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Home My WebLink About17340 �i XtQ �Y-['_cz( CITY OF DIAMOND BAR —'�"�'' � I}EPARTMENT OF COI��Qv1ZRJiTI'&LIBVELdPMENT 5ERVICE5 21825 E.Copley Drive -" (409)$60-3195 Fax(90A)861-3117 PRESS � �;q�*'` BUILDING PERMIT APPLICATI{}N �IRMLY � AODDR'ESS,�'� � ? 1��_�..1.h.A .��,,� APPLICATICSN � r 4�� Nt)BER 1� t/��V#JC DATE - ISSUE TYPE OGC � APN �O7 TFiAG DATE CONST. GRdUP � OWNER Pulte Hames ADDRESS �$��'� Van Karman StE z�� ZONING SETBACKS � GITY __�.r�LICLf' z3p 926�2re�. 9497974400 R�Q�NT RW Gl APPLICANT � TEL. g�p��(DE STREET RW p � GONTRACTOR_ SAME SIDE ❑ � AdDRESS — PROPQSED USE Q CITY ZIP TEL. - . w ARCH/ENG/ z DESIGNER HOV@ D@$! Cl NC1.DWEL. Np. NO. � ADpRESS ��Q- G'�NfaOY" en er P. UNITS STQRlES BEDROOMS � ctrv New��t..,,BCziP.�2fifi6T��. 94976db812 � dESCRIPTION SQ.FT. FACTdR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFFVADD(liEM O p I HERE6Y AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FpOM THE CONTFACTORS LI- � Garage/CarpoR W CENSEUWFqRTHEFOf..ItlWINGREASON{SEc?W1.58uSINE53,wDPROfESSIONSCODE:ANYCl7vo� � COtlNTYWMICHREftUiRESAPERMtTTOC.ONSTRUCT,AITER,iAAPROVE,DEMOUSH,ORREPAiRANYSTRUG W P3t10/DBCI( W TURE,PRIOp TO ITS ISSUANCE,ALSO REDUIRES THE APFUCANT FOR 5UCH PERMIT TO FILE A SIGNEp W STAT`eR1ENT THAT HE OR SHE IS IICENSED FURSUANT TO THE PftOViSiONS OF TNE CONT'ftACTOftS ti- � CENSE LAW(CHpPTER 9 fOOMMENCING WITH SECTIqN]OtlO)OF D�VISION 3 O(-THE BUSINESS AND PAO� � POOUSPB � FESSIONSCODE)ORTHATMEORSHEISEXEMPTTHEREFROMANpTHE8A51SFORTHEALIEGEDE%EMP- (�J � TI�N.ANYYIOLA7pNOFSEGTtONl431.56YANYAPPIiCANTFQRAPERMITSUBJECiSTttEAPPLICANTTO Z Re-Roof '. � A CIVIL PENALTv OF IJaT MORE iHAN FIVE HUNDflED DOLI.ARS(5500).): � ❑1,.450WNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSO�ECOMPENSATION. � Commeroial � Wil�DO THE WdRK.AN6 THE 5TRUCTURE IS NOT INTEt�DED OR OFFEREO FOR SAIE(SEC.�oaa,BUSi� J NESS AND PROFESSIONS CODE�THE CONTRACTOR5 LICENSE LAW�OES NOT APPLV TO AN OWNER OF � PROPERTYWHO$UILDSOpIMPPOVESTHEREON.ANDWN400ES5UCNWORKNIMSELFOftHeftSELFOR m ['C THPpt7GH NtSOR HER ONl�'EMPI.OVEES.PR6VIOED THAT SUCH IMPROVEMENTS ARE NOT IhLTENpED OR QOFFFAEOFORSALE.IF,HOW'EVER,THEBUILDINGORIMPROVEMENTISSOLDWITF'INONEYEAflOFCOMPLE y� TION,TME 4WNEft-0UtiQGR Wi4l HAYE THE 9UR�EN OF PROVING THAT HE Oft SHE OID NOT 8Ut(.D 4fl � IMPROVE FOR THE PURPOSE OF SALE). , ❑I,AS OWNER OF THE PROPEFiTV,AM EXCLUSIVELV GONTRACTING WITH LICENSEU CONTRACTORS � TO CANSTRt1GT 7HE PflOJF.CT{SEC.194a,BUSINESS ANO PAO�ESSfOT}S CAOE:TNE CDNiRACTOFS t1� V3IUdtio� ADJ.AREA_ 4J CENSE IAW OOES NOTpPPI_V Ttl AN ONMER 4F A PROPERTV WHO B�ILDS OR IMPROVES iHERE4N,AND = WHOCONT�9ACTSFORSUGiPRQJECTSW{THACONTRACTOR(S)UCENSE�PURSUANTTOTHECONTRAC�� QUANTITY DESCRIPTION FEE � TORSUCENSEtAW.y. � J � =.7 1 Ata EXEMPT UNDEFi SEC. ,^_ B.