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2016-32801 6-16-2016 16479 PATINA HVAC BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT City of Chino Hills 14000 City Center Dr.,Chino Hills,CA91709 Counter Phone (909)364-2780 r( F �" • Building Permit 24-Hour Inspection Line (909)364-2790; • (NOTE:You must call before 3p.m.for a next business day i :pectin City Hall Main Number (909)364-26r0 • NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PER T NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MA G INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR= REQUESTING INS TIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. PERMIT No. HVAC CIO(E)LOCATION-HERS REQ'D 2016-32801 BUILDING ADDRESS •APT./UNIT NO. ISSUED DATE ISSUED BY 16479 PATINA CT 6/16/2016 Cotter,Melissa APN TRACT MAP# LOT FLOORS/UNITS PROJECT PERMITS P.TYPE 101767203 TR 13507-2 :15 / CENCUS CODES CONST.TYPE 'ZONING TYPE OCCUPANCY TYPE VALUATION TOTAL SQFT BLDG.SQFT 434 Res Add/Alter VB R-3 $24,000.00 0.00 Current Name:MARIANO TIGNO Fee Group/ Fee Description Fee Amount Payments Address: 16479 PATINA CT CHINO HILLS CA 91709 Transaction Type Ph: 909-519-8187 Mechanical C/O $106 60 Email: M@CH.ORG e t- lit. stem wlEner 105 60 .105.60 E' HAMPIONS.=SERVICE.CHAMP.IONS" Contractor Address: 22911 SAVI RANCH PKWY YORBA LINDA CA 92887 Ph: 714-692-7977 Email: m@ch.org 0 7. LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION AMOUNT'PAID. I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sec.7000)of Division 3 of the Business and Professions Code,and my license is in full force and BALANCE DUE $0.00 effect. In securing this permit I am acting with the knowledge of and on behalf of the owner of the property. Date: O. ‘,5'4 Contractor. OWNER-BUILDER DECLARATION 1 I hereby affirm under penalty of perjury that I am exempt from the Contractor's Licence Law for the following reason,(Sec,7031.5,Business and Profesional 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 therefrom and the basis for the alleged exemption. Any violation of Sec.7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more that five hundred dollars($500.00) I,as owner of the propterty,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 improvement is sold within one year of completion,the owner-builder will have the burden of proving that he 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 the project(Sec.7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor (s)licensed pursuant to the Contractors License Law). I am exempt under article 3 of the Business and Professions Code. Date: Permittee: Print Full Name: WORKERS'COMPENSATION DECLARATION 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 .I certify that I have read this application and state that the above information is correct. I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is with all city and county ordinances and state laws relating to building construction,and hereby authorize issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes. have and will maintain workers'compensation insurance,as required by Section 3700 of the bor Code,for the performance of the work for which this permit is issued. My worker's compensation (P 1-40 11/44 i surance carrier and policy number are: _ I#: D I Carrier. .t Policy APPLICANT SIGNATURE DAT v Applicant: TIFFANY.DOUTHIT. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the worker's compensation laws of California,and Address: 31225 LA BAYA DR STE 112 WESTLAKE VILLAGE CA 91362 agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. ,Ph: 909-210-3116 Email: M@CH.ORG Lic.Information Exp Date ate: k.,0.„V\O\\.,\9 • Applicant: . tV I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and Safety Code,which regulate the storage,handling and use of hazardous materials WARNING: Failure to secure worker's compensation coverage is unlawful,and shall subject an employer to criminal penalities 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. COMMUNrr EVEL gMENT- lL 1NiG b: ; F "Y D1Vi�€ N. Coil x 909)$6 2 1J before 3: .for ` : I o .� r.. Rost l.:a � _:.J� I �._.J_ .< ALL E `EE T iT . ECT: File this fait =p t p°o gar.p r a t records.*viie jo ..i. om I .. • I PE TI N TE INSPECTORNSPECTOR INSPECT I •Gra dEig HI cI 'Fall`k pecti : Preg rade r eetin Footing,Rebar Rough Grady 'Lrft on�d E rrs Terrr c 2 Li t`Borcl Bea :Sub:C rrain : 3fl:Lift Bond eam Finish r ding Drain/Seal Soils Cerrti fication radii g e tification,Rough Re Tear off,Existing Conditions Un ro i:5 Li n Sheatl ail in Building:Sewer Liz Roof Final aterr Supply.Lin LIB ;El tri el r i nduit rrirr� r P' l : ....... .....: o rr Drain Catch Basin Location/ ebarr./Bonding Light i SNOT'B K FILL UNTIL i;B ' E 1 6P'P HOVE rr Co�duit ` rif i Er� r � F Elt o pa t on.�r i tui :r��ditio ing P' L NOTTG:131E FILLS . �1!NTIL F ENCI NG'I COMPLETE Fence,::Gate&, larr . lrrd l ra°J Iat ii p on: Final Pool Waste P Iii robing. 1aF'utter Fire Pr ct�oni Equip` LIEF":Me lriani al Pi U F E lectrical Thru t Bilocks U F Frac in Hydro UW Insulation' Flush S�ibtloor Weld Outlet lr asp; ABOVE IS REQUIRED P'RI R:Ta FOUNDATION 11ISP'E TI N: Overhead Hy o Fotrnt1ti irrcti : Tea+P� Pole Setbael /Footing.-O to Pourr EIectri .I l a FE I ��darpperr T <. Harrdtre/HoId--Lir ' Pier a' ai sons/Tendons FINAL'ItISP ECTIO f P H! Y P'ERMITTEH° THO UT FINAL HO t1OT'PUR.C N RETE U NTIL AB `E IS P'PRO EIS e int En irronri ent l Health De xt Stye I n 1) Plann mg Dei (384-2752) Renf I ailing P bl rc.Works 3 -2774) Exterrior alis Fire (393=3388) Interior Walls Land a e ::!:HarelvveretHold.Downs .ALL ABOVE MUST B E AP'PRO E D B EF RE:FIf LBLI ..;:: Final Crede C 9. pec:ion: Ftn�l E I�etr Frarin Final P l imb ing r. / F�e��t i El��trie Final f est uric I Dom. - I Fern IleFrar�iedl _: Final Bir ldmg/Con tr retren F ough Pl i mbing/Tepe�it eater C,1eterr:t umber: COVERNO WO RIC IU NTIL. BOVEIS. P'P ROVED::.-: Ir��l�, rri CERTIFICATE i F•: UP NCY OITO ISSN IE b all pe ti :. Interrior STH E CIO-•• 11 U � EXT Li6TH - Cl2LOOCY15 ST:NNA3'. 1 1arir ,Frepla � Dtz.f.2) - Plat °Ties,Firs Elecl \ Feetin Frame< Lr lit � I NOTICE T OWNER`:Call fes.ENTAL INSP'ECTI N o . >�ati� Final T prrrY �ll rf° [ ri �i - b00001.d for a pr �l