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Home My WebLink About17341 �c x �� r�{--{ CiTY OF DIAMOND BAR - �`�"?`- DEPAR2'MENT OF COI�IIvi[iJNITY&DEVELOPMENT SERVICES !�� 21825 E.Copley Drive _ (909)860-3195 Faac(909)861-3117 PRESS -.4� BUILDiNG PERMIT APPLICATION FIRMLY � J06SITE ��=�--��C� . '"�R—� DATEICATION � l r. �.-� NU BER_�„�x.1��/C � ADORESS` s�� c� �, �^''S=C--+L'+.s ISSUE TYPE OCC APN LOT TRACT � dATE CONST. GRdUP p OWNEq �Ulte �Oftl@' ADDRESS �$�� vOti Karman t@ 2�� ZONING SETBACKS � cin Irvine ziP 92612r��. 9497974400 FRONT Rw o g APPI.ICANT v TEL. REAR ['� � SIDEtSlQE STREET RW =� _� � CONTRACTpR_„ SAME SIDE � � ADDRESS PROP�SED USE � ClTY ZIP TEI. - �w ARCH/ENG/ Z DESIGNER H�� pe�� NO.DWEL. NCl. NO. a ADDRESS �� NBW,(J� �.E.'��r U�r- UNITS STORIES BEDA�OMS i_ � CITY _L�Le.1N.�1bYt BtX�A.�.Z�.S2OTEL._ ��g7SO.I�H�I � BESCRIPTION Sd.FT. FACTOR PSF ADJ.AREA/VALUATION � qWNER-BUILDER DECLARATIpN SFR/ADp(REM O C] I MEFEBY AFFIRM UNpER PENALTY OF PERJURV TNAT I AM EXEMPT FROM THE CONTRACTOFS LI- � Garage/Caroort W CENSEIAWFqflTNEFOLLOWINGREA50N(SEC.To31.5&J&INESSANDpflOFESSIONSCODE:ANYCITYOft T. LJ .f,6UNTYY�tIK�iRE-0UtRfS4PERM(TTOC6NSTRUCT,ALTfift,tMPROVE,OEMOUSH,ORflEPAiRANYSTqUC� W patip/Deck � TURE.PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT fOR SUCH PERMIT TO fILE A$IGNE� W W STATEMENT THAT N€OA SHE iS L�CENSE�PURSUANT TO TttE PftQY1Si�N5 O€THE CONI'RAC7t)RS t,l- � '� CENSE LAW(CHAPTER 9(COMMENCING WIiH SEC7ION]000)OF U�VISION a GF THE BUSINESS AN6 PRO- � PO4USp8 � FESSIONSCO�E�ORTNATNEORSHEI9E%EMPTTHEREFpOMANDTHEHA515FORiHEALLEGE'JE%EMP� � TION.ANY YlOiATiON 6F S£CT�N 7031.5 8Y ANY APP��FCAN(FflR A PEftMIT 5U8JECT5 TNE APPUCAh1T T0 z Re-Roof � A CIV1L PENAI.TY OF NOT MOpE THAN fIVE HUNDRED DOLLARS(5500�.�: — �-y ❑I,qSqWNEROFTHEPROPERNORMYEMPLOYEESWITHWAGESASTNEIRS4LECOMGENSATION, � �ommerciai `-",�1. Witl DO THE WORK,AND 1HE STRl7CTUftE IS NOT INTEiJ6E0 4R ffFFFRED KOR SAIE{SEC.�6d4,eUSi� J NE55 AN�PROFESSIONS 40DE:THE CONTRACTOpS LICENSE LAW�QES NOT APPLY TO AN oWNER OF � PROVERTYWHOBUIlD50�tlMPROVESTNEREON,ANDWNODOESSUCHWORkHIMSELFORHERSELfOft � (L THROUGti HIS OR HEA OriMI EMPI.DYE6S,vROViDED THAT SUCH IMPROVEMENTS AR£NOi iNTENDED OR m W�, OFFEREDFORSPLE.IF,HOWEVER,THE9UILDINGORIMPRQVEMENtI550LDWITMINONEYEAROFCOMR6� � TION,THE OWNER�BUIiDER Will HAYE TH'e BVAF}EN 4F PROVING TyAT HE 4fl SHE OtD N4T BUItD QR � IMPRQVE FOR THE PURPOE�E OF SALE), O I,�S O WNEfl OF THE'PR9PERTY,FM E%GLUSIVELV CONTflACTING WRM LICEN$ED CONTRACTORS � TO CANSTftUCT THE PROJV=CT{SEC.70A4.8U$INESS AN4 Pti�FES3IQN$CflbE:TNE GONIRACT6ftS U- VdIUBItOt1 ADJ.AREA W CENSE UW DOES NUTAPPLYTOAN OWNER CIF A PROPERTY WHO BUILDS OR IMPROVESTHEREON,ANb � 4VFIOCON7RAC75FpRSUCH7qQ1ECTSWITHACONTRACTOR(S)UCENSEDo��RSUANrTOTNECONTRAC- QUANTITY QESCRIPTfON FEE � iDRS tiCENSE IAW.). � J � ❑1 AM EXEMpT UN�FI?SEC. ,_ 9.8 P.C.FOft THIS RERSON Q a3 — �-- U � ¢ vnTE owNfs� _ U � �ICENSED G4NTRACTORS DECIARATION W Q GC IHERE&YAFfIRMUNDERPE:NALTYOFPERJURYTHATIAMLICENSEDUNDEFPFOVISIONSOFCHAPTEF � d fl jCOMMENGING WRH SEC�tON 7DW}OF OtviSION 3 0F7HE BtISINE55 AN6 PROFE5S10NS C06E,AND W MYIICEN5EI51NFULLf4RCEANDEFFECT. m (��S� � I,ICEN5ECLA55 A ��.Na. 517593 � � p(�(�((�+1 n _..