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Permit No. 10139 Community CