITY ' --- ZIP TEL ARCII/ENG/ DESIGNER itn•kry-k,,... A .., , ADDRESS aorfashimvevilemc.. CITY Z I •0 IiteMs TEL - FW OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI. CENSE LAW FORTHE FOLLOWING REASON(SEC. 7031 5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTYVASCH REQUIRES A PERMIT TO CONSTRUCT,ALTER IMPROVE DEMOUSH,OR REPAIRANYSTRUO TURE PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. WISE LAW(CHAPTER s(COMMENCING WITH SECTION 7000)OF onnsion 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 ViOLAT/ON OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(MO)): DI,/SOWER OF THE PROPEFITY.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 COOE 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 s ALE. F. HOWEVER. ME BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COUPLE- TICN.THE EMBER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 LAS 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 OVA PROPERTY WHO BUILDS OR IMPROVES THEREON.AND WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTORIS)LICESISED PURSUNCT TO THE CONTRAC- TORS UCENSE LAW). 0 I AM EXEMPT UNDER SEC. B&P.0 FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HFJEBY AFFIRM UNDER PENALTY OF PERJURY THAT IAN LICENSED UNDER PROVISIONS OF CHAPTER • (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND , MY LICENSE BIN FULL FORCE AND EFFECT I LICENSE CEASS LIC. N0. 517c91 A ; DATE 9/3/O1 CONTRACTOR F_Lulte_Homes_ WORKERS'COMPENSATION DECLARATION I NUMB AFRRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS fi COMPENSATION.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORM FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECT/ON / :f 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS I ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. Pacific Employee ins. Co. POLICY NUMBER WLRC: 43011 R7 A (THIS SE-CDCN NE3)NOT BE COI/KELM OF DIE PENVIT IS FOR ONE)4J•DREDCOLLAFtS(SIM 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 5055 TO BECOME SUBJECT TO THE MAKERS'COM.ENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37500! 1145 LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. 3 1 DATE 5/1/O1 APPLICANT: PuIte Homes WARNING. FA/LURE 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(5100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN J SECTION 3705 OF THE LABOR CODE INTEREST AND ATTORNEYS FEES. CONSTRUCTlON LENDING AGENCY ) C I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTOR LENDING AGENCY L- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3007,CIV C.). C LENDERS NAME None(Pulte Home Corp) LENDER'S ADORESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT IL/ I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING , CONSTRUCTION,AND HEREBY AUTHORIZE RESENTATIVES OF THIS COUNTY TO ENTER UPON THE 5T: ABOVE-MENTIONED PROPERTY FOR INERT ION PURPOSES 5 •-...., It.:5'401? A0.41fif. e .c D \ ^ 4 0 neniorree NAME(PRINT) .----/4 0 ,r) SIGNA:4 OF....ret - DATE C CO Ui LU LL 03 -J 0 LII N0. DWEL. UNITS TOTAL FEES MallatiMllllll nimilf1E11111M0IN IIeCTM 11111111101 111111 mummisesimmmirb ",t• II_NM?, :MCI 1111101AIIIIMEM s MVP=t 111111M1111101 T AI 4:1 )0•1.OQ c, NAL-l.o"). )(1<ti *);_.) N0.STORtES PtAti-N3C. 0 ADJ.AREA ACTOR PSF -5 L ADJ.ARE ALUATION 1 • FEE ai '.),••)Q 31. PRESS FIRMLY APPLICATION DATE ISSUE DATE CITY OF DIAMOND BAR INSPECTION RECORD B;�„CIr( s, !"..Tr. S.'F'DFT..-lE.'1. UT i, UNDt�P-I",OCR c_;!..)N.P lir TIREPLACE FOUNDATION • ";F:'Er. i. b GE BOND BF AM ! i t , A- ' ------ ;.IVATRQFP',..Pf t 'PrION t ,--P7ATNG POi,,.=1-24° TEST. AT,ON; I MID HT i-.?nNn BEAM -t ;8 FT. BOND BEAM t.-71r)ND BEAM I . PRF-(3r-IALYING ,BENCHING R�T)Liri'-',GRADING � POnt r7ENCIN:Ti 1 PC101,c)NAn )Fr: • lt