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� �' CITY pF DIAMOND BAR
-""�"" - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
w 22664 E.Copley Drive Suitc 19d
(909)860-3195 Fax(909)861-311? PRESS
�'A�'� BUILDIIVG PERMIT APPLICATION "Est�tes" Platt 3 B/L FIRMLY
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a ADQRESS 720 Crestview Dr. DATE ~'�� ;� � NUMBER '�„� #_
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DEPARTMENT OF COMMUNI'I'Y&DEVELOPMENT SERVICES
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• " POlUlt�NA UNlFIED SCH�?L1L QtSTRlCT l�It� �
Fac(ltties Planning,Growth & Development Department ����
800 �outh Garey Avenue
Pompna, California 91766
Certiflcatton of Compliance
wilh fss provi�iatis af Gavamma�t Code Saction 53f380&65995.3
_ �'>�-�� iao�t�" r,��-� J���z� �,a��r�y
Uw�bpsr Nrnt �PDlicsnt —
-�'�'�D� ��Gnil L�AL�+hE*.1 � ,2Qo �c.��-t.. �t��+n�S �1�-�I�,i• £',2t�
9VMt Addr�a Company Nart»arid Phcrr N�xnber
��Vl�� G� q�21�'1'Z-
, i1i GOdi MIUf� !I
(,�l..�G�� '��""� - y'-�p� The person sigrong represents that he/ahe is authorized to sign on
T�,� behalt ot ths awnerldevetoper and that tl�e inlotmation provided is
e�� ttue and accunate to the best of hisJher knowledge.
nl�!- � �t�'�� �Zl�✓
FEE SCHEDULE:
The development fee�levied by the Pomona Unified 5chool District(PUSD�under pravisio Sec6on 53480 8 55995.3 of the
Govertment Cade are:
Residential Devebpment &'f.84Jsq R. � i;"�� ,�'.(� — ���
' Commeraial0evebpmen# S0.3Qtsq. . ``�,--�___�.---"u��
Development Type: �Ngw c�t�aon ❑Addition [�flther
�'I����rd ��� �Z-21��
�TnKk�Adaus .
�Yes �No
Nurr�WrdbiNdiy(�)inProjrct PlinChdcNwribrN) Carr/wcfaVD�vMopm�ntSu+wy
1. `7C1C.; G�.��kv�.c,,..� �s . .�.�v,•�,Q.. "��3�� �' �F''r N�• 3'`�
la t Mdr�ss th»ol Buil6nq Me( Ft Fw
2. �tc?„_j.�r-r.�-��� `t-' .�o� �"Zra � �01+'��� �
La!Addrw�� Uw d uilany Ana{ Ft? FN
w�. """1.G.t� C.V'1�rTv i tv�+ l/� . �(?1N1� �✓� ��Q � �►L/�.'��
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4 `al�� �4�t.Lv.� L..T. uNI�F-�� +✓�.F`T��C` (� �.t' �� :� `� - �,�--
�.
Lot/Adaos Ua►ot BuildrnQ Aru(Sq.Ft) FN
Buflding ceipt of Subtotal�•Z,.cp�2�-Y�, �
��� �Residential FE This is to certify Uiat alt iees due to the �p'°`
�Commercial Pamona Unified School District under
provision af Govemment Code Seation
❑o�her 5�oso a sssss.a as a prer��uisi�e�o
�Exempted the isauance of e Buildmg Permit by the
DeparUnent of Public Warks tsave been
reoeived. Based o�.fhe infortnatian
Total Square� ..7j�, ,�,� P�$ented sbave,this CertiFu;a6an of
��Q�a�� t-14 2 .�r 'x Completion is hereby executed. !
r�-�
❑Ysrined Tt3ta1 Fees Due�'�Z.�Pa�L�. '�
p�,�.. 'h�''�p !
'� oate
_------- ,��,�.
PU acilities Plenning,Growth 8 Fiscal Services dapartme�r�i�"
i
apment C)epartment ��1��
�p�T'HV�M DIS7RIBUTION:Whlto•qty/County
Yelbw-PUSD Fac�klra plenNng
Plnk-PU9D FbFcal S�Mc�s
{ioldsntod•Owntt!D�vabp�r
� •-
WATEii
RECLAMATIpN
So��o WAS1E MAN.�EME�. C O U N T Y S A N I TAT I O N D I S T R I C T S
OF LOS ANGELES COUNTY
1955 Workman Mili Road, Whittier, CA 90601-1400
Mailing Address: P.O. Box 4998, Whittier, CA 90607-4998 JAMES F. STAHL
Telephone: (562�699-741 1, FAX: (562)699-5422 Chief Engineer and General Manager
Cyrww.lac�l or�q
ounter ou : 7:00 a.m.- 4:00 p.m.Mon.-Thurs.