__.__ � U RA7E�X��rIJVt_3�+CQN7RACTOR, i'LII�C� _, a �� W � WORKERS COMPENSATIUN 4ECLARATION ¢ = U � i HER�BYAfFiRM UNDEA PFNALTY OF PERJURY ONE Of?Nc FO�LDWING DECURATlONS: � - Z Q � I HAVE AND WILL MAINTAIN A CEFiTIFICATE fJF CON9ENT70 SEI.F-INSURE FOR WDRKEPS' _ C6MPE➢75ATION,ASPROVIOE08YSECT30N37900FTNElAedRC.06E,FORTNEPERFOPMANCE C3 4 OF THE WOflK FQR 1NHICN THIS PEPMIT IS ISSUEO. � � �"G'� _IHAVEANpWILLMA'�MAINWORKERS'CAMPENSATIONINSUHANCE,ASREQUIREDBVSEGTION � 370o OF THE LABOH CAqE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 � ISSUED.MY VJ6iiKERS'CAMPENSATION INSUflANC'c CARRIER ANO P4:.ICY NUAiBER AftE-. CONSTRUCTION � /^� ....�.._......... � CARRIER p��cifhicf�Ei�mt �}��" 'no�'J�•�[ l.l�• i�i' p(j{NREVIEW _.,_ ._,.,._.. � aouCv NUMeEa_ YY V ii�a.,,�`►.� � QL'!�__. ELECTRIG �t Q (iHI55ECT�'NJNEEDhOTBEGLYr1R.ETE�OF7NEPEW.1f115F{7RONEHUI�DReDOqA.AFlS($1W)OflLE55). PLUMBING .,_„_ W i GERi4FYTHAT(N T}{�pEftFOPMANCE 6F TNE W6HK FOfl WNICH THiS PERMiT IS ISSUED.i �ECHANICA� � .� ..�.� —_.� („� SHAL4NOTEMPLOYANYPEFSC7NINANYMANNERS(]ASTOBECOMESUBJECTTOTHE (j) WORKEAS'COMPENSATIONLAWSOFC.AUFORNIA,ANDAGREETHATIKISFKKlLDBEC�Me �NSPECTIQNFEE _ ... � SU&lECTT6 THE YK)RK£RS C6MPENSATiQM PPOV�SIONSOF aECTiON 3�00 bF?HE IABOR • � CO�E,I SHAIL FORTHWITH COMPLV WITFi Tf{pSE PfiOVISIONS. �SSUANCE _ ... Q DATE: J`�V�—M.� Pulte Homes SMIP � _ LIGANT: _ � ENEt�GY P1C 'j WAANING:FAtLtfRE'�SECURE WORKEFS'f,bMPEN$ATION COVERAGE�S UNLAWFUI.,AND GHALlOE '—"' J � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINE3UP1pONENUN�REDTHqt15PND ENERGYPERMIT tX�ILARS{f t[1�.009}.!N AQDI'fiON TO THE COST OF C'JMFENSATION.DAMAfi£S 0.5 PftOV}DED FOR IN �'-- J SECTION3lOBOFTNELAD�FlCpDE,INTEREST,ANDATiORNEY'SFEES. RETENTIONFEE: � — ....._._ d CONSTRUCTI6N LENOING AGENCY pRE-ALT FEE: _ _. Q � I HEREBY AfF4RM UNO'eA PEIJAISY OF PERJU�Y TNAT THERE IS A CONSTRUCTION LENDING AGE�tCY _ FOPTHE 7ERG6RMANCE OF THE WORK FOR WH�CN THIS PEAMiT�S iSuUED(SEC.308].CIV G.}. -�� Z "' INOn� (Rul�l_—.� — � l£NDER'SNAFiE_ 1— LEM�ERSADDRF53___ _._ � ICEflTiFYTHATIHRVEftEAQTHI.SAAP1..if.AT14NANqSTA'.ETHATTHEABOVEWFORMATIONISCORftECT. TOlAL FECJ Vs�SV W I AGREE TO COMPLV WITN 0.Ll CITV hN0 COUNTY OR6INANCESAN�STATE UWS REL0.TING TO 84IL�ING � f.ONSTRl1CTION,ANp HE�IEBV AUTHORI2E REPRESENTATIVES Df THIS GOUNTY TO ENTER UPON THE � A�VE-MENTKNJEDFftOPERTYFOFiiNSPEC"'IONPURPOSE5. CC7MMEIVTS_ _ � J —_. ....—. __. . � .. ..__. _— m PEFMIi"rEE NAME(PRINT) ....__. d � (/� SIGNATUREOFPERMITTEE � �AT� � RECPT.NO..,,, ID BY _ _ VAUDATION � WHITE—Departmeni Copy.YELLOW—Finance Copy,PINK—Asaessor Copy,GOIDENR00--Pile Copy,6fi£EN—ApRlicanYs Copy . y� i �, '� I '.x��, `�3��'�p�,� �eR�B",� V 128° -l�,�po�,ms�; :�; 'L�4 � � � y � � _ � _ > m a a,t I l 6 w w fl a xa�iwr�� < rom�� . . � ��, ��,= , •,�; �s ,:. � , . ` �4� '3�'yi . ....... . .... ...�: '.. ... .. ,_ .. ..._ . . .. . . � �I '�. ) = ..... � 7 ��i F I � - � b. : . ... . .. ........ .. .... . . ... ..._. .._... ` i i } �°�,(�`� � ' . . . . . � _;° a �S"a'"w�"��`a '�-s a".. � r.�k��`� a ir °' ��'i�a.�� .` _ s&�hi�� ,�� " ��,�,�,�� _ __ , _ _ � ad�� s ` �� r � _ _ — y j' �a � c( s - �- �.� s � �,' s,.� � -� � M e;� '�= `_ . ... . . ... ... .. .. : �,.