HomeMy WebLinkAbout15981 >-'-�°�,_.
� "' ',
�� ` CITY OF DIAMOND BAR I � ��-'`
DEPARTMENT OF CQMMUNITY&DEVELOPMEN'f 3BRYICES �-_�_`` -
�W 21660 E.Capley Dcive Suite 190
(9Q9)86t)-3195 Fa�c(949)861-311? << �, PRESS
��'��'��� BUII.DING PERMIT APPLICATION �� �C..�n 3 �c2. FlRMLY
p ADDR'ESS_T�� ����CJ�X`� ` 6A7E GATIQN �.r��"�-1,,�� NUMHER 1� �I p!C�✓ i ��J� S.�r`
� APN LOT -�d TRAGT, ] �-G-l.0�" fSSUE TYPE OCC
DATE CONST. GROUP
p 4WNER WS�_1�.�. _���—
p ADDRESS ZONiNG SETBACKS
CITY -�V 1�� ZIP�Z TE `i.�1 �Gt p FRONT RW ❑�
�j��^"2_ TEI.. --""" REAR �
APPIfCANT �. � SIDEISIDE STREET RW O
CONTAACTOR r SIDE _ �_— ❑
� ApDRESS� _
� GITY ZIP TEI. PaQPOSED USE __
�+ ARGWENG! �
DESIGNER � � �" NO.DWEL ' NO. NO.
AddRESS UNtT5� STORtE5 BEQROOMS
� CITY S iv `ZIP^��Z� T .�"����J�„�-�
u� QESCRIPTlON SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER OECLARATIQN SFR/A6D/REM 3
O
6 I HEFiEBY AFFlPM UIVpER P�NAI.7Y 4F GEfilURV THAT i AM EXEMPT FROM THE CANTRACTOP$U- Gefe9g/C8f�7pI( � � �
41J CENSELAWFOA7MEFIX.L0441NGHEASt7N�5EC.7S+i.58U51NE55ANDPROFF5510N5CODEANYCITYOR (j�
�7 ODUNTYRVMICNREfllNREtiAPEpMRTOCQNSTRUCT,ALiEfl,IMPROVE.OEAIaLISH,ORREPAIRANYSTRUC� L(J polIS7�D9Ck � '�
Z TUf4E,PRpR TO ITS iSSU+WCE,K50 REW�RES TFiE hPPUCANT FOH SUCM PEPM4T TO�ILE A SIGNED
�� STATfMEM THAT HE OR SNE IS UCENSE�WRSUANT TO iHE PROVISIONE 4F THE CONTRACTOR5 LI- W
CENSE tAW i��R s(���NCINO WfTH SECTK/N 70D�)qF OIYISION 9 bF TNE BUS�NESS AND PPO- u' POOUSPB
FESSIONSCOOEjORTNATHEOR5HEI5E1(EMPTTHEREFROMANOTVSGBASiSFORTNEACLEGEOEXEMp- �
TpN.,iN'/VpL.ATiOHOFSLCTIpN7431.58YANYAPPI.ICANTFOHAPEWMTSU&tECT5iHEAPPLiCANT70 Zr f�-Appt
r, A qVIL PENALT'oF NO7 MQRE THM!FIVE HUNORED DOItARS(SSDo).):
� O�,ASpWNEROFTN(:PRQPEH7Y.ORMYEMPIOYEESWI7HWFGESASTHEIflSOL.ECOMPENSATION, G� CommefGi�i
WILL DO THE WORlC,M101'HE 5TRUCTURE IS NO7 INTENpED OR OFFERED FOR SAIE{SEC.7oN,BUSI- ,�
� NESS MJD�flOFE551QY5 tX76E:THF CON'7AACTORS L�CENSE UW OOES NOTAPPLY 70 AN OWNEROF =
PpQPERTY WHI�8{Jy,p$pR 1AtRPOYE5 THEREQN,AND WHO DQES SUCH WGRK HIMSE4F Ofl NEHSELF OR
CC 71��ROUONNISORMEROWbiEFiPLOVE6S,PROVIDEdTHATSUGHIMPRtlVEMENTSARENOTINTENDEDOR �
� ,OfFEHEDFDflSKEIf,HON�EVER�F7E6UILpMGORIMPROVEMENTI550LDWtTHINCNEYE4Rqf'COMOt.E
� t10N,"ME OWNER-BUILOEFl WILL HAVE TME BURpEN OF PR�VW�7MAT HE OR SH£Q�D NOT BUIID ISR
IMFflOVE FOR 11tE PURPOSE OF SALE�.
