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Permit No. 10544 CITY OF CHINO HILLS Community Development 2001 Grand Avenue APPLICATION FOR BUILDING PERMIT Chino Hills,CA 91709 LICENSED CONTRACTOR'S DECLARATION APPLICANT INFORMATION BUILDING INFORMATION Permit Number: I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Name: VAN DAELE DEV.CORP Address: 2902 CHAMPION ST 110544 Section 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. Address: 2900 ADAMS ST. STE.C-25 APN: i D3'1412(p p,-aa WORK AUTHORIZED Contractor: VAN DAELE DEV.CORP. City,State Zip: RIVERSIDE,CA. 92504 Lot: 41 BY THIS PERMIT Address: 2900 ADAMS ST.STE.C-25 Electrical: X City,State Zip: RIVERSIDE,CA. 92504 Phone: (909)354-2121 Block: Grading: X Phone: (909)698-0433 City Bus Lic#: 2168 Tract: 15723 Mechanical: X License Class: B Plumbing: X License#: 518827 City Bus Exp: 1/31/97 Structural: X Date: 9/18/97 OWNER INFORMATION OWNER BUILDER DECLARATION PROJECT INFORMATION Name: VAN DAELE DEV.CORP. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: Proposed Use: SINGLE FAMILY RESIDENCE I I,as the owner of the property,or my employees with wages as their whole compensation, Address: SAME AS ABOVE will do the work,and the structure is not intended or offered for sale Project Description: Location on Property: Square Feet: EI,as owner of the property, City,State Zip: am exclusively contracting with licensed contractors to #1 LIVABLE 2750 construct the project. Phone: #2 GARAGE 571 n I am exempt under Section I I BPC for this reason City Bus Lic#: #3 PATIO 25.5 I #4 WORKERS'COMPENSATION DECLARATION City Bus Exp: PROJECT TYPE Zoning: I Setbacks I hereby affirm under penalty of perjury one of the following declarations: ENGINEER/ARCHITECT INFORMATION — Land Use: I ❑ I have and will maintain a certificate of consent to self-insure for workers'compensation Addition: FY: as provided by Section 3700•of the Labor Code,for the performance of the work for Name: THIELMANN ENG. Alter: — Model/Plan PLAN 3C SY: which this permit is issued. — Group: R Convert: RY: Address: 1078 TOWN&COUNTRY — Division: 3 riI have and will maintain workers'compensation,as required by Section 3700 of the Demo: SSY: Labor Code,for the performance of the work for which this permit is issued. My City,State Zip: ORANGE,CA. 92668 New: X Type: V-N workers'compensation insurance carrier and policy number are: Repair: a an P Y Insurance Com (CALIFORNIA COMPENSATI Phone: (714)647-0595 — 04 `I Policy Number: W957109153 City Bus Lic#: Expiration Date: 17/1/98 City Bus Exp: APPROVAL INFORMATION PERMIT FEES / nSection need not be completed if the permit is for one hundred dollars($100)or less Approved by: IDEBY CONRAD Electrical: j39150 Eng/Arc Lic#: 25742 Date Issued: 9/18/97 Geo Review: $0.00 I certify that in the performance of the work for which this permit is issued. I shall not employ Finance Code: C-4 Grading: $75.00 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 Census Code: 101 Issuance: $29.00 Section 3700 of the Labor Code. I shall comply with those provisions. Comments: Mechanical: $58.83 Date: I Signature: I Plan Check: $114.91 Plumbing: $258.00 Structural: $1,149.06 I certify I have read this application and state that the above information is correct. I agree to comply with all City Ordinances and state laws and hereby authorize representatives of this City Total Permit Fee: 1$1,987.30 1 to enter upon the above mentioned property for inspection purposes. Date: I(1/I /R ei I Signature: Valuation: $166,000.00 4 CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY 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 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,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH. O 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 0 IS 0 IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING AND SAFETY DIVISION IPERMIT# /® 544 Call(909)590-1511 Ext 282 before 3.00 p.m for next day inspection INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Miscellaneous Inspections: Pregrade Meeting Masonry Fireplace Rough Grade (if applicable) Terraces Plate Ties Throat Damper Sub Drains Shower Pan Temp Power Pole Finish Grading Electric Green Tag(wiring to be protected) I ` Soils Certification Ground Rod Grading Certification Gas Test(after drywall) Rough Gas Yellow Tag Final Other As Built Approved Reroof: Underground Site Inspections: Tearoff Building Sewer Line i Roof Nail/Existing Conditions Supply Water Line I Swimming Pools: Storm Drain/Catch Basins Location on Site U/G Conduit/Electrical Rebar Bonding DO NOT BACK FILL UNTIL ABOVE IS APPROVED Gas Piping/Test Verify Soils Engineering: Predeck Compaction, moisture,conditioning,etc. Final Underfloor/Undersalb Inspection: U/F Waste Plumbing LW-- FINAL REQUIRED-POOL NOT TO BE FILLED U/F Water 0,(,. / (,L4 i—. UNTIL FENCING IS COMPLETE U/F Mechanical Fire Protection Equipment: U/F Electrical UG Pipe U/F Framing Thrust Blocks OK to Install Insulation Hydro OK to Install Subfloor Flush Weld Outlet Insp. ABOVE IS REQUIRED PRIOR TO FOUNDATION INSP. Overhead Hydro Foundation Inspection: % Other Setback Q--3p"i? ,,A Test/Final Perimeter Footings Interior Footings - :11FINAL INSPECTIONS UFER Ground(Rebar/Copper) j n / (NO OCCUPANCY PERMITTED WITHOUT FINAL) Hardware/Hold-Downs .4 D ( County Environmental Piers/Caissons/Tendons fVX 1 Health(if required) Cly OK to Pour Concrete / 4 Public Works I — Fire 'I ,G1 `/ I DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Landscape • _j}�'r 1 Shear Inspection(Wood): ,A I/1- Building A —' I Exterior Walls 1q�7 Interior Walls CERTIFICATE OF OCCUPANCY Hardware/Hold-Downs OK to Install Lath 1( I Connection to Roof(if required) ,/' ) ( OK TO SUPPLY Roof Nail Inspection• =44441 .TOV--L,‘ 1 Frame Inspection: OTHER: Framing Lath ,,/l �% Plumbing TopoutA% I_ I Rough Mechanical ^ I Zj Multi-Story Waste Test \ OK to Insulate /_ _ II OK to Place Drywall ( LA t-') v' ' i Ivt..,� COVER NO WORK UNTIL ABOVE IS APPROVED Drywall Inspection: \71 ' /� ...0k--- _Nail/Screw \ NOTICE TO OWNER L o L Drywall Shear Nailing ^ I I. Call for FINAL inspection on every job This permit will expire if work is OK to Tape Drywall 411V. suspended or abandoned for a period of 180 days. Call for inspection OK to Stucco every 180 days to help permit active