7:00 a.m.- 3:00 p.m.Fri.
Account No.: -0403187
SEWERAGE SYSTEM CONNECTION FEE Disccicc rTo.: 21
Date: December 28, 2000
Properry Owner: PULTE HOME CORP
Address of Properry: 52267 TRACT, LOTS 26,27,28,29
DIAMOND BAR, CA
Thomas Guide Page:
Contact: JERRY HAINES
Phone: 714-981-8215
Mailing Address: 18401 VON KARMAN STE 200
IRVINE, CA 92612
Counry Assessor Map Book, Page,and Parcel Number. 8701-006-070
Structure is Proposed.
User Category and Units of Usage:
Category: OlA
Number of Units: 4
Square Footage:
CONNECTION FEE CALCULATION
4.00 � X $1,290.00� _ $5,160.00
�J
Number of Units of Usage Connection Fee Per Unit of Usage Connection Fee
� � �
COMMENTS:
$5,160.00
Connection Fee Due
`Fee Payment Received From: Proce d hy:>
t
PULTE HOME CORP'' ` �d y;'
Amount: $5,160.00 Ck. No.;07638 F�
D.C.r ' eC 25,2�
BUILDING DE COPY VALID ONLY WHEN STAMPED
w
��Recycled Paper
UI tMOM)BAR ti
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
"Estates"Plan 3 B/L
PRESS
FIRMLY
JOBSITE
ADDRESS 720 Crestview Dr.
APN LOT 28 TRACT 52267
OWNER Pulte HOme Corp
ADDRESS 18401 Von Karman
CITY I rvi ZIP 92612EL.9497974400
APPLICANT ame TEL.
CONTRACTOR
ADDRESS
CITY
ZIP TEL.
.y
/
G
D,
A/�/vYJf
DESI
NER
ADDRESS
CITY ZIP TE
0 NER-BUILD R DECLARATION 177
1 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 HIMSELFOR 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 OFCOMPLE-
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 CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI-
CENSE LAW DOES NOTAPPLY TOAN 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 V 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 CIO.TR.
ff
V�T
OR
DATE
DA
CONTRACTOR-
WORKERS
COMPENSATION DECLARATION
I HERE V AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
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'ERFORMANCE
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
KER
S'COMPEN�SATKKJ INSURANCE CARR RAND POLICY NUMBER ARE:
ISSUED. MY W�
j^'
CARRIER
POLICY NUMBER G-c
(THIS SECTION NEED NOT BE COMPLETED OF THE PERM IS FOR ONE HUNDRED DOLLARS($100)OR LESSj.
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
SHALL NOTEMPLOY 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 7W OF THE LABOR
CODE,I SHALL/FORTHWIT COMPLY WITH TH E PROVISIONS.
ATE
PL
CANT
�ZZFi�
:AP
AP
I
D
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(51 W.OW). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTION 3700 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY TH THERE IS A CONSTRUCTION LENDING AGENCY
MIT IS ISSUE(SEC. 3097,CIV.C.).
FOR THE PERFORMANCE OF THE WORK FOR WHI THIS P ER
/
LENDER'S NAME
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 FOR INSPE TION PURPOSES.
\7/ 11
PERMITTE AME(PRINT)
SIGNAT E F PERMITTEE DATE
APPLICATION(;I �
PERMIT P/C
DATE/'� NUMBER;II
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ^
REAR ^
SIDE/SIDE STREET RW ^
SIDE ^
PROPOSED USE';EWE R LATER I AL
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION
SFR/ADD/REM
W Garage/Carport
LI Patio/Deck
L
J
LL PooVSpa
0
Re-Roof
Z
Commercial
IU
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
U
W
w
DI
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a
Q
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2
U
W
2
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES
COMMENTS
RECPT N0. PAID BY .J L VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117�oy PRESS
BUILDING PERMIT APPLICATION Ea-1 le L FIRMLY
JOBSITE D 1Z.
ADDRESS
APN LOT 2-TRAGT Z
OWNER V
ADDRESS/IF SAD/
CITY Zy/A/Fz ZIP92-IC 71.TEL. 9 9 717�y
APPLICANT g,F TEL.s-Mf,�
CONTRACTOR TF
ADDRESS
CITY ggf-V/Afe r7�ZIP'FZ4/2 TEL.9 9 4
ARCWENG/
ft' �grc�
AQ
1
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DESIGNER
ADDRESS S
CITY_W ZIP 9W/2 TEL.' 7W
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 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).):
^ 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 OFCOMPLE-
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 1,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 NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANTTO THE CONTRAC-
TORS LICENSE LAW.).
