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Permit No. 6375 City of tkino Hills APPI_IION FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 14794 Street CALLE BRILLANTE SINGLE FAMILY RESIDENCE APN 1032—i42_-01 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 13 Block Tract 15660-1 N Struct. ll Plumb. Applicant WESTERN PACIFIC HOUSING ® Mach. ® Elect. IS] Grading St No. 18001 Street COWEN ST STE H Type of Project ® 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 St No. 18001 Street COWEN ST STE H Description Property in Sq. Feet City IRVINE Zip 92714 Phone 714-442-6199 1 LIVABLE I 11303 Engr/Arch Lic No. 2. GARAGE I 1405 St No. Street 3 I I City Zip Phone 4. I I Contractor WESTERN PACIFIC HOUSINGREMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Lic NO. . Sewer I Min. Depth I S/1/100 I Size St No. 18001 Street COWEN ST STE H 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 Licensed Contractor's Declaration PLAN 2 I hereby affirm that I am licensed under the 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 B License Number Date Contractor SAME Address City and Zip Phone Owner Builder Declaration I hereby affirm that I am exempt from the Contractor's License Law for the following reason El I, as the owner of the property, or my employees with wages as their whole „...,......„.............._..........,, U compensation, will do the work, and the structure is not intended or offered for sale rri'4a DUI, 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 PD,FR1 Da 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 of the work for kuch-ttis permit is issued. Setbacks I Model/Plan 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 psi mit is issued My worker's Ry I SSY compensation insurance carrier and policy number are Ins. Co.: 4.A.. C.+ i.�SJ�rY•�v %NS.•+.�tiCa L,,, Group/Division/Type Policy No: 'cA! 9G 31 3 620sR3/VN Exp Date: zi5fieVALUATION (This dechnn need not be completed if the permit is for uric hundred doolars($100) or less) $82,000.00 ❑ 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' compensation provisions of Section 3700 of the Labor Code I shall forthwith co.. • • ith those Electrical $143.33 I Structural $737.22 provisions. / s E eb L11fsa Signature_ _ s' . Plumbing $208.50 Grading $75.00 Warning: Failure to secure workers' compensation coverage is unlawful, an. i_r act an employer to criminal penalties and civil fines up to one hundred thousan. .. ars (5100,00. , in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. Mechanical $78.81 Issuance $29.00 I certify that I have read this application and state that the above Geo Review I Plan Check $47.91 information is correct. I agree to comply with all City Ordinances and state laws and hereby aut e representatives of this City Issuance Approved I Total Permit Fee to enter upon the above-=i.-. .roperty for inspection DC $1,319.77 purpose - / '/ ' /�6 Date Issued Permit Number Signatuje of Applicant or Agent Date 6/21/96 6375 —\ . Nh4C-4.-1” Print Applicant's/Agent's Name FINANCE CODE C4 CENSUS CODE 101 (\ •3TRUCTIONLENDINGAGENC\, _Al. 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 ADDRESF 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. o 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 38 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 DIS ❑IS 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 I DATE I INSPECTOR, Setback/Location Iii /6, --'f' , ,4/1_/ I Rough Plumbing I/..j 7i�-3.Pi-.' / I Jr) - / Temporary Power I ' / / ) Shower Pan Test [/ ' 7(A f 7 V Foundation Reinforcing Steel __ Stucco Mesh or Exterior Siding -E"( �f71// Excavation and Forms L ` � _ Insulation ' Slab Grade Sewer � ,Pi S7c// �� Ground Plumbing Soil I'7-/o, -9 ;, fin/ Interceptor ' Ground Plumbing Water 7.--/ - ‘,.. ,!2i { Septic Tank I Underslab Ducts , • Leach Line or Seep Pit I Underslab Conduit Water Service ,I' Underslab Gas Lath ord5i-ywall Nailin 9/' ' ��/ Fireplace Foundation I Gas Line Air Test ft 7f 4 I ' A-14 Joists and Girders I Final Energy I 6 I .----r- Electrical Electrical Ground Final Plumbing I I Mid-Height Bond Beam I Final Heating/A.C. I 8-Foot Bond Beam I Final Construction ./. . Final Bond Beam I Final On Site Improvements / I p_ z.z Fireplace Bond Beam _ Final Off Site Improvements /_ I 1 ikiilRoof Sheathing y' 4letut.� 1.-R-4f,_J FiFinal Dedication L _ / Framing and VentilAtion �, ` ( nal Zoning /I / It /I *4 Roof Covering /11.\\1._._/_ I \\ I I Final Electrical ` ' /e . 11 /ill' V Rough Heating `Ivwn 11-i I t\- I I Final Gas I / I III I ' ,A " I Service and Ground I lj \( "/i I 1 h1TI\I I Developer Fees Paid IV I' I t I is 111 I Rough Electrical .c.../11\lam 1 n I/w Fire Dept. Approval Verified A1 t If " `� v Bonding I I \ I Certificate of Occupancy / I I L Over Head Electrical I \ I \ I / 1 I Fence Height I I I / Gates I / Heater I v Pool Drainage I li SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N - W. E. S. • Inspector's Signature and Initials 0 t. - . . . DATE OF ISSUANCE PERMIT NUMBER LO -at -- cl co 3 i 5