(yJ ❑I.AS 6MMER OF TNE PROPERTY,AM EXCLU5NFlY CAN'fRACTiNG WiiH LICENSED IXJMRACIORS
¢ TO CONSTRUCT TME PflOJECT(SEC.]U44,BllSINESS ANO PROFESSIONS CObE:THE CONTAACTOqS LI� V21UditOfi U ADJ.AREA
LLI CENSELAWbOESNOTAPPIYTQPNOWNEA4KAPpOPGR7YWHOBUILD50RIMPROVES'NEHEON.AND "�-"— .. -
F N41C1COMMCTSFOR5Up1pPOJECTSWiTH�t(X�NTMCTOFi�S)UCENSEDPUR3UANTTOTHECOMtUG �7y� DESCRIPTION FEE
TOFS UCEN5E UW.).
J
Q C!I AM fiXEMP7 UNDfiR SEC.__ _,_, 8.8 P.G.FOR Tri}S REASON Q ��,
3 OA7E ___'� �WNEA_.���._.�. � V � "_T+-�—��_...
z te_c
� UCEDtSEQ CONTRACTOR5 DEGIARATfON � �
s� '� � .
� !HEREBY,�F'IfiM UNDER PEklLTY C}F YERIUiiY THAT i AM LiCENSEp UNRER PflOVISIONS OF CHAPT�R
Y S�µ£NCWfl WRH SECTKNi i�70K OMSION J OF THE BU3MES5 AN�PRbFcSSIONS CO�E,ANCl 2 t nC.- _
MY UCEHSE 75 Mi FlXl FiSqt:f'AND EFFECT. �
`5 "'�`,�._._,_
� LICENSE CUSS�_� tiC.NO.���_„�„__n_ � �S�� ,� -�
!— r j'����� J�,,�,�� -- ` --
� dA'fE�:•�j�, _,y�,_�,. CGNTAAGTOR_jj._r�G�_..f,Z,�i!�� �-'�� t1-
� �K�a'
� WORKERS'CQMPENSATIQN DEC4ARATiON Q {$ 1 _
�T'L�
� 1 NERE Y AFRR�i UN4ER OENA4�l'OF PEflJUi7Y nNE CK THE FOLLOWING OECLAFlATlbNS: Z ��
� ,._IH�VEANDWi4LMAiMP,iNACEATIFICA7eOfcANSEN?TOSELF-iWSUREFORWURNFRS� _
COMPfNSAT10W,A5PROY{DEb8Y6ECTiONa�ooOFTNEUBORCODE.FOR7NEPEFFpRMANCE C7
aF TME WOftK FOR WMCH TkiS FERMiT IS IS5UED. � ��
w
t HhVEltND WILL AiA1N7,\IN WORKERS'COMPENSATION iNSJRANCE,AS REQ11fiE�BY SECTiON h
'�4'. 310o OF 7NE W3QR CCI�E,PoR TNE PERWFMANCE 4f THE WOPo(�-0R WHICH TfiIS pERMl1 IS �}�� a
Q ISSUEO.MY RKEl1S'�7MPENSALIONlMSURANCE CARRifR 14N6 GOLICY NUMB ARE: CQNSTRUGTiON cr�
� c,wwen Clt. �`_L�,Is.�__Yh ��I�C � 'y`��e��,._,r�.�i_ PLANREVIEW _._.�.._.. ... .� j ��,j
nz v ICV NUM9EN..�L�.i�.._L1_-L-,_�r.��__,7r1_...[�-.-_ E�ECTRIC � � " .•:= 1 �i11}_i�_,._,.—�St u�,�_.S�t1�
Q (7 j"li A __ .�,��('� , 4 tiJ
d t�s'EtTcr+r�nore.Emnv-tierFnoFn+EaEFlnrr45:rx:.cNEMxcflEnoxuRs(b�oa�ai�E.Ss1 P�UMB�NG __.- �� '1.l . . 4l. V'
� I CENTIFY THAT M THE PI=RfORMANCE OF TH6 WORK iOF WHIGH iNfS PERMIT IS ISSUED,I MECHANICAL _� CTl.Z��-.✓ , ,J.(!� ('� O ^ �
S4+ALS.NQTEMPLOYANYPERSONINAUYUANNERSOASTGISECOMESUBJECTT07HE �� 1�, j
� WORKEftS'GOMA�NSATM�N IAWS OF CAttfORNiA AryD/GAEE THAT IF I SNOULb BECOME INSPECTION FEE _.,,_„ �,i W ,V�
� .4U8JECT TO iME VXaR%&RS'CAAtVENSATiON PHOVISIGNS OF SECTION aToo OF T4}E 4.ABpp T
= GCO£,i SiiAt7.FORTHWnN COMPLY WITH THOSE PROVISICNS. ISSUANCE
! �_....
pDATE:J��� APPL,'CANT. _�iJ 1�`� �t.*/'b'1�„s _.._T_.. SMIP J �'U � �.
� WMNIMG FNLURET�SECURE VfPRKERS'CpA7PENGATiON CDVEFAGE IS UNLAWFuI.,ANp SHAI.LBE ENERGY P/G ._ . „" �-'
� SU&IE6TAAIEMV:OVERTQCRIMINALPENALTIESAN�CIVIIFMESUPTOQNFNUNOREUTHOUSAND ENERGYPEf2MIT ___h.��.�,,,������-.� _��.� /
p011.AA5(i100,004},M ADDITiON'O iHE COST OF COMPENSATION,DAMAGESA5 PROVIDE6 FONlN - . �
� SECT�ON37680FTHELABORCOC£,INTEREST,ANUATTOHNEY'SFEE9. RETENTIONFEE: , _
d COR7STRUCTfON LENDING AG£NCY PREAU FEE: �/y��-�
� !HERE6Y AfFIRM UNDER AENAL(Y t)F PERJUPV THAT THERE IS A CONSTRUCTLLIN�ENDIMG ACIENCY ____����I��^f' -'. ' —_
FORTNE PERfO(iMANCE OF THE Vlf.iflK F4R WHICH TH�S PERMIT IS ISSUED{SEC.3tl47,ClY.C.), —"` - � 7'�"''. '--"'"" "-
ua � ///��� JyJ;�'.��yy " n
� LENDEH5 NAME��-.����-L�if_l��'•���, . C 1. , ` _.
..._.._�_ �._ .__..
!_- IENOERSADDRES5�_,_��,�.�._..__�4._.__ ( ^y
� I CEflTIFY THAT 1 MAYE READ TNIS APPLK:ATIt7NAND SThTE THAT THE ABQYE INFONMATN7N IS CARFiECT. TQTAL FEES ` �� � ' � ��� •��.
� 1 AGREE t0 COMPIY WITN Alt GTV ANC3 COVNTY ORDINpNCES AND STATE LAWS pELATMIG TD W1LQINL+
� COMSTRUCTKIN,0.ND t1ERE6Y AUTt�OpiZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
Z NW4E-MEN7K7NE0 PR6PERTV fPP INS CTION PVRPOSE5. GOMMENTS
� �i�r��� �� _
m __ _ _ _
¢ PfRM�TTEENAMEIP / J ._.. ,_..
cn C+c.31 �"��1��C "� _�
� sic ia oF�veFluin °n'E RECPL NQ. `�-PAID 8Y _ ..J YALlDATION
~ WHtTE-De rtment C
pa opy,YELLOW--Finance Copy,PINK-Assessot Copy,G�OLRENROD--Fite Gopy.GREEN-Applica�Ps Gapy
����m,a� �'� a s�c"�i�`'�,� ..t �'�#t:`�.� .��n �'"�'.
� =�������<
����+r��.� � �� ��� ��_.
,
,,q � ���,� �
�;�;� � �.
>
e � � � �
„,, . � � � ���
�
��.
�
�%�,�, �� � s��� � � .�.� ;
� , ��„ � " x � � , : _ _ � .
y ,
� ; ,�,�,k������,.��-��8. . .� , . �
, . ; , ,
, � � � �� � � �
.
o .
�I ` � � �
'30 1 - � � ,, , � � ._ � � . ; �.
- . .
�� - _ _. . , . _
„ , _ , ,._ _
_ _ _ - , _
___ . � � ,� . � � �
_ _ �,�. �_. � �� _� -
.
, .
� . , : ., _
e � _ .
� ,
�
��� � �
��2���± � ' . _
, .
�. . . . .
_ .. . .
� � � �. _. , ,
. . _ . -�� ;. , , ,
_ : . , ,..
_ __ _ , .:,, � ��� _. _._�� � - �
�1 - , _ -
_ _. � _
_ - ; �- _ti ,.,� �
+� ��� � . � _ _
.. _ , , —
a _
_ 1�
� _
���y�� � _ : _
.. .
�I�Z _G� -
U� __
, � ,� , . ; - � � . � �
,; " � ` ._ . � � � ,
_ '� . _
. _ . .
