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' � CITY OF DIAMOND BAB ( � ,i
���--- DEPARTMENT OF COMMtTNITY 8c DEVELOPMENT SERVICES
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21550 E.Captey Qrive Suite 190
(904)860-3195 F�(909)861-3117 �� '► j� PRESS
I„'""'.� BIIII,DWG PERMTT APPLICATION ��� � ��� Z � �,,,, FIRMLY
} JOBSITE r� �t��- J'�p APPLICATION i �1 pERM1T ��^S p( } (�,
o ADDRESS�,� ��/�-�.5�(��� 1/"f'--. OATE_ t ' f+J��J' NUMBER �..}�I�� #_ �rt_1`�
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C?ATE GaNST. GROUP `
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�� �F DESCRIPTION S4.Ft ACTOR PSF ADJ.AREANALUATIpN I
� OWNER-BUILDER DECLARATIqN � �
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I NEREBY AFFIRM UM�ER PENALTV OF PEM.IRV THAT I M1 EkEMPT FRdM THE CONIMCTOfiS LL GdC948/COfPOIi ��'d
� CENSEUWFORTNEFOl.l,O'NMGREA� {SEC.7Q3tS8USINESSANOPROFE5510NSCA�E:N4YCITY6H (J} �
GOl1NT'(WtNGHRE�iIIRESAPERRSTT6C�ISTRl7CT.ALTER,RAPR6VE,6EMOUSH,ORREPAIRRNV5TqUC� W Pa�10/D6Gk
NRE,PRIOR TO IT5 ISS41M10E,ALSO REOUIRES TNE APPUCANT FOR SUCM PERMIT TO FIIE A SIGNEb W
� STATEMENT THAT HE OH SHE IS LICENSED PURSUhNT TO THE PHOYlSXJNS Of THE CONTRAC70F?5 U•
CENSE UW(CtUPTEF c(<XSAiMENGN4i KNTi SECTiON to0o)OFOIYISION 3 Of THE BUSINESS FNO PRO- � PoO�Sp2
FESSIONSCOD�ORTFUTf1EORSHEISEXEMPTTHEREFPOMNNUTHEBA5ISFORTHEALIEGE�EXEMP. (�
T10N.ANY YICXI:TION OF SL=CTIQN T431.6 8Y RkYAPPtiGRNT FOftAPERMHT SU8JEC75 THE APPIiCANT T4 Z qe-Rooi
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� (71,ASOVRJEROFTMI:PR4PERTY,ORMYEMPLOYEESWITNWAGESASTHEIRSCJLFCAMPENuATION, CDrtirti6t'Cidl
M91100 THE WORK,lWD 1'HE STf�ICTURF 15 NOS IN7EN6ED O#2 OfFEflEO FOR SALE{SEC.Jtr44,BUS�• .,,�
� NE35 AND PROFESSIqJ5(X70E:THE CONTRACTOpS LICENSE LAW DpES NOT APP�Y TO AN OWNER OF � "
PROPERTV VfFlO BUILDS Oli IMpFlOYE5 TMEREON,AND NMp DOES SUCH WOtiN HIMSEIF Ofl HERSELFOft
� IHROU6Fi HIS OR NEROWN EMPLOYEES,PROViDED TNAT 6UCFi IMPROVEMENTSARE NOT MTENDED OR m
OiFERED fbR S/LE.if,FNSWEVER,7HE BUILDING Ofl IMPROVEMENT IS SOLD WITNIN ONE YEAR OFCOMPI,E
� TION,THE DWNER�Rl11LCER WI�y,}y�YE TME BURDe;N OP PR4VING 7HAT HE OR SHE DID N4T BUIIA Ofl "'
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�^ TO CONSTPUCT TNE PR6.lECT(SEC.?it4i,@USINESS AtiD PROFESSION5{`,ODE�TNE WNTRAfTORS lI- VdIU81i0(1 # � � ,,,,,,,__,ADJ.AREA
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�'�z' DATE „ 4YMER_. i U . �� I
� i.N1ENSED GONTRAC74RS DECLARATION W �� � *�v
� 1 HEREBYAFFIRM UNOFq P�NAI.TY OF PEflJURV THA71 AM LICENfiED UNOER PPOYISIOMS PF GtiAPTEA
� •{CAMMENGMWWtTH5F.C7IQNTOD�}pip!VISi6N36FTHEeU47NES5ANDPflOFESSiDNSCODE,AND z � �
?{� MY LICENSE IS IN FULL FpR1:E NJO EFFECT
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� I HEREBY FFIRM UNDEP PEVALTY oF PER1URY oNF oF7WE Eo�.tCtYnNp DEGCARntKNts: Z ���� �
� +IHAVEANDWILLMAINTAINACERTIFICATEOi'CONSENTTpS[LK-INSUflEFORWORKFRS' _ �
COMPENSA7KKd,AS�t�ViDfD BY SEC7IPY 37on OF TNE tA60R COOE,FOR TNE PERFORMANCE U �' -G'` ���'�.�
p F TME WOWK FOR VIHICN THIS PERMIT IS ISSUE�. � ,.