&P.C.FOft THIS ftEA50N U � —._...... ...._ ..' � U' DATE . 6WNEfl ._... U .. "�—' W Q UCENSED CON7RACTORS QEC�ARATION W � !HEREBY AFFIRM UN�ER PE.NALTY Of PEF.ILIRY TkAT I AM UCEN5ED UN�ER PROVISIpNS OF CHAPT[fl � � 9(COMMENGING WITN SECTION 7oWj OF DIVISION 30�THE BUSiNESS At3D PflOF[SSIONS C06E,AND Z }'C MV�ICENSE IS M NLL FORCEAND EFFECT. m !1��C Q (yJ `t J � UCEN5ECLASS A�_/��t ��o.No.,�17593 .. � � OATE.._ ��C.R�L�1.1J I il t GaNTRACT6R Pl7I Y$ a W � WC>FCKERS'COMPEN5ATlON DECLAFtATIC7N � Q � U � i HEREBY AFfIRM Ub1DER PENAITY Of PERJURY 6NE OF TNE F4l'ubW�NG DECIARATlONS: z Q f� IMAVEANDWILLMAINTAINACEFTIFICATEQFCONSENTTpSEIF-INSUftEFORWORKEAS' 2 �—CAMPEP7SATION.AS PROV@EO 8Y SECTIAN 31no C1F THE IABOR CDOE,FOR TNE PERFORMANCE U � OF THE WONK FOR INHICN THIS PERMIT IS ISSUED. � � w I HAVE AND WILL MA�NTNIN WORKEflS'GOMPENSAiION INSURANCE,AS REOUIREDBV SECTION � 3�oa pF THE LABOR COPE,FORTNE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS " ^ iSSUED.MY W6ftKEI;S'CAMPENSATKJN tNSURANCF CARfttEF AND FOIiCY t�AlUOER ARE-. CONSTRUCTION � �,ap�FR Plc�i�f�/i�Cp E� mp lns. Co. P�,NR�viEw � � POLICVNUMBER_J.Y_SL.I_lL..��n�1R7Q . ELECTRIC t� 4 Y� .50 �,.,� (iHISSEGTQNNEQl�OTBEWMPLETEOOFTNEPERMI7ISFORIXJEHUrDRcD�01.l.AFiS�510010RLESS). PLUMBING I.IJ Z t CERTIFYTHAT iN�tiE pERFORMANt;E OF TI+E WORK.'Ofl WHiCH THi5 PERMIi IS�SSUED,i MECHAN�CAI, _, _._.,._ (,�} SHALLN07EMPlOVANVPE9SONINANVMAN�E%SOASTOBECOMESUBJECTTOTIIE {/� WOflKERSCOMPfNSATiONIAWSOFCAIiFOPNIA.ANDAGR[ET'NATiflSHOUIDBECOMc INSPECTIQNFEE „_,__ _,. SUBJECT i0 THE WOFKERS C4MPENuATiON PPOVISIONS OF SECTIbN 3�0o pF'HE LABOR � � COpE,1 SNALL FORTHWITM COMPLV WITH THOSE PROVISIONS. ISSUANCE __,.. ,,,,__,�.. � �`1�-'��PLICANT: _.l_.��HOII�I�S SMIP p DA7E�. _ . ."—`"' W ENERGY P/C � WARMNG FA�WFE TO SECURE WORK6RS'COMPENSATION COVERAGE IS UNLAWfUL,AND SHAL'�BE —'—"—"—" �y SUBJECTAN EMPl6VERT0�.RIMINAL PENALTIES AN�qVIL FINfiS UP T40NE NUNDRED THOUSAND ENEPGY PERMIT pOLLARS{5100.OW}.tN A6DItiON TDTHE CO3T 4F CQMPENSATION,QAMAGES AS PRQVIDED FOk IN —"' --" --""—"" � 5ECTION 37�BOF THE LABOR GODE,INTEREST,NNpATTOflNEYS FEES. RETENTION FEE: _,._ ,..�.. W C6NSTRUCTION LENDWG AGENCY PRE-ALT FEE: d - CL INER£BYAGFIRMUNDEaPEIVALTYOfPEP.iVftYTtiATTHEREiSAG�iS'if'.UCTIONl.ENDINGAGENGY . 0- FOR THE 7E�fORMANCE OG"THE WORK FOR WHICI I THIS CERMIT IS iSSUE�(SEC.309],GIV.G.). Z "' None t p�_t.�e.� � LENQEP'SNAME_„ _.—.-.. _ F— LENDER'SADORE55_____ �--- c � 10EA?IfYttlATEHAVEREAOT4ISAPPItCATiQNAND5TASGTHATTHEA�DVEiNFOAMATiflNiSCOftftEC2 TQTAL �E[�� 5�+�� i AGR6E TO COMPI.Y WITH Atl CITY ANp COL'NTY ORJiNANCES PND STATE LAWS RELATWG TO BUILDWG 4 GONSTRUCTIpN,ANU IIEFlEBVAUTHORIZE REPRES[NTATIVES OF THIS GOUNTV TO ENTER UPON TNE � A86YE�MENi'IONED PR�PEATY FOR MS?ECTIOM FVftPOSES. COMMENTS f� .._ ..... J _. � � m PERMIttEE NAME�PPMT) . . ��—� -� YC � �-- _ __.. _. —... ..... {f} SIGNATURE OF PEPMITTEE DATE RECPL Nd. PAID BY VALtDATION_ _ — ~ WHITE—DepaRment Copy.YEILOW—Finance Copy,PINK—Assessor Copy,� DENR4 Pilg Gopy,GREEN—ApRlicant's Gopy i; 's �yir i -''� �, e ��i�x. ,�� '_ ti� �`�� r i � ,�� +^��' „�,� �� i��a��r��C � � • �� , �.. . r , � ,� ,.� _ � , . , � � - ti �. .,�. � �� . i . ,, �, . .... . ... . .. ... , �_ ��.�''��a': .. ... . �� _.... ..._. . . ... ... ......... ._. _..... .._.. ..!. .. � �� _,_ :.. � '. � . . ..... .. ... .... . _ � ffi „ i � - �' �" :' i ;'r ,-�e,;'� . . ... .. .. ; , " . . ... . - . __ -. � � � � °� , �Y ;+Fi a ,. `� -•� ��. "''m U��',p'�, 'i'c ��7'��5'�`� �,�i,, ..... .. . . - , 9i .- 1 ;� '.w, ' .. . . _ ... .. .. _ . . ._ _.. _.. .. � i�- - _ � ... . .. . .. s�" ;��1 �� ', ,. _ � � � i -. i� � : �'� r ..� . _ _ . .. . . r� � � `n"�a� ;a.r ""' � _ , , , � ' .,��, � � . e � ' �, � , ,, ,: .� gr ,��.�e , : . .. ... .. . . ... . .. . ... . . . _._ .. ..._ ... . � . s . ., ..... . ... . ... . a �. a�_ r . �. . �.- � `i . .. _ _ � .. , �v:i'' ,a> _. € ... .. .. . . ... ._ ... . _ . .- . . ... CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVE�OPMENT SERVICES 21825 E.Copiey Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION CXlp�rc?t' PRESS FIRM�Y JOBSITE n ADDRESS,7 Vt�l.-i � .* APN�OT TRAC OWNER Pulte Homes ADDRESS 18401 Von Karman Ste 200 CITY Irvine zip 92612rEL..9497974400 APPLICANT TE�. CONTRACTOR-SAME ADDRESS CITY ZIP TE�. ARCH/ENG/ DESIGNER Hove Design ADDRESS 7W Newport Center r. CITY Newport Bc2h'92660TEL. 94976008 12 OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE�AW FOR THE FOL�OWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT.A�TER,IMPROVE, DEMO�ISH,OR REPAIR ANY STRUG TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APP�ICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE IAW(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 A�LEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APP�ICANT FOR A PERMIT SUBJECTS THE APP�ICANT TO A CIVIL PENA�TY OF NOT MORE THAN FIVE HUNDRED DOL�ARS($500).): D I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SO�E COMPENSATION, WI�L DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SAI.E(SEC. 