�
� h' �
t
� � � �
L , .�� � dYb�.. Y,�'
�.u�.�-+�3 cr�f�''' -2�_�t , . � � .�. . � ,.�.�. r.,,,������.: �� �
, � . .,_ _ _
: . � ._.; �_..,
_ ..
, , . a� . _
_ _ _ _ ,
�_ �.�:� _ _
;t��v _
r�a � � .�� � ,� ��� - � _
� � � - -
� ..� f�r �k� .
� �����u� '����8���t���`�„k
,� �'�'�� ��'��� �° a __ _ �
� y,;��Ma�.aw'��"�.�'�*� � �a�` �� ... _ ... . . .._. ..
�� �`r; v��'����*�"�' � �� . ...... .._.. .._ .. . . .... .... .. _. .. . . .. ... . . . . . �
�,+ r ;s� � t "�Z�fi`�3° .. ... ...
a ,� �,,� �b��� �° �
s���.§� �`� -',��"�S:�x�"��;`#��5� ._. �� _ .... . .. . . ... . . . ._ ._ ._ _. . . .. . .
- q xfi
' ��r x � " Y _
����,� � s �, �<
�'"°'��,� �p_ A � � �* .. ___ .. __ .... . . - _.....
a ���,� '�...;.� aw�yt ;m Y;� . ...
x q �,. -'' �"a: ;�,� .. � ... _. ..... _. _ ._ .
���'a�^i �.. "kt�+' Kn ho�:,.F? . ._ .._ .a.. ._.
, �. t` :_ �,..—, .rn .. - � -,....,., a..... ' .�
n.,a�.a ..^. � .._..»m ,..�.
� ~ CITY OF DIAMOND HAR
� -��� DEPARTMENT QF COMMUNITY&DEVELOPMENT SERVICES
1 „ 21bfi0 E.Copley Drive Suite l90
� � (909}86U-3145 Faa(909)861-3117 �R�`S"S
���»�^�p BUILDINGPERMITAPPLICATION °�states'" Ptan 3CR FIRMI.Y
� JQBSITE APPLICATIQN }t' � PERtuiiT < c�� P/G
Q ApDRESS72� CY'@StVIeW � DATE � !*�.�� NUMBER �`-� -'
#
� ISSUE TYPE OCC
APN LOT. 1_� Tf�AGT__,�Z 2 6 7 DATE CONST. GROUP
p dWNER Puite ��mes Corp
"' AQDRESS ��d� Vt1Yl Karman Zt3FtING SETBACKS
� IYVICt� FRONT _ RW C7_�__�
CITY ZIP� TEL. REAR C7
APPLIGANT � TEL. SIDFJSlDE STREET RW ❑
� CONTRAGTOR. ����[� SIQE O`.
pG ADDRESS� pppppSEDUSE SEWER LATERAL
� CITY Z!P TEL.
z� ARCHlENGI q�,
DESlGNER"� '� L .Z�'_C '4�"N-"�S t)�-� . —
� ADDRESS ��J�' �jL _. (p NQ.DWEL NO. NQ.
-1�-�—� UNITS STORIES BEDROOMS
N CITY �''��� Z!P�����E
� DESCRIPTlON SQ.FT. FACTOR PSF ADJ.AREANALUATfON
� OWNER-BUILDER DECLAAATION SFR/ADDIREM
O —
[� 1 f1ERE8Y/tfFlRM�M1DER PENALtt OF PERJURY THA7�AM EXEMP7 FROM THE CONTRACTOAS Ll� �dfelg8(Cdl'p0f!
