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Permit No. 20104 BUILDING ADDRESS: 16135 FIRESTONE LANE PERMIT NUMBER: 20104 1 �� BUILDING INFORMATION APPLICANT INFORMATION , t\ BUILVISTrPERMIT APPLICATION Address: 16135 FIRESTONE LANE I Name. MARIA C.DELGADO H Community Development APN: 11093122-22 1 Address: 116135 FIRESTONE LANE '1 -: .. 2001 Grand Avenue Lot: 22 W ( City,Zip Code: 'CHINO HILLS,CA 91709 "., \. Chino Hills,CA 91709 Cross Streets• WINGED FOOT Phone/Pager: 1(909)606-5387 I ext ,'.,!Inl!t LICENSED CONTRACTOR DECLARATION Tract/Parcel: 113295 City Bus Lic#• IN/A I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation. 1$13,325.00 I ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and OWNER INFORMATION Name. 1N/A effect. OWNER BUILDER DECLARATION Name. 'MARIA C DELGADO Address. I i hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress: 116135 FIRESTONE LANE City,Zip Code:1 I,as the owner of the property,or my employees with wages as their whole City,Zip Code: 1 Phone � 1 ext. 1 CHINO HiLLS,CA 91709 1 0 4compensation,will do the work,and the structure is not intended or offered for sale. Phone. 1c909)606-5387 1 ext. 1 Lic#: 1,asowner of the property,am exclusively contracting with licensed contractors to Bus Lic#. 1N/A ( City Bus Lic#. 1 consuct the project trBus Exp I lam exempt under Section i I BPC for this reason I APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: 'DAWN FORSHA I hereby affirm under penalty of penury one of the following declarationsContractor (OWNER BUILDER 1 Date Issued 17/22/02 I i Address. Finance Code 1C City,Zip Code: 1 have and will maintain a certificate of consent to self-insure for workers'compensation 0 as provided by Section 3700 of the Labor Code,for the performance of the work for I Census Code. ''1 n n A),- / which this permit is issued Phone or Pager 1 1 ext. 1 1 Final Date: 1 G C— �' G i ",' � Bus,Lic.#: 1 1 Final By: -' '0/_- I: I have and will maintain workers'compensation,as required by Section 3700 of the Lic #: ' 0 Labor Code,for the performance of the work for which this permit is issued My Extension. workers'compensation insurance earner and policy number are: Exp Dal. I Reviewed By `OGER MOON ( (- �— 1 Lic.Cl.: : 1 1 INSURANCE INFORMATIONApproved By: 'ROGER MOON Insurance Company: 'EXEMPT 1 PROJECT INFORMATION Policy Number: 1 11 / PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date: 1 Structure: 'ADDITION I 'REAR ( 1 198 0 Section need not be completed if permit is for one hundred dollars($l00)or less Garage- I I 1 I 1 1 I certify that in the performance of the work for which this permit is issued. I shall not employ Patio' 1 1 1 I 1 •ny person in any manner so as to become subject to the Workers'Compensation Laws of Porch• 1 ( 1 California and agree that if I should become subject to the workers'compensation provisions of Other: 1 1 1 Section 3700 of the Labor Code. I shall comply with those provisions ROOM ADDITION / n eel,: PROPOSED USE / (f (/� Date: i I Signature: i I i 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 to COMMENTS i 6.--Y- 2/ �C/`� enter upon the above mentioned property for inspection purposes—. ` ��%� Date: /!i L/C7z Signature: ><i /.'`�(� -- �—� I Q ajE yam' 7 '„rte'" ii r / /7(.'--.1; 1 r / � OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT ISSUANCE PERMIT FEE INFORMATION _ Zoning. 1PD Over X 1 0 1 19_ Issuance. 1 $29.00 1 Electrical. 1 $0.00 1 Front Yard. _ i Land Use: 1FR-1 1 Side Yard 5/5 Cut: 1 0 1 School NO ' Permit Fees: 1 $212.60 1 Plan Check: $0.00 1 Plumbing: 1 $0.00 Development: NO ( ( 1 Plan- ADD("I'fON Rear Yard• 10' Pill. 0 SM IP: $1 40 Tye 1R3 SSY. Total 1 0 1 Sewer: 1 NO ; Mechanical' 1 $0.00 1 Structural 1 $183.60 I Type: NO $0 00 i Grading: 1 $0.00 Geo Review: Total Fee Due I $214.00 1 Water: ( 1 '� , mSPECTI0N ��������m_�N������������y Permit Number A -specdon Date Inspector Inspection Date Inspector Grading: Prmg de/NooUng FINAL INSPECTIONS (Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL| Terres County Environmental Sub brains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Building Sewer Final Grade U.G.Waste Plumbing Final Electric Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical /f / U/G Conduit/Electrical ' Final Building/Construction )" ' Compaction Report #UmtmrXNeterNumber �^-'7 ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION FooUnQo CERT|PiCATE0FOCCUPANCY UFER Ground (Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVElS APPROVED 3ha�r -7 8//rfm, Roof Nailing / 19/l-/oz' ' ^ ~ ' -/ Exterior Walls/ Interior Walls */Al Hardware/Hold-Downs Rough Electric -n�� A��� Rough Mechanical --' Rough Plumbing/Topout Framing c '' ' - ' COVER NO WORK UNTIL ABOVE IS APPROVED |nau/oUonm�— c? n° � " Drywall Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections : Footing,ReBar 1St Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS : Location/Rebar/Bonding/Light Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence, Gate&Alarm Final Pool • Temp Power Pole Electric Release Gas Test 4