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qw I FUYEAN6 WItLI�iAtlYTJJN WOFlKEPS'C6MPENSnTiON iNSURANGE,AS REOUIRED BV SECTION ��.
� 3]00 pF THE LABJR I�pp,FOR THE P�RFONMIWCE OF TNE WbRK FbR WHICH THIS PERMl71$ t (_:_(\' Y�_.._
tSSUED.MY W4AKEF5' PEMSAi�N Ih"SllPANCE CtttRIER A48]POi_ICY NUMBER ARE: CONSTRUC7ION `_ � t ti i
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� I CERTIFfTHAT itF TFR=PEi�aRMANC£OF THE l4t�RK FOR WN7Cti TH�S�ERtiiT IS ISSUED,i MECNANICA� �y CT-'V'�+_3�U, �_}.Z-`C� � �
SHNLL NOT EMPLOV/JJV PERSQN IN ANl'MANNER SOAS TO BECAME 5l1BJECT TO 7HE
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W SUBJECTAN EMPLOVEH TO Q3IMINAL PENALTIES ANCS CIVIL FINES UP TO qNE YIUNDREp THpUSAN� ENEFGY PERMI7
pOLUflS{St00.OQ0),M ADOITIOM TO THE COST Qf CAMPENSAT:ON,DAMA6E5 AS PflOY1DE0 KOR IN -- �..
J SECTION37060FTNElABt)RCQCSE,iNiEREST.ANDATiORNEY'SFEES. f ^ �("�
aC _ RE7ENTIC7N FEE:�
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a t�ONSTftUGTidN�EtJDlNf�AGENCY PRE-ALT FEE: _ __� r
� I NEREBYAFFIqM UNUER PF-N,4L?Y OF PERJl1flY 74AT THEflE�S A GONSTAUCTION LEN�WO AGENCY _T
FOR THE PERWFA.ihNCE OF THE WORK FOR WN�i/Ct�•iTFtiS PERAiiT IS ISSVEG jSEC.9oa7,CIV.C}. — �
� tEt�Eft'SNAME `—`-����.(_�t��i.._,.1„[:1_1-i.-... ,l"r ,�, =.._,._ ' ' __
F'- LENDEflSADORESS__ r
�� ICERTIFYTNATIMAYEREAC1TiISAPPUCATIONANDSTATETHATTHEABpV£INFORMATIQNluCORflEGL l�TA� F�LV� �{"`{j\' ����ii �
I AGREE TO CCMIP�Y WITti ALL CITY ANQ(;OUNTY ORDP�tANCES AND STATE UWS REUTMG TO 6UIL61NG � „� 1�1 H•+ � �,J � � ��
� CQNSTRUCTION,ANU HEREBYAUTHORIZE FPPESENTATIVES OF THIS COVNTV TO ENTER UMJN THE j
Z. A90VE-MENTqNED PflOGEHP'FORINSP C1IGN AURPOSES. COMMENTS
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• CITY 4F DIAMOND BAB `'�
� ��— DEPARTMENT tJF COMMUNITY&DEVELOPMENT SERVICES �=�^
W . 21660 E.Copley llrive Suitc 190
(909)860-3195 Fa�c(909)861-3117 PRESS
•�';�«°�..' BUILDING PERMTT APPLICATION "�st3tes" Pl�n 2 C/L FIRMLY
� JOBSITE APPLICATION �_.("\ PERMIT r i"�PIG
p naoaEss_734 Crestview Dr. DATE � � ` `�� NUM9ER ,����..� #
� lSSUE TYPE OCC
APN LOT Z� 7RACT 52667 DATE GONSt GROUP
� OWNER PLlltp VOt1 Kr7N[3lr7�__.
