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Permit No. 6945 �' 1 City of C5ho Hills APPLIC ON FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 14791 Street CALLE BRISA . SINGLE FAMILY RESIDENCE APN - t l) 32-142--4-0 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 35 Block Tract 15660-1 ZIStruct. ® Plumb. Applicant WESTERN PACIFIC HOUSING ® Mech. ® Elect. ® 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 1$001 COWEN ST STE H Description Property in Sq. Feet St No. Street City IRVINE _ Zip�92714 phone 714-442-6199 ' LIVABLE I 11167 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 Sewer I Min. Depth I S/F/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 PLAN 1 Licensed Contractor's Declaration 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. ❑ 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. ^^ m ❑ I am exempt under Sec____,B&PC for this reason Date Initial Workers' Compensation Declaration I hereby affirm under penalty of penury one of the following declarations: Zoning Land Use PD,FR1 ❑a. 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 which this permit is issued. Setbacks Model/Plan ❑ b. I have and will maintain worker's compensation, as required by Section 3700 of the FY I SY I LaborCode, for the performance of the work for which this permit is issued- My worker's Ry I SSY - li compensation insurance corner and policy number are: Ins. Co.: Group/Division/Type R3/VN Policy No: Exp Date: VALUATION (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 Worker ' C•u sensation Laws of California and agree that if I should become subject to the —e compe sation provisions of Section 3700 of the Labor C•.- hail_forth h—co : with those $695.64 provisions. _ -. - E.L�trical $128.37 Structural Date _--_ /__ - '\ -, Signature • � _ C • Iumbing $208.50 Grading $75.00 Warning: Failure to secure workers' compensation coverage is wful, and shall subject a , employer to criminal penalties and civil fines up to one hued thousand dollars ($10O, in addition to the cost of co-.;per;.ation, damages as provid ection 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 Geo Review I Plan Check $45.21 information is correct. I agree to comply with all City Ordinances and state Taws and hereby aut.., ze epresentatives of this City Issuance Approved Total Permit Fee to enter upon the al2 Aggirmentione., property for inspection DC I - $1,270.52 oses. I _ �� / ���� Date Issued Permit Number Sign(u're of Applltsaftyor Agent_'` Date / / 9/5/96 I 6945 FINANCE CODE C4 CENSUS CODE 101 Print Applicant's/Agent's Name F \ ONSTRUCTION LENDING AGENC 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,FALSEWORK,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 DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD QATE INSPECTpR DATE, I INSPgCTOR Setback/Location gfrbeV4 t0 Rough Plumbing /n 9 , , In I A Temporary Power •7 ', Shower Part Test VCT I (/ mei P1 Foundation Reinforcing Steel //' / Stucco Mesh or Exterior Siding j)._24'3.--1414,, •11.6- Excavation and Forms ,V)/ /j.1/ ///\ / Insulation t -I/ i,, Slab Grade /,' // �I///IO /7/ )V Sewer `)-(o--� Ground Plumbing Soil 1 6ci 1*49 ' 3 Interceptor I Ground Plumbing Water 4 rj* /i171/ Septic Tank I Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service //—/J3—qC Underslab Gas Lath or Drywall Nailing [VIII 1 c' _ I PrV Fireplace Foundation Gas Line Air Test ,4sni • Joists and Girders Final Energy Electrical Ground Final Plumbing _/1 ,I' Mid-Height Bond Beam Final Heating/A.C. _ �Y\� 1/ ,, 8-Foot Bond Beam Final Construction /I /674,./ ' Final Bond Beam Final On Site Improvements \/ � ( I t� Fireplace Bond BeamFinal Off Site Improvements Roof Sheathing V 1'113-6(_ 1174Final Dedication / I Framing and Ventilation I\ t` T N Final Zoning • Roof Covering I Final Electrical I-2--)-9-7 Q Rough Heating _ \' \\i \ \ \ Final Gas -7D0--c171 Service and Ground _� � ,t, Vy�C \ V Developer Fees Paid r Rough Electrical j.Th \ W4 _ IX' • Fire Dept. Approval Verified k- .c °V'\ c Bonding J \ IC/ t N Certificate of Occupancy Over Head Electrical 4) \I Fence Height I Gates .1 Heater I Pool Drainage I SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials D TE ISSUA CE PERMIT 77