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CITY OF DIAMOND BAR -�'"��'
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21825 E.Copley Drive ` �
'� (909)860-3195 Fax(909)861-3117 / PRE S
�"���Y�� BUILDING PERMIT APPLICATION �v ,,j /�l F LY
� JOBSITE J�l� C : APPLICATION 1 .r
o ADDRESS lJ V DATE NUMBER #i
� 2� ISSUE TYPE OCC
°r° APN LOT TRACT � DATE CONST. GROUP
p OWNER P��Ite Homes
o ADDRESS �$4Q� �/OIl Karmar StP ��� ZONING SETBACKS
z CITY �r�j�p ZIP Q7��ZfEL UI14747l14(1Q FRONT Ryy ❑
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Q CONTRACTOR SAMF SIDE ❑
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� CITY ZIP � TEL. PROPOSED USE
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z DESIGNER Hove Desian
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS LI- GelB(J2/CBfpOff
W CENSEUWFORTHEFOLLOWINGHEASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
U COUNTYWHICHREQUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC�
w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI� �
� CENSE LAW(CHAPTER 9(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSp2
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREfROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
V TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(1500).):
ZOI,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COmmBfCiel -
WILI DO THE WOFK,AND THE STRUC7URE IS NO7 IN7EN�ED OR OFFERED FOR SALE(SEC.701�,BUSI� J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMEN7S ARE NOT INTENDED OR m �
QOFFEREDFORSALE.IFHOWEVER,THEBUILDINGORIMPROVEMEN71550LDWI7HINONEYEAROFCAMPLE .
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR 7HE PURPOSE OF SALE). �
w ❑I,ASOWNEROFTHEPROPERTV.AME%C�USIVELVCONTRACTINGWITHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.70/�,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U0SIOn ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEFiEON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUAN7707HECONTRAC- QUANTITY DESCRIPTION FEE
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� O I AM EXEMPT UNDER SEC. 8.8 P.C.FOR 7HI5 REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENAL7V OF PERJURY THAT I AM LICENSED UNDER FROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7oao)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�X MV LICENSE IS IN FULL FORCE AND EFFECT. m 4� .S O
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� LICENSE CLASS q ���.No. 5 US9 3 �
V DATE �, Il Q�CONTRACTOR P61��g d
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z
Q
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Z COMPENSATION,AS PROVIDED BV SECTION 37000F TME 1A80R CODE,FOR THE PERFOHMANCE W
QOF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIpED BY SECTION
Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF TFIE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
� CARRIER Pacific Em� Ins. Co. PLANREVIEW
Z POLICY NUMBER W(�R L1�3 011�7 A ELECTRIC
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� (fHISSEC�IONNE�NOTOEOJMPLEfEDOFTiEPERMfTISFORONEHUWREDDOLtl�FLS(St00)ORLESS} PLUMBING 4� .SO
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C7 SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
? SU&IECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR �
CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
� 0 Pulte Homes
p OATE: .�l–�n– F�LICANT: SMIP
J WARNING:FAILURE TO SECUf1E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVER70CRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 37080FTHE LABOR CODE,MTEREST,ANDATTORNEV'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS ACONS7RUC710N IEN�ING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'SNAME �IO�e—�_PUItP�
� LENDEfl'SADDRESS
� TOTAL FEES
� I CERTIFV 7HAT I HAVE READ THIS APPLICA710N AND STATE 7HA7 7HE ABOVE INFORMATION IS CORREC7. C C.C O
w I AGREE 70 CAMPLV WI7H AlL CITY AND COUNTV ORDINANCES AND STATE LAWS RELA7ING 70 BUILDING V V J
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED 7ROPEqTY FOR INSPECTION PURPOSES.
Q COMMENTS
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�
m PERMITTEE NAME(PRINT)
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� SIGNATUREOFPERMITTEE DATE
= RECPT.�0. PAID BY VALIDATION
~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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ELECTRIC GROUND __ � � UNDER FLObR DUCT '
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GROUND PLUMBING ; UN�ER FLOOR CUf�IQUfT_ G �
SLAB GRADE � FiREPLACE FOU�IDATION ' �
---�_.—.___� ---
TEMP POWER _ �__FIREPLACE BOND BEAM __
W,4TER SERVICE � MID HT. BOND BEAM _ __ _
ROOF SHEATHIh1G 8 F�'. BOND BEAM ______ � ______
FRA�ING/VENTIUATION FINAL BOND BEAM _ ______ ! ___
ROOF COVER PRE-GRADING ;
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING __
ROUGH PLUNIBING j FINISH GRADING __
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATHISIDiNG POOL FENCING I
WALL I(VSULATIOP! POOL FINAL
CEILING IIVSULATIOiV �FF SITE IMPS. �
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DRYWALL NAILING , /-� DEDICA,TIOiVS _ _ _ _
SEWER ��"-� �� � •••�•�� FIiVAL EPJG. �
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SEPTIC TANK %%� LANDSCAPEIIRRIG.
SEEP PIT/L.L. QN SITE IMPS.
GAS AIR TEST FINAL ZO(VING
FINAL CONST. F!RE DEPT. FINA!
FINAL HEATIRIG HEALTH DEPT. FINAL
FIPJAL ELECTRIC I DEV. FEES PAID ,
FINAL PLUMBING ENERGY �
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