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Permit No. 7369 City of COno Hills APPLIC DN FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 4961 Street FAIRWAY BLVD REROOF RESIDENCE C- APN 'I n711-174-1 R THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 1 Block Tract Z /'(p ® Struct. ❑ Plumb. Applicant wreTUGa pnnGlnlr. n Mech n F) t. n Grading el St No. _99Q Street nl i nptie PI ACT Type of Project ❑New LI Alter iii Addition City UPLANn Zip 91786 Phone 981-6498, ® Repair ❑ Convert. ❑Demo ❑ Occupancy Permit Owner TONY VELAS UEZ Project I Location on I Size Q Description Property in Sq. Feet St No. 4961 Street FAIRWAY B!vn City CHINO HII I S Zip 91709 Phone 393-830 1' REROOF I I Engr/Arch Lic No. 2. I I St No. Street 3 I I City Zip Phone 4. I I Contractor REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ALL WEATHER ROOF!�G Lic No. zsaszo,� Sewer I Min. Depth I-- S/F/100 Size St No. 790 Street N LOMA PLACE City I IDI Atkin Zip 91786 Phone 981-649€ Cubic Yards Excavation Fill Over Excavation City Business License License No. 3AC7 Expiration Date 11/30/97 vv Licensed Contractor's Declaration HOT MOP 15 SOS. SHEATHING INSPECTION REQUIRED. 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 License Number Date Contractor ;. .z. o,. .7_ 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: EI, 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 ❑ 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: Zoning Land Use Da. I have and will maintain a certificate of consent to self-insure for workers' RS compensation as provided by Section 3700 of the Labor Code, for the performance of the work for whit -permit is issued Setbacks I Model/Plan 111 b I have and will maintain workers compensation, as required by Section 3700 of the FY I SY LaborCode, for the performance of the work for which this permit is issued My worker's Ry I SSY compensation insurance carrier and policy number are: Ins. Co.: /9R ‘-2-c2‘-2-c2N/9 6-r--' /sGroup/Division/Type Policy No:, /LC7D//(S'zi V 4 Exp Date:` / — / .- 9 7 VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less) $3,000.00 ❑ c. 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 Workers' Compensation PERMIT FEES Laws of California and agree that if I should become subject to the workers' compensation provisions of tion 3700 of the Labor Code. I shall forthwith comply with those Electrical I Structural prove 6. ` 6 t:7-P �� G (T' I{(II % $64.80 Date /� Signature_ Warning: Failure to secure workers' compensation coverage is unlawful, and shall subject an Plumbing Grading employer to criminal penalties 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 Lai-:;-Code, interest, and attorney's fees. Mechanical Issuance $29.00 I certify that I have read this application and state that the above Information is correct. I agree to comply with all City Ordinances Geo Review Plan Check and state laws and hereby authorize representatives of this City Issuance Approved I Total Permit Fee to ter upon the above mentioned property for inspection P p —9-6- -- � DC �a�an //:-- . Date Issued Permit Number Si ure of A.. L' .1. Agent Date ' ) -.e2- v 7L 11/6/96 7369 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 0/S •:ONSTRUCTION LENDING AGENCI 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 ADDREcc • 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. D 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 OIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS-OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit r Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A.C. 8-Foot Bond Beam Final Construction (P /4V- VSFLI Final Bond Beam Final On Site Improvements Fireplace Bond Beam / J _ / Final Off Site Improvements Roof Sheathing • ///7I'-1 p 71/ Final Dedication Framing and Ventilation I ' , ' ' I V_ Final Zoning Roof Covering [; y Final Electrical Rough Heating - Final Gas Service and Ground Developer Fees Paid Rough Electrical Fire Dept. Approval Verified Bonding Certificate of Occupancy • Over Head Electrical Fence Height -. Gates ' Heater Pool Drainage SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S Inspector's Signature and Initials. DATE OF ISSUANCE PERMIT NUMBER