�� . �' _� ... _ .. .. , � _ . .. .. . . - �'. � �.�.r .li 2° i ... � „ , s �_ + :, a4 i x e.' , � ',3 :'r . . .. . . ... . . .._ .. ._ _. ... .. . .. ... .. ... .. . . � . - � . .. ... . . . . . � � .� ��3 ��. � _ 4 h : r` .. � ,.��,` �-„�,.w:'=�s-�"�"'.�.�'"-::� ... .. .._. ... . _.. . . .. _ . . .. .. . . . CITY OF DIAMOND BAR x r�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copiey Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRM�Y JOBSITE C! 'a'�D fl' p ADDRESS_ APN LOT TRACT I' OWNER Pulte ome ADDRESS 18401 Von Karman to 200 CITY Irvine zIP 9261 -E�.9497974400 APPLICANT!TE�. CONTRACTOR-SAME ADDRESS CITY ZIP TE�. ARCH/ENG/ DESIGNER Hove design ADDRESS 74W ewpor Center r. CITY Newport B�he 92660TE�.949760081 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,ALTER. IMPROVE, DEMO�ISH,OR REPAIRANYSTRUG 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 CONTRP,CTORS LI- CENSE tAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F 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).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMP�OYEES WITH WAGES AS THEIR SOLE COMPENSATION, WI�L DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SA�E(SEC. 7044, BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS�ICENSE�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 EXCLUSIVELY CONTRACTING WITH �ICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE IAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE tAW.). ^ 1 AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PER7URY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY�ICENSE IS IN FUL�FORCE AND EFFECT. A 517593 LICENSE CLASS LIC. NO. DATE EXp 9/30J01 CONTRACTOR Pulto WORKERS'COMPENSATION DECLARP,TION I HEREBY AFFIRM UNDER PE NALTY OF PER]URY ONE OF THE FO�LOWING DECLARATIONS: -1 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�,4BOR 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. POLICY NUMBER 4301187 (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 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�ABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. Pulte Homes 10-QP T DA E: LICANT: WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOLI�,RS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOFI CODE,INTEREST.AND Al�'ORNEY'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 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH AL�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 INSPECTION PURPOSES. PERMIITEE NAME(PRINT) SIGNATURE OF PERMITfEE DATE APP�ICATION I I � at NU DATE J"-1 # NUMMBE BER # ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWE�. N0. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. Ff. FACTOR PSF ADJ.AREANA�UATION SFR/ADD/REM U) Garage/Carport W Patio/Deck L�I LL Pool/Spa 0 Re-Roof Z Q Commercial co Valuation AD.I.AREA QUANTITY DESCRIPTION FEE ] U I- U W Z Z M 41.50 CL Q U Z 2 0 w CONSTRUCTION PLAN REVIEW E�ECTRIC P�UMBING MECHANICAL INSPECI'ION FEE ISSUANCE SMIP ENERGY P/C ENER6Y PERMIT RETENTION FEE: PRE-ALT FEE: TOTA�FEES 66.50 COMMENTS RECPT. NO. ID BY VALIDATION WHITE-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GO�DENROD-File Copy,GREEN-Applicant's Copy