W CEHSEURWfOR7HEf{1lLOWiNGREASON(SEC.i031.58U51NES5ANf1PROFESSWNSCObE:ANVGLYOA (n
(� CAUtiTYKMiCHqEW�RESAPERMYfTOWNSTRUCT,ALTER.IMPROVE,DEMouSF1.OAREPAiHANYSTRUC� W p�tiD;Deck
� TURE,PRiOR TO ITS ISSUANCE.�1L50 REW IPES TNE APP�ICANT FOR SIICN AERMi7 TO FILE A StGNED W
STATEGENT THAT HE OR SNE IS LICENSED PURSUANT TO THE PROVISKKJS(JF THE COM1iTRACTpRS Li-
� CENSEUW4�PTEReIWA7MENCINaWITMSEC710N19tlo)OFpiYi5KNi30FTHE8USINESSANOPRo- � POoUSpO
FESSiONS OODEJ Oft THA'ME ORSHE IS EXEMPT THEREi'ROM AN�TME BAS15 F6fi hiE ALL6GED EX6MP (�
TION.ANYVIOLA7pHOFSEGTIONT03158YANVAPPLIChNTFORAPERMITSl/BJECTSTHEAPpLICANTTO � Re-Roof
� ACIVIL PElJAL.TY OF NQ7 IAOftE TNM1 FME NUNt1flED DOLLARS(SS00}.):
ry �I,h5�WMEP�FTNEPR6PERTY.OqMVEMPLOYEESWITHWAGE5A5THEIRSOIEWMPENSATlON, � �OmRIBfCl91
��. ylil,L DO 7NE W4iiK.ANO THE STqUCTVRE IS NOT INTENDEO OR OFFERED FOR SAI,E(SEC.loU,8U51- �
NESS ANO PADFESSiOA'S CODE THE CANTRACTORS UCENSE lAW D065 NOT APPLY TO AN OWNER OF
� PqOPERTYViFiOBUiLDSOR1MPqOVE$THEREON,ANDYhfOQOESSUCFf440flNMIMSEIfORHER56LFOR m „�
� THRDUGHHISORHEROWNEAIPLOYEES,PFiOYIDED7HATSUCNIMPROVEMENTSARENOTMdTENDEDOR
OpFFEREDWRSPLEIF,H0INEYER117E9U14DINGOftIMAROVEMEN7'ISSOIOWiTNfNONEYEAROFCOMPLE�
Z, TION.7HE OWNER�6UILpER N7LL HAYE THE BUflOEN Of PRtrYiNO TMI�i HE Ofi SHE D�D NOT 6UIIA OR
� IMPROVE FOR TNE PURP0.5E OF ShIE�.
w ❑I,AS OMMEROF THE PAOAERTY.Ak 6XCiUSNELY CONTRACTING WITH LICENSED fiANTRACTqqS
� TO CONS7ftUCT TME ARQIEGT(SEC.7osi,Bu5iNE5S AND PROFESSIONS CADE:THE CONTRACTORS ll- VaiuBtiOn ADJ.AREA�,�_,
W CENSEtAWDOESNpTAPF'tYTOAN6WNEROFAPflOPERTVWFiOBVIlD50RR.5PqOVESTHEHEON,ANQ
� WNl)iX7NTflACTSfbRSUCNpPWECTSWITHAGONiRACTOR{S)lIL`ENSEDPUHSUANTTOTHEfANTRqF QUANT�TY DESCRIPTION FEE
Y TONSUCENSELAW.}. ..-.
� J
�j ❑I11M EXEAIP?UN�EI7 3EC. ______._._.._,___B.d P.C.FqR THiS REASON � _ _
�S .._._.�_.�._ ..�_..___.v_ _' .. Q
4' {MTE _.��.�. OWNER�..—'_.�. " �
g w -
LfGENSED CONTRAC70R5 DEGLARATiON -�
� W
t MEREBY t�FIRM UNDER PENALTY OF PERJURY tHAT I AA1 IICENSED UNpER PROVISIONS OF GHAPTER �
� Y(L�FiMENCiNO W�7M SECT�ON 7000}OF OIVISKKJ 8 0F THE BUSINESS M1D PlaO:ES51t�N5 C.ODE,AND Z ..
X AiV(,iCENSE�S�N Rlll FpRCEAND EFFECi, m
L1!
0 �tCENSE GtA --.�� LIG.N0.� I �� �
r
� DATE_
�"t'- ��_ coNrHncrpa�� o-
Cit �l"�' ._
� WbI�KERS'COMPEN5ATION DECLARATION Q � _�
� f NEREBV FIRM UNbER PE�ALTY OF PERJURY bNE 9F TleE F4LLOWING OEGLqkATk�NS: U i_
<!J Z
Q
� � AYE AND Will kAAiM7AM!A CERT�FiCATf 6F CONSEM TO S£LF-INSURE FOR W:JRKER:�' Z
� COAiPENSrTt�N.A5 VH�Vf6Eb eY 9ECTION a�a0 0F TNE LABOR CODE.FUR TNE CEiFOFMANCE W .._. __._,_,_._
OF THE WORN FORiMi�GH TM$PERMIT IS ISSUEO. .�
� -
� I HAVE IND WILL Mn1NTA1N WORKERS'�MAENSATION INSURANCE,pS REQUtpED BY SECTION
Q ' T3inoOF7MELABORq�bE.F�RTH6PERFORMAhCEOFTHEWOPKFOaWHICHTHISPEflMItIS
� tSSUED.MfYjJ+�'�.,A�K.E�R;'tXMPENSAT�ONiNSUAANC CARRIERANOPOUC�YY/U�MBGRA�A j�. CONSTRUCTI(�N _,__,.