� ADDRESS 18441 Von Karman zorv�N� s�aa,cKs
� ciTy irvine ziP 9261�E�. 949797440 FRONT Rw c�_
APPUCANT _ T��, REAR ❑_.___�
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0 I HEREBY AFFRUi UMOER PEN/LLTY UF PEFWRY THAT 1 MI EXEIAPT FRG1M 7HE WNTRACTt?RS LI� G8f8t,j@JC3(p012
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TURE.PRION 70 ITS ISSU�WCE.ILL.SO REQUIRES THE MPLICANT FOR SI1CH PERMI7 TO FILE A SIGNED �
.� S7ATEMENT THAT HE 6R 6HE iS tiCENSED P�0.SUANT 7a TNE PPOVISIqVS UF fHE CqNTHACTOR9 l4
� CEtiSE UW(CMAFTER 9 tfbMMENG'�NR wiTti SECTiDH�oJoy oF DMS�N 3 OF THE Bt1SiNESS ANO PRa �'�' PooU9pa
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NESS ANd PROFESSIONS(X10E:THE CON'fMCTORS LICENSE UW DOES NOT ApPI.Y Tb AN OWNEH oF
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Z TqN,THE OWNER$UIL6EIi Wlll HAVE THE BURDEN OF PFOVING THAT HE OR SHE DID NOT BUILD OR
� IMPHOYE FOR TtIE PURPOSE oF SAi.E), ..r
� ❑I,ASOWNEROFTHGPHOPFR7Y,AMIXClU51VELYCbN7HAGTlNdWtTHl.10ENSEDCONTRACTORS
(r TO CONSTRUC7 TME PRQII:CT(SEC.10M,6USIWESS AND PROFESSIONS�DE 7HE CONTPACT4RS U- VBIUIISlOft AC3J.AREA
tl! CENSE UW DOES NOTAPPLYTOAN 6WNER OF A PROpERTV WHO BUiLDS OR IIipROVES TNEFEON,AND �
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W _.t NAYCAN6 Witl.MAtNTAiN WORKERS'C6MPENSATioIV INSUfiANCE,AS REOUIRED BY SECTION
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4 ISSUED.MV W ERS'COMPEN6Af10N INSURANC /�,A RRIER ANQ P�l�CY>NUMBERAR[/:,rvry CQNSTRUGTION „_�. „_,,._._._.�,_..�_,._...
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� I CERTIFV T1AT IN THI:PERFORMPNCE OF THE WORK fOft WNICH THIS PERMR 1S ISSUED,I MECNANICAL �_. .--
�^ SHAl4 NOT EMPLOY qNY PENSON IN ANY MANNER SOAS TO BECOME SVBJECT 10 TNE
� riY3RKER5'GOMPENSAiKK3LAW50FGAI.(FOpNiA.ANqAGqEEiHhTifiSHOULD6ECOME INSPECT�ONFEE _ �^ I`
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� SU&IEGT AN EMP40YEH TO CIIIMINAL PENALTIES ANb C:VR.FINES UP TO ONE NUNDRED tMOV5AN0
� DOttARS ifi00.IXJ0},IN ADD�7�DN TO THE COST DF CpMPENSATION,DAMAGESAS PHOVIpED FOR M ENERGY PERMIT _,,,_.,,, -
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� SECTIOPf�708�THE tA�R i:ObE,iNTEREST,AND ATTORNEY'S FEES. RETENTIQN FEE: _,,,_ .._
d C:ONSTAUGTION LENCING AGENCY PRE-ALT FEE A,_„_._ . --.-..