D 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.
��
SIf3
/•I
LICENSE CLASS LIC. N0._
+
DATE(30-ci�/-CONTRACTOR PL•ITE 1&�C'f.
EXPO
COMPENSATION DECLARATION
WORKERS
II HE FFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
VE 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 WORKERf COMPENSATION INSURANCE,AS REQUIRED BY SECTION
3700 OF THE LABOR(.. FOR THE PERFORMANCE CF THE WORK FOR WHICH THIS PERMIT IS
ISSUES. MY WORKFRS MPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE'.
p
CARRIER-t(3kf I
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/
A
QLICY NUMBER
D
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(TF&SEECTOW NEE
BE COMPLETED OF THE PERMIT IS F(Y: ONE HUNDRED DOLLARS($100)OR LESSF
NO
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
a i •�CtD APPLICANT L;//L?e
T
DA
E:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE I5 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 dh -L' + E 1/0'I F Co•I
LENDER'S ADDRESS
I CERTIFY THAT(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
CONSTRUCTlON,AND HEREBY AUTHORIZE RE ESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPEC N PURPOSES.
PERMITTEE NAME(PRIN
SIGN?E F PERMITTE DATE
APPLICATION t7 PERMIT
DATE N
UMBER
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. F CTOR PSF ADJ.AREA/VALUATION
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QUANTITY DESCRIPTION FEE
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INSPECTlON FE E
ISSUANCE 0 U .
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ENERGY PERMI T 06.1
RETENTION FEE:
PRE-ALT FEE:
Vi t
TOTAL FEES 5 �E2+h N 4(�
COMMENTS
RECPT. N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-Applicant's Copy
POMONA UNIFIED SCHOOL DISTRICT
Facilities Planning,Growth&Development Department
800 South Gorey Avenue
Pomona,California 91766
Certification of Compliance
with fee provisions of Government Code Section 53080 8 65995.3
�> L-(� �-10�11��? 12�
Residential Development 51.84/sq h. �ti'Tf,� (�--� '
../
14i u
Fom+ Nwn6er
Dw�abpar Norte APDicant
I'��D(�f�G�n�l Y1\>?�J ��200�u�-c. (-}ors ql� •9�1. 82c5
31rNt Addreaa Company NarM and Photo Number
I eVI�E Gf�r q 21.Q12-
c'Ny,�: p code
QYQ • �a�- N�tOa
Commercial Deveopment 50.30Jsq.
FEE SCHEDULE: -
The development fees levied by the Pomona Unified School District(PUSD)under provisiorytS�Section 53080&85995.3 of the
Government Code are:
Development Type: ONew Construction
Addition
S'pphatwe n
The person signing represents that he/she is authorized to sign on
behalf of the owner/developer and that the information provided is
true and accurate to the best of his/her knowledge.
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^Verified
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Pomona Unified Scholl District under
provision of Government Code Section
53080&65995.3 as a Prerequisite to
the issuance of a Building Permit by the
Depeltrnent of Public Wontcs have been
received. Based on.the information
presented above,this Certification of
Completion is hereby executed.
3
Date
Fiscal Services Department
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DISTRIBUTION: While-Cky/County
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Pink-PUSD Flacal Servkes
(301deMOd-OwMl/Devebpe/
COUNTY SANITATION DISTRICTS
OF LOS ANGELES COUNTY
1955 Workman Mill Road,Whittier,CA 90601-1400
Mailing Address: P.O. Box 4998,Whittier,CA 90607-4998
Telephone: (562)699-7411,FAX: (562)699-5422
&vwunt3460u&w.
0 7:00 a.m. -4:00 p.m. Mon.-Thurs.
7:00 a.m.- 3:00 p.m. Fri.
SEWERAGE SYSTEM CONNECTION FEE
JAMES F. STAHL
Chief Engineer and General Manager
Account No.: 0403187
District No.: 21
Date:
Property Owner:
Address of Property:
Thomas Guide Page:
Contact:
Phone:
Mailing Address:
PULTE HOME CORP
52267 TRACT, LOTS 26,27,28,29
DIAMOND BAR,CA
JERRY HAINES
714-981-8215
18401 VON KARMAN STE 200
IRVINE,CA 92612
County Assessor Map Book, Page,and Parcel Number: 8701-006-070
Structure is Proposed.
User Category and Units of Usage:
Category: OlA
Number of Units: 4
Square Footage:
CONNECTION FEE CALCULATION
4.00
Number of Units of Usage
COMMENTS:
X
$1,290.00
Connection Fee Per Unit of Usage
December 28,2000
$5,160.00
Connection Fee
$5,160.00
Connection Fee Due
CJ Recycled Paper