� C;WR�ER�N�7.�:�J C:- O � JJvf C'fJ�" PLAN REVIEW __... ---_.Y,w —
> �ry j
b'`-F"���E�;�
Z Pot.1CY NU�.tseR.,�. � .�.._ �, — EL[CTflIC _ _ ._
sC
p ln�ssEcrnr+nea�note�ca�*.�n�n�rrwrr�sFaRaueir�rr.�E000u.sasts+m)cw��ssl. PLUMBING .__ L��
� (CEA7��YTHAT iNTNE PERFORMANCEOF THE WOFK FOfl WHICH THIS PERMIT IS ISSUED,1 MECHANICAI
Z .�._.__� _..� .__.. _�_
Ly" SHAiL NOT EAiPIOV FJJv PERSt1N IN r1NY MANNER SO AS TQ BECOME SVBJECT TP THE INSPECTION FEE
(/y WORKEflS'l.:dAPENSA"IOH Uw5 OF(:AlIF4RNl0.�u Af.REE THAT IF I SHOVI�OEA:CMtE ��-�� -- '�} --
SU9JECTTO7HEWORN:EflS'GOMPENSATIqNPR�VIS10N5UFSECTf9Na�0o4FTHElA80R ir�C��jANCE _„� _._.. �"'-�'��
� CODF.,I/SHAl1,F�H'CHNI;H COMPLY WITH T EE PHOVISIONS, '�_"/^�
p dA7E:��L_�L1_I AGPLICANT: -��.-4-<,_�=-J���'=.-,—J� SMIP _.__.. _ ..__
w ENERGY P!C
� WARNtNO:iA7LURE TO SECURF VJORKERS'C:OMPENSATION COYERAGE IS LtNIAWFUI.ANb SHM.I BF -- —'- — --"" �—
� SU&IECTANEMPLOVERTOCRIIdINALPENALTIESAN�CIYlLFINFSUPTOONEMUNDREOTNOUSANU ENERGYPERMIT _ _.._�.._.,�.� —„—._.- —
r pp�uq5(ftao,0o11).IN A�OITIOH TO TNE COST Q�CS7MPFNSATICN,DAASAGES AS PNOYI6ED FqR IN —" ' '-
� SECTION 3lqaOF THE 1.A60R CODE.INTEfiEST,ANDATTORNEV'S FEES. _ RETENTION FEE: ._.,_„_,__.._ ,_ .. . —
W CONSTRUCT�ON IENDING AGENCY PRE-AL7 FEE:
o- __ _,— —
O
� IHEREBVAFFIR/ALINDERPENAI'-YOFPEPJVflYTNAT�ISACONSTRUCTIQY DINGAGENCY
W FOiiTHE PEAFORMANCE oFTHE WrORK FtiH WHICkI THIS E�45 lSSUEO(SEC.3 9T,GV.C.). — �
���S� _.�-_.
.�._.._.. .,-..__
� �ENDERS NAMF._. .._ - -- �-.._.. ._ .� .._.—
� L€NDER'S PDOflESS .__,_._..� _ . �^y [� " -�
� i CERTIFY THAT i HAVE READ iHIS APPUCATIONAND STATE THAT THE A@pVE lNFORMATION IS GC)RRECT. TVTAL FEE+7 �`�� � �'
� i hGREE Tq CAMPLV WI7H ALl CIIY AND CqUNTY Ofl�llJANCES ANQ STATE Uw$REU�TINO TO BUILpiNG
CONSTRUCTION,AND NERE6Y AUTHORIZE AFPRESEN7ATIVFS OF THIS COUNTY TO ENi�R UPON THE
� A90VE�i.�ENTqNEp PROPE�iTY FUft IYS CTIOM PURP45ES.
,r � COMM6NTS
� �"�/����/J � /ti
� _51..L:.�v_�" _..— - ._..�. .�.. .._. ._
m PEFIMITI'EEt1AME(PRI ) —_.`.-- _ .-, _... .-_.-
� �_!1-�f _�+_,�,,�_
� t��-� _.
