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Permit No. 6366 City Of ino Hills • APP!_•TION FOR RUII_DING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 14814 Street CALLE BRILLANTE SINGLE FAMILY RESIDENCE APN (0 3 2 —I c L--1 I THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 15 Block Tract 1 5660-1 ®Struct. ® Plumb. Applicant WESTERN PACIFIC HOUSING ® Mech. ® Elect. ® Grading St No. 18001 Street COWEN ST STE H Type of Project y New ❑ Alter ❑Addition City IRVINE Zip 92714 phone 714-442-6199 ❑ Repair ❑ Convert. ❑ Demo ❑ Occupancy Permit Owner WESTERN PACIFIC HOUSING Project I Location on I Size 18001 COWEN ST STE H Description Property in Sq. Feet St No. Street Phone 714-442-6199 '" LIVABLE I 11167 City IRVINE Zip 92714 Engr/Arch Lic No. 2 GARAGE I 1395 St No. Street 3 I City Zip Phone 4 I I Contractor WESTERN PACIFIC HOUSING Lic No. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 18001 COWEN ST STE H Sewer I Min" Depth I S/F/100 I Size St No. Street YES City IRVINE Zip 92714 Phone 714-442-6199 Cubic Yards Excavation ,Fill Over Excavation City Business License License No. 2487 Expiration Date 9/30/96 PLAN 1 Licensed Contractor's Declaration I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section _ __w_ ,_"• ___µ_____ __ 7000 of Division 3 of the Business and Professions Code) and my license is in full force end effect. License Class B License Number Data Contractor SAME Address ____ ____,..___.,__.--,-__....,M City and Zip Phone Owner Builder Declaration I hereby affirm that I am exempt from the Contractor's License Law for the following reason ❑ I, as the owner of the property, or my employees with wages as their whole . compensation, will do the work, and the structure is not intended or offered for sale ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec ,B&PC for this reason ----- -"-- -------------- „--—„_ Date Initial Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: ZoningI Land Use Da. I have and will maintain a certificate of consent to self-insure for workers' PD,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued Setbacks Model/Plan MIb I have and will maintain worker's compensation, as required by Section 3700 of the FY I SY LaborCode, for the performance of the work for which this permit is issued My worker's RY I SSY compensation insurance carrier and policy number are Ins. Co.: �A . �cntirer\je 1A•T.o..) *, Group/Division/Type R3/VN Policy No: w 96 3 136 2;3 Exp Date: Z% 57,-4. VALUATION I (This dection need not be completed if the permit is for one hundred doolars($100) or less). $75,000.00 ❑ c. I certify that in the performance of the work for which this permit is issued I shall PERMIT FEES 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' corn nsation provisions of Section 3700 of the Labor Code I shall forthwith comply ith ose Electrical $128.37 Structural $695.64 provisions. Date_•61Z.1 /5� Signature_ �_ _ � ' Warning• Failure to secure workers' compensatr�age is unlawful, numbing $208.50 Grading $75.00 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 3706 of the Labor Code, interest, and attorney's fees Mechanical $88.80 Issuance $29.00 I certify that I have read this application and state that the above information is correct. I agree to comply with all City Ordinances Geo Review Plan Check $45.21 and state laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to enter upon the above ie Toned property for inspection Dc $1,270.52 , . (� . ( Q� _ <,-- -./2.1 79e- Date Issued Permit Number Sgnature of Applicant or Agent --J bale 6/21/96 6366 M t�G A A . L_-4' Jt T 1---" FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 (` TRUCTION LENDING AGENCI._ ,k.• I HEREBY AFFIRM 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 LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW. ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH. ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION. • DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑IS DS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD I ;DATE/ I INSPECTOR I DATE I INSPECTOR Setback/Location I //?;,/ '(,, I ,4--7V I I Rough Plumbing �� Zr-, A Temporary Power I / '/ - - I n I Shower Pan Test r7-77'7(A f f7 1f Foundation Reinforcing Steel--1 ,Stucco Mesh�r Exterior Siding 1-2 i 5 fp 1_,,10„,v/ Excavation and Forms 'miry / _ Insulation )�j-�j'(� Slab Grade J / /_�P / Sewer IQ-- ` ' I Ground Plumbing Soil ' 7// /7.47 I Interceptor I Ground Plumbing Water I 77/!f/ .4-iNi Septic Tank I I Underslab Ducts � Leach Line or Seep Pit Underslab Conduit 1 Water Service l Underslab Gas I I Lath o(Drywall Nailing ,-- -7� Fireplace Foundation I I Gas Line Air Test /QA-479CQ Joists and Girders I I Final Energy I Electrical Ground I Final Plumbing �� Mid-Height Bond Beam Final Heating/A.C. /' 8-Foot Bond Beam I I Final Construction ,Ii Final Bond Beam II Final On Site Improvements I V I Fireplace Bond Beam I I _ \\ Final Off Site Improvements I V I ) \€,L' Roof Sheathing e , I01"" -- i ics (,kFinal Dedication I .7/7 ,I"/Xf Framing and Ventilation n co •T Final Zoning I . ( ,/,IV `� Roof Covering Ill\v!_, I \ I Final Electrical 17 Ir/ti' r I I . . Rough Heating •11001 r / Hri)cvi___ Final Gas � q I .41 7/�Service and Ground ! .4 "%! Developer Fees Paid , I / II/ ' ` Rough Electrical I Y2 \ /kj I r I z` Fire Dept. Approval Verified I i r I y14 ,/ Bonding I }4\( I ' \ Certificate of Occupancy I (I Over Head Electrical I " \ I V, I Fence Height I r Gates I Heater I I Pool Drainage I I I . , I - I SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. • S.• Inspector's Signature and Initials . ' lS DATE OF ISSUANCE PERMIT NUMBER