� 7 NERE$Y AFFIftM UNOER VENNLTY OK PERJURY TN TitERF IS A CONSTRUCTION LENDING AGENCV
n- FOR THE PEftFORMANCE OF TNE WORK FOR Wt# T/H}f��ERMiT IS ISSUED EC.3�9>,CiV.G.).
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w !A6AEE Tb CAMPlY WI TH ALL GTY ANa COUN1'Y ORD�NANGES ANO STATE lAW3 REUTING TO BtllIDING
� CONSTqUCT1(NJ,AND HEREBV AUTNQfl12E fiEpRESENTATNES OF THIS COUNTY TO ENTEft UPON Tt1E
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RECLAMATION
50,,o wA,TE MAtiA��MENr C Q l.!RI T Y S A N I TAT I O('�! D i S T F�I C T�
OF LO�a ANCELES Ct�UNTY
1955 Warkman Mill Road,Whittisr, CA 9Qb01-14Q0
Mailing Address: Fd. Box d998,Whittier,CA 90607-4998 JAMES F. STAHL
Telsphone: (562'699-741 1, FAX: {562)b99-5d22 Chief Engineer and Generol Mant�ger
t,�a nter�ia ric'�: '7:00 a.m.- 4sd0 p.m.Mon.-Thurs.
7:�Q0 a.m.- 3:00 p,m.Fri.
Accounc Na.: d4031$7
DistrisrNo.: Zl
SEWERAGE SYSTEM CC1riNECTI�N FEE
Dace: December 28, 2004
Property Own�er: PULTE HOME C(?RP
Address of Property: 522b7 TRACT, LOTS 2b,27,28,29
DIAMOND BAR, CA
Thomas Guide Page:
Contact: JERRY HAINES
� Phone: 714-981-8215
Maiiing Addre:;s: 1$401 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: OIA
Nurnber of llnits: 4
Square Faot�ge:
C�NNECTION FEE CALCUIJATION
4.C�0 � $1,240.C10 = $5,160.00
Number of Units of Usage Connection Fee Per Unit of Usage Cannectian Fee�
� �
� ( �
COMMENTS:
$5,160.�) i
.�_.(
^ Connectlan Fee Due
I
Fee PaymentReceived From: Proce d t�y:
S '
PULfiE H�ME C�RP ed y:
Amount: $5,i60.OQ Ck. No>:07638 :
D.�:c D' : ec' 28R 24�4
BUILDING DEP' CdPY � VALIll ONLY W}iEN S7'AMPEU
w
��j Recycled Paper
^
' � � PO�liIIfONA UNlGIEQ &p HOO e�DpSTRlCT F t*�#��t?���
p pa m
800 South Garey Avenue
Pamana, Califarnia 91766
Certificatian af Compliance
wilF►�r proviaions of Govemment Cade 8ectian 53880 8�65995.3
�1�—E-�_..�'��1� ��� J�rz�� �sH.,���
owrbp.�Harn� -��c.rt
,..�. �0� �f�nA YA¢..n�t�+J �'C�`2+ac� ��..��I--t, �-�-o�e.� �`ft4'�'t�t ' ��t�
StnM Addr��s Company Namu and Phon�NumOar
��V�'�� Gf� q�'Z(.P i'Z-
c�y. c.zw o�.iu�.
t,�Gf' "'y�"'7 ' �`f�� The persort signing reprasents thetlw/she is euthorizad to sign an
T.�.�,bM behalf of the awneddevelaper and ltiet the infortnetion provided is
��� true and accurate to the best of hislher knowledge.