Uy SIGN RE OF PERMITTEE �� OATE � ( �/ t
= RECPT.N6. PAIU BY YRLIDATI4N_� `--h--- _
~ WHITE—Departm6nt Copy.YEU.QW—Finanoe Copy,PtNK—Assessor Copy,GOL6ENROD-�-Fiie Copy.GREEN—Applicant's Copy
€"� r Y �:,;.. -
� �'..�* ,�^�o-.�„� � r,d ti��.�t���,k''�'y�sw6 .,.. ^�'°�z .
� €
��������� }�.��� ���������
,
�
_„„�
� » � �
�; ��. � � � -
�� . �� - -`�r .
. � �
��� � ' � � _ .
� � � � � �°��- �����
� �� ,: �
F. � �.���.���.��,� �, � r —� _
__ . .E,- __
_ _.
_ � � �, -- .
— _ � r � s� _ _ _ _
__ -- � _ _ _
— �. �� , �, ;,
_ � . , _
_ - �, __
__�_ .: . _ _
- ;T, . ._ ;
� �< � _ �; .ra __ _.
__ -- , _
� � - , � � �,x, --
_ .. � �,
, _ _
v __
, — i _ .
___ �,_ _ __
_ _ _ — 3 -� ;_� ,�o � __ _ _ _
__ -- — __
_ ; . __
- � � -
�� � � � l�� � .
7�`�-a C ��� � �
"_` J _ _ ._ _ .�.
, �.� . _ ... "_. � `. , �� � . .. .... � .
—... . .___ �
.. . �.t a»�."��'.. � _
� -.' .. � ,. „3 ewk+t���P�� ��Ka���� .. �
. . ... . . .... . . .,c�¢i _'a? . � . .
.. . ...... ...... ..... .....
� .._.. ...... ....... ... .
�i3�"+��� t� ��f wTM'YZ `� ....... ...... . ... ... .. . .. ..... � .
�"a° �"YP r � ���`Y��������}5 ...... .... . � . . ....... . .. . ..
i
x � � � y.. _
' � u�,�'�� ��� �"1�� ' _
� , � �,e� _
�. :� � ^`,�- .. . . .. . ..
� n a�"��� '��� �C�.. a�*�,�,ar�� ... .... ... -
nY'•� _. .. . . . .
k _ — � �
. q �w�yg`dk�9'��`s�"�"�`�,J P�°t�`,�." . . .. _.... . .
ri
'�,"� ��n �.� .5�.^''�.'�' �K�� �'` . . ... . ..
� � � � �«a"�4-���t��"#�'La���k` -- ... .. .. . ... . ... .. . .. �� �
� ������.��,������-0�� _.
��� � ;�,x �a - �
�'����'`�� �'��s�.�,�v,�m� _ � �� �
� � � � � � ' _
znr d r� �
S � wg�'"� s'"�.
� w�?�* �"� � z �, � — � � _
,f...>�`u��. � r.�n.�`,�-�,��.�,�. < ' .. .__ - � =..,e.... ., ..
...�. .�...,.....�_-_..e. .
., _ _..,,..._.,.-.� ._.
�..�.�.-«�.e.„�,__�.w........ ._.......
- 1
rNmun
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117« 11 PRESS
BUILDING PERMIT APPLICATION TS- k5 ?t4 FI-(Z FIRMLY
Vv,
JOBSITE-lik ST� !
ADDRESS
Kf
APN LOT TRACT
OWNER AA e_5,/I
T
ADDRESS,H
CITY�Cji�e_ZIP°D 0 L-TE
APPLICANT S P/V-2_TEL.
CONTRACTOR
ADDRESS
v
CITY ZIP TEL.
ARCH/ENG/
L
DESIGNER J]IC}Jc I 5YI L 5�I k SO
. 1
5
h
k LU
DDDR S
�
t
A
*vIyIJ '-Y-�'
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 REOUIRESA 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 Y(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).):
(7I,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 OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
V440 CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
^ 1 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
G (COMMENCING WITH SECTION 1500)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LIC
NO
3
LICENSE CLASS
I
q_-2c�"/'L CONTRACTOR l,t,_}Cr Ckl
DATE
p
ICI'
T
ION
COMPENSATION DECLARA
WORKERS
I HERE V AFFIRM UNDER PENALTY OF PERJURY ONE CF THE FOLLOWING DECLARATIONS:
1 HAVE AND WILL MAINIAIN 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
37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY{.Jp�RK.ERS'_MPiENSATEON INSURANCE CARRIER AND POLICY NUMB
�
I
/^'
POLICY NUMBER-_7QI.LLIL�._.-[.1 •7 63_-_
A
j .. 11
OT E•E COMPLETED OF THE PERMIT LS FOR ONE}&PUlED DOLLARS(EIWIORLESS}
(T S'(.-'nLNJ NEED N
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
WOE. I S
ALL FORTHWITH COMPLY WITH THO
ROVISIONS.
