Permit No. 2004-1459 •
/ ''S` BUILDING DIVISION OF COMMUNITY EVELOPMENT DEPARTMENT
2001 Grand
Cit
of Chino H i I Is Coun er Phoneenue,Chino Hills,C(909)709 364-2780
24-Hour Inspection Line (909)364-2790
Building Permit (NOTE You must call before 3p m for a next business day inspection)
• City Hall Main Number (909)364-2600
LILY Oi CHINO HILLS
c•��c
NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED PLEASE USE PERMIT NUMBER
WITHIN 180 DAYS FROM DATE OF ISSUANCE, OR IF WORK IS SUSPENDED AT ANY BELOW WHEN MAKING
TIME FOR MORE THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY INQUIRIES OR REQUESTING
OR STATE LAWS RELATING THERETO. INSPECTIONS
PROJECT DESCRIPTION PERMIT No
8 X 10 ICBG PATIO COVER 2004-1t5, c
BUILDING 710 ADDRESS
DCALLE VISTA -- 0 APT/UNIT No ISSUED DATE
10/01/2004 ISSUED
YMBAYRTI //II��
APN PARCEL MAP# TRACT LOT/PARCEL BLOCK CONST TYPE ZONE OCC LAD U�BiI
1032-142-60 TR 15660-1 1 V-N UN R-3 R sidential
CENSUS 9 ODES OVERLAY
E LAY DIST BBLDG SOFT SP S PE BL
LROJEECT PERMITS SETBACK 9 Y SETBACK RY SETBACK SS'Q SETBACK SY
32
FR
FEES
Description Calc. Paid
W MOELIJONO, YOUDY LAU Plan Check PC $19.50 $19.50
2710 CALLE VISTA
0
CHINO HILLS, CA 91709 Total Paid 9/17/2004: $19.50
Issuance/Suppl F $29.00 $29.00
OWNER BUILDER SMIP $0.50 $0.50
Structural $30.00 $30.00
, CA
Total Paid 10/1/2004: $59.50
0
I—
U
Contr Lic: Grand Total: $79.00 $79.00
p Expiration:
v License Type:
Workers Comp:
Expiration:
Bus. License:
Expiration:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under 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 In securing this permit I am acting with the knowledge of and on the
behalf of the owner of the property
PROJECT DESCRIPTION
Date Contractor
OWNER-BUILDER DECLARATION 8 X 10 ICBG PATIO COVER
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for
the following reason(Sec 7031.5 Business and Professional Code. Any city or county which
requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its
issuance,also requires the applicant for such permit to file a signed statement that he or she is
licensed pursuant to the provisions of the Contractors License Law(Chapter 9 commencing
with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred
dollars($500)
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do
the work, and the structure is not intended or offered for sale (Sec 7044, Business and
Professions Code The Contractors License Law does not apply to an owner of property who
builds 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 improvements is sold within one year of completion,the owner-builder
will have the burden of proving that he or she did not build or improve for the purpose of sale)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct PROJECT INFORMATION
the project(Sec 7044, Business and Professions Code The Contractors License Law does
not apply to an owner of property who builds or improves thereon,and who contracts for such I Desc I Location I Sq Foot I Valuation
projects-with a contractor(s)licensed pursuant to the Contractors License Law) PATIO COVER REAR 80 $960.00
❑ yyem Exempt under Article 3 of the Business and Professions Code
>�9te 1Ofo110q Owner. AtAk
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ I have and will maintain a certificate of consent to self-insure for workers' compensation, as
provided for by Section 3700 of the Labor Code,for the performance of the work for which this Total Valuation $960.00
permit is issued
I certify that I have read this application and state that the above information
❑ I have and will maintain workers'compensation insurance, as required by SectiGn 3700 the Is co:rect I agree to comply with all city and county ordinances and-state-- - -
Labor Code,for the performance of the work for which this permit is issued laws relating to building construction,and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ purposes. i
any person in any manner so as to become subject to the worker's compensation laws of
941
'pl IfrlV11`A
California,and agree that if I should become subject to the worker's compensation provisions Jl' ^T (0/01 I
O/QS 'b1-1
of Section 3700 of the Labor Code,I shall forthwith comply with those provisions APPLICANT SIGNATURE DATE
APPLICANT INFORMATION
MOELIJONO, YOUDY LAU
2 710 CALLE VISTA
( CHINO HILLS, CA 91709
Date. Applicant
909-393-5282
WARNING' Failure to secure worker's compensation coverage is unlawful,and shall subject an
employer to criminal penalties and civil fines up to one hundred thousand dollars($100,000),in I certify that the use of this facility shall comply with sections 25505,25533,
addition to the cost of compensation,damages as provided for in Section 3706 of the Labor Code, and 25534 of the Health and Safety Code,which regulate the storage,
interest,and attorney's fees
handling and use of hazardous materials.