��� ' ���� ���
FEE SCHEC)ULE: r— ""
The deveiopment fees�evied by the Pomone Unified School District(PUSD)under provisio�Section 53080&85995.3 of the
Govsrrxnent Cade aro:
Reslden�al Lk+velopmenC $1.841sq it. � ti�`7�f .,,�(' -"�-I" -
" Corntnetciai t)evobpment SO_3t31sq. . `- _�-
Development Type: ��W�t��«, ❑Addi6on ❑awQr
r � �f �2— L�X t
i�vv{�rYn
TnrktPr,y'�Add�
,�,,� �Yes ❑No
Nunb�rdMidvqt�j in Aroj�ct Pir,Ch�Nwrt�r(si Carin�auD+vdopm�nt 9uiwy
1. `7Ap C.r.t�+��c...3 �s . .��e,,rv�.Q. .3� . �� �' �P1 �-1'�C�' 3''-t
La t Addn�� tfst of 8uiitinp Ma( Fi. F�r �L
2. "�10 �',V•G�-�+tv..t L�" -1�odl/�t �.��•"T� � �O i��' �'"'t
La/Addrr� Uw ol�— /vN{ .FlT .•— ••— Fw
3. -��2c� cx.���F-�,�� �� . �o,r� �. '�ta � '7,D►c�.��
la 7 f`ddnrs IM�d BWiinp Ma(9q.Ft) FN
a. =� Cn-�..��.� r.`�-- t�d�.t, 3, +�7�-�� � c�,+�� � Z2--
la Addw.s Ua c}B�ii6np Ma{Sq.FL) Fw
J.
La/Addrw� UN ui16�0 Arw�Sq.FL} �
BuJldirtg ceipt af Subtatal�•Ztp�2Gn�a. ..�-
�S� �Res�dentia! �e This is to�rtify that a11 fees due ta the r""P'°'
❑Corrimeraisl P��a Uni6ed School District under
provision a#Gavemment Code Section
❑Od�►er 53080 8 65995.3 as a�rerequisite to
�Euemptsd the issuanca of a 8uilding Parmit by the
bepartrnent of Public Works heve been
received. Based on the informetion
Total Square presented above,this Certificatian of
Foatage� ��i�-��'�� �O^7R�etion is hareby executed. �
❑verifled Total Fees Due��'Lt,��`Z(�, '�
D`ate-� � p���
� � ! ���
PU acilitiea�P�anning,Growth 8 Fiscal Services Depar�ent
opment Oepartrnent ��1��
R+sNCt tkne� OtSTFiIBi1TIOP7:WAitp-CRY/Counly
YNlaw-PUSp F�cllltl�PlanNny
Pink-PtJSD Ficcat Sxvic�s
(3ukMnad•Chvr»r/Dwelop�r
n
r
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES••,!__��
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117��'� i� ! PRESS
BUILDING PERMIT APPLICATION �5�� ?���_�{� �C I-/�FIRMLY
ADDRESS
APN LOT TR CT.> 24�0 7
OWNE��,
ADDRESSI�� � !/Q71!'
CITY.�X2-!�//�'�ZIP9z6�2-TEL9�'1797t/'y
APPLICANT�'.�X.t>E TEL.
CONTRACTOR �
ADDRESS� �
CITY ZIP TEL.
ARCWENG/
DESIGNER ^
ADDRESS
CI ZIP TE t
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR
COUNTY WHK;H REQUIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE. DEMOLISH,OR REPAIR ANY STRUC-
TURE. PRKKt 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((X)MMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSKNJBCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP-
TKN1.ANV 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(f500J.):
^ 1,AS OWNER OF THY: PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WILL DO THE WORK,AND 1'HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI-
NESS AND PROFESSIONS(X)DE: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 AHE N07INTENDED OR
OFFERED FOR SALE IF,HOVIEVER,THE BUILDING OA IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TKkI,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 E%CLUSIVELV CONTP.ACTING WITH LICENSEG CONTRACTORS
TO OONSTRUCT THE PRQII.CT(SEC. 7014,BUSINESS AND PROFESSIONS CODE:TF/E CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUG'Y PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAG
TORS LICENSE LAW.).
^ I AM EXEMPT UNDER SEC. ,. ._,8. 8 P.C. FOR THIS REASUN
DATE OWNER
LII:ENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
0 (COMMENCING WITH SECT KNd 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS� LIC
NO
� � 75�3
r
DATE� "� �-�_CONTRACTOR_L C_���_CI ��y�
�X� 'WOR
ER
SA
IO
R
I
0
E
D
K
C
MP
N
T
N
ECLA
AT
ON
S
1 HEREBY FFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
f I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70SELF-INSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE
F THE WORK FOR VIHICH THIS PERMIT IS ISSUED.
I HAVE ANO WILL MAINTAIN WOFIKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
3700 OF THE LABOR IbDE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKEP'.S' �-y-�
PENSATK%V INSURANCE CARRIER AND POLICY NUMBER AR
ul
E:
/
i
CAP.RIER ��i LAY%
.Z� G...0/
�
POLICY NUMBER��C� ��,_,s_�J�, �_�,
�+�q�
SEL'T1C�NEE�)BE GDN1Pi.EfFD OF iYlE('ErA%T6 FOR ONE HJI-DRED DOLLARS(f100)OR LESS).
I CERTIFY THAT IN iH'c PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SHALL NOT EMPLOY/J-FY PERSON IN AN1'MANNER SO AS TU BECOME SUBJECT TO THE
WORKERS'COMPENSATKXd LAWS OF CALIFOFINIA,AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROYISK)NS OF SECTlON 3700 OF THE LABOR
CGOE,II SHALL FORTF!WITH GOMPLY WITH T
OVISIONS
�OSE PR
��
�
L
/^'
� ���1�
P
I
T
r��(•1 � � � '�7C�
PL
DATE: �«
A
CAN
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
BUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(5100.000),IN ADDITION TO THE COST Of COMPENSATKOJ, DAMAGES AS PROVIDED FOR IN
SECTK)N 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
HIS PER
I
T IS ISS
T
M
U
E
G (
S
EC. 3oD7,CIV. C).
/)
r
l
/v
LENDER'S NAME Nc�N �� �y� �C 1 SV'I �I'��/- ,
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION,ANU HEREBY AUTHORIZE EPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOViE-ME�N'T�KK,/JE')D PROPERT" FOR INSP CTK)N PURPOSES.
s�(��f C/V'14..t�i��
PERMITTEE NAME(P)/•- �� � p�
^'� //J-
BIG URE OF PER TEE
SATE
WHITE-Department Copy,YELLOW--Finance Copy,PINK-ASSeBSOr Copy,GOLDENROD--File Copy,GREEN-Applicant's Copy
II
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 2 C/L
PRESS
FIRMLY
JOBSITE
ADDRESS 730 Crestview Dr.
APN LOT 29 TRACT 52667
OWNER JUIte Von Karman
ADDRESS 18401 Von Karman
CITY Irvine ZIP 9261-EL. 949797440
APPLICANT TEL.
CONTRACTOR-
ADDRESS
f
CITY ZIP
TEL-
ARCWENG/
DESIGNER//r/A Kf rr?1 G
ADD SS
CITY ZIP TEL. q!T tq GC�G3
�r
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 REPAIRANY 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 THATHE 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 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 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-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 LIC. N0. �
DA CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I HERE AFFIRM UNDER PENALTY OF PERJURY ONE CF 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
F THE WORK FOR WHICH THIS PERMIT IS ISSUED.
i HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTlON
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MV W ENS'COMPENSATION INSURANC J�AIIBRIER AND POLICY NUMBER ARE
CARRIER 1 rJ�4 i
POLICY NUMBER
�
Ca
(TF9S SECTION NEED WIT BE COMPLETED OF THE PERMIT IS FOR ONE WAC44ED DOLLARS($I00)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,OF THE LABOR
CODE,I SHALL FORTHWITH COMPLY WITH T-E PROVISIONS.
PP
IC
NT
E-1157
L
DATE:
A
L
A
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE 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 TH THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHI T ERMIT IS ISSUED EC. 3097.CIV.C.).
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.
PE.RMITTEE NAME(PRINT
SIGN RE OF PERMITS DATE
APPLICATION,A�_i\1
PERMIT
r' !t� P/C
DATE V 1 NUMBER #
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW^ ,
REAR ^
SIDE/SIDE STREET RW^
SIDE ^
PROPOSED USE SEWER L ATER IAL
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION
SFR/ADD/REM
U) Garage/Carport
W Patio/Deck
U- PooVSpa
Z Re-Roof
Commercial
5
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
cc
U
W
LU
(D
Z
m
EL
U
Z
2
0
LU
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING .
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES (I . S
COMMENTS
4714
RECPT. N0. L_PAID BY VALIDATION
WHITE-Department Copy,YELLOW--Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy
COUNTY SANITATION DISTRICTS
OF LOS ANGELES COUNTY
1955 Workman Mill Road,Whittier,CA 90601-1400
Mailing Address: P 0. Box 4998,Whittier,CA 90607-4998
Telephone: (562)699-7411,FAX: (562)699-5422
C-o n ei Hou&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 Categoryand Units of Usage:
Category: O lA
Number of Units: 4
Square Footage:
CONNECTION FEE CALCULATION
4.00
Number of Units of Usage
X
$1,290.00
Connection Fee Per Unit of Usage
December 28,2000
$5,160.00
Connection Fee
COMMENTS:
$5,160.00
Connection Fee Due
Fee Payment Received From:
PULTE HOME CORP
Amount: $5,160.00 Ck. No.: 07638
VALID ONLY WHEN STAMPED
0 Recycled Paper
POMONA UNIFIED SCHOOL DISTRICT
Facilities Planning,Growth&Development Department
800 South Garey Avenue
Pomona,California 91766
Certification of Compliance
with fee provisions of Government Code Section 53080&65995.3
r)Li HO A415-OAP
Dwebper Name
I '40I 14,06A YAQMJ SCE 200
Stn"Address
WVI+'E CA CELL-01-1-
UK State zip Cods
Q4q• 'I'a-7-q'-foy
To"
ron.i
Q lI L. ��I 87�trJ
Addition
FEE SCHEDULE:
The development fees levied by the Pomona Unified School District(PUSD)under provisio
Government Code are:
Residential Development
Commercial Development
Development Type: §g New Construction
•� •-•d tr S-Z-'4U-7
Address
Number at building(s)in Project Plan Ch.* Number(s)
1.
2.
'1Cp cr.�ykv�__
La/Address Use of Building
-710 �� .c";�,a. 'tom .ovt.t
La/Address Us*of Budding
3. Gr.cs+v;cy- 7--k W_
Lot/Address Use of Building
4. C--I v�,�,-�t.. f.o.v�.c
5.
LotPAddress
Lot/Address
Building
Use
Residential
^ Commercial
Other
Exempted
Total Square IN 27�P
Footage- 1
^verified
f
Date
Us.of Building
PU acilities Planning,Growth&
DOelopment Department
Use of Building
Applicant
Company Name and Phone Number
Section 53080&65995.3 of the
Signature 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.
$1.84/sq
.ft:
1410
Foen Number
llf 1.g2(C
D Other
Ana (Ski. Ft
3t Lt-T4
Area ( . Ft)
•r'6t0
Area (Sq. Ft)
31 L4-7V-11?'!5
Area (Sq. Ft)
Area (Sq. Ft)
ceipt of
Fe This is to certify that all fees due to the
Pomona Unified School District under
provision of Government Code Section
53080&65995.3 as a prerequisite to
the issuance of a Building Permit by the
Department of Public Works have been
received. Based on.the information
presented above,this Certification of
Completion is hereby executed.
Date
Yes^ No
CorWnrdorv0.velapnent Survey
Fee
F..
$ '71010'Q'
Fee
Fe.
F..
Subtotao. pl ii'e.-t'I.
This Page
111 4-7
Total Fees Due
-t(r,' (,
Rse.lpt Number DISTRIBUTION: White-City/Courdy
Ysllow-PUSD Facilities Planning
Pink-PUSD Fiscal S.Mces
Goldenrod-Owner/Developer