E
S
P
H
DATE: il--I APPLICANT: 10:1 1 'Tc 0-.S
WARNING: FAILURE TO SECURE W'ORKERS'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-0 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR COCE,INTEREST,AND ATTORNEY'S FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
RMIT IS ISSUED(SEC. 3087,CIV.C.).
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS P
E
LENDER'S NAME•I FI�� �'L�L
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 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
NTIONED PROPERTY FOF INS CTION PURPOSES.
ABOOVE-M
E
PERMITTEE NAME(PR
1
SIG R OF PERMITT DATE
APPLICATION I t(,_� 1 NPERMIT UMBER I '/C
J 3'tT
DATE'-/I
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
SFRIADD(REM ' 3
Garage/Carport C,
W Patio/Deck y
LL PoOUSpa
0
Z Re-Roof
Commercial
Valuation ADJ.AREA
ITY
DESCRIPTION FEE
/Iev
a L(
1
w
J
w
z
rJD
1
W
J
a
z
a
s
Q)
r
� ���
CONSTRUCTION I I
PLAN REVIEW
ELECTRIC :6 111)-t
PLUMBING .V L o
r..
(«0
J
.1 ,
V
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY PIC
�
ENERGY PERMIT_T_r
RETENTION FEE:
PRE-ALT FEE:
7L
TOTAL FEES t C�i
COMMENTS
RECPT. N0. 1 PAID BY VALIDATION
WHITE-Department Copy. YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy
'e¶t
III,
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 3CR
PRESS
FIRMLY
E
721 Crestview
DDRE
A
SS
ADDRESS
LOT 11-00 TRACT 52267
OWNER Pulte HOmes Corp
ADDRESS 1804 Von Karman
CITY 1 rvine ZIP 92612TEL.
APPLICANT TEL.
CONTRACTOR_
ADDRESS
CITY ZIP TEL-
ARCH/ENGI
sd
L
(^'
DESIGNER'Z
ADDRESS L I t_sf- .. (}
CITY e fiE
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 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO.
FESSIONS CODE)OR THA-' HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(1500).):
^ I,AS OWNER OF TH E 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-
TK3N,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
^ 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
0 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
Y(COMMENCING WITH SECT ON 7000)OF DIVISION a OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CIA LIC. N0.
DATE PCONTRACTOR)11" 1J_
,E57 ry
COMPENSATION DECLARATION
WORKERS
f HEREBY FIRM UNDER PFI,ALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
/
/-
T'AYE AND WILL MAINTAIN ACERT,FICATE OF CONSENT TO SELF-INSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FUR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY RKER.5'COMPENSATION IN
SU
RAANNC CARRIER AND POLICY NNUMMBER A/IR
NS
I
('7IQI•"JC%4-
CARRIER tl �
���{
�
POLICY NUMBER
(THIS SECTION NEED NCI BE CCkW_ETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(SIIF)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
E.I
CO
OR
THHWITH COMPLY WITH TH SE PROVISIONS. )
SHHALL F
D
I
FO
DATE: L APPLICANT:
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 ATTORNEYS FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENAL-"Y OF PERJURY THAT THE IS A CONSTRUCTION L DING AGENCY
FOR THE PERFORMANCE OF THE WO
K FOR WHICH THIS MI IS ISSUED(SEC. 3 B7,CIV. C.)
R
LENDER'S NAME__,_._�/�� '�
LENDERS 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 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INS CTION PURPOSES.
PERMITTRI)
SIGN RE OF PERMITTEE DATE
APPLICATION 3 I PERMIT C i PIC
I
DATE NUMBER
ISSUE TYPE OCC
DATE CONST.GROUP
ZONING SETBACKS
FRONT RW^
REAR^
SIDE/SIDE STREET RW^
SIDE^
PROPOSED USE SEWER LATERAL
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION
SFR/ADD/REM
Garage/Carport
w Patio/Deck
L
LI
U- Pool/Spa
Z Re-Root
Commercial
M
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
IY
H
U
w
W
CD
Z
Fn
0
Q
Z
S
V
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING L
MECHANICAL
INSPECTION FEE
ISSUANCE y�,UCJ
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
IJ
TOTAL FEES(
COMMENTS
RECPT N0. PAID BY VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy. GOLDENROD-File Copy,GREEN-Applicant's Copy