7044, BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE�AW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUI�DS 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-BUI�DER WIL�HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUI�D OR IMPROVE FOR THE PURPOSE OF SALE). ^I.AS OWNER OF THE PROPERTY.AM EXC�USIVE�Y CONTRACTING WITH �ICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE:THE CONTRP,CTORS LI- CENSE�AW DOES NOTAPPI-Y TO AN OWNER OF A PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCI-I PROJECTS WITH A CONTRACTOR(S}�ICENSED PURSUANT TO THE CONTRAG TORS LICENSE�AW.). ^ I AM EXEMPT UNDEFI SEC. B.&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MV LICENSE IS IN FU�L FORCE AND EFFECT. LICENSE CLASS A LIC. NO. 517593 DATE,-E x p 9/30/Ol CONTRACTOR Pu I to WORKERS'COMPENSATION DECLARP,TION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY ONE OF THE FO�LOWING DECLARATIONS: I HAVE AND WIL�MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE IABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WIL�MA NTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE�ABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND PO�ICY NUMBER ARE CARRIER Pacific Emp Ins. Co. POLICYNUMBER WORL4301187A (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DO�LARS($100)OR�ESS}. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHAL�NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUB]ECT 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 SHAL�FORTHWITH COMP�Y WITH THOSE PROVISIONS. DATE: 5-10-OA�P�ICANT: Pulte Homes WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERP,GE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATfORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA�TY OF PER]URY 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 None(Pulte) LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMP�Y WITH A��CITY AND COUNTY ORDINANCES AND STATE�AWS REIr4TING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMIITEE NAME(PRINT) SIGNATURE OF PERMITfEE DATE APP�ICATION el PERMIT /C t 1'LIO # DATE NUMBER ISSUE TYPE OCC DATE CONST,GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW O SIDE^ PROPOSED USE N0. DWE�. N0. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. Ff, FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial m Valuation AD7.AREA QUANTITY DESCRIPTION FEE J U U W W Z 41.50 ] CL Q U Z Q 2 U W CONSTRUCTION PLAN REVIEW E�ECTRIC PLUMBING 41.50 MECHANICAL INSPECTION FEE ISSUANCE 2 5.00 SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTA�FEES 66.50 COMMENTS RECPT. NO. PAID BY VA�IDATION WHITE-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GOZDENR05--File Copy,GREEN-AppiicanYs Copy