• CITY OF CHINO HILLS •
COMMUNITY DEVELOPMENT—BUILDING&SAFETY DIVISION •
Call (909) 364-2790 before 3:00 p.m.for next day inspection
Post in a safe, conspicuous place at front of job. Provide permit number when calling for inspection. Have approved plans on job at
time of inspection.
NO WORK SHALL BE COVERED WITHOUT INSPECTION
File this permit with your permanent records when job is complete.
INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR
Grading: Block Wall Inspections:
Pregrade Meeting Footing,Rebar
Rough Grade 1st Lift Bond Beam
Terraces 2nd Lift Bond Beam
Sub Drains 3`d Lift Bond Beam
Finish Grading Drain/Seal
Soils Certification
Grading Certification Rough ReRoof:
Tear-off, Existing Conditions
Underground Site Inspections: Sheath Nailing
Building Sewer Line Roof Final
Water Supply Line
U/G Electrical Service Conduit Swimming Pools:
Storm Drain/Catch Basin Location/Rebar/Bonding/Light
DO NOT BACKFILL UNTIL ABOVE IS APPROVED Gas Test
Gr Conduit
Verify Soils Engineering: Ro Elect
Compaction,moisture,conditioning,etc. POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE
Fence,Gate&Alarm
Underfloor/Underslab Inspection: Final Pool
U/F Waste Plumbing
U/F Water Fire Protection Equipment:
U/F Mechanical UG Pipe
U/F Electrical Thrust Blocks
U/F Framing Hydro
U/F Insulation Flush
Subfloor Weld Outlet Insp.
ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Overhead Hydro
Foundation Inspection: Temp Power Pole
Setback/Footing—OK to Pour Electric Release
UFER Ground(Rebar/Copper) Gas Test
Hardware/Hold-Downs
Piers/Caissons/Tendons FINAL INSPECTIONS
Slab Grade—OK to Pour NO OCCUPANCY PERMITTED WITHOUT FINAL
DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED County Environmental
Health Dept (391-7570)
Shear Inspection(Wood): Planning Dept (364-2752)
Roof Nailing Public Works (364-2774)
Exterior Walls Fire (393-3888)
Interior Walls Landscape (364-2766)
Hardware/Hold-Downs ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG.
Final Grade
Combo inspection: Final Electric
Framing Final Plumbing
Rough Electric Final Mechanical
Rough Mechanical Final Building/Construction
Rough Plumbing/Topout Water Meter Number
COVER NO WORK UNTIL ABOVE IS APPROVED
CERTIFICATE OF OCCUPANCY
Insulation OK TO ISSUE
Drywall Inspection: OTHER:
Interior
Exterior
EXT LATH
Stucco Scratch
Miscellaneous Inspections:
Masonry Fireplace
Plate Ties, Fire Block
Patio/Deck: •
Footing
Frame
Access/Light/Switch NOTICE TO OWNER:Call for FINAL INSPECTION on every job. This
permit will expire if work is suspended or abandoned for a period of
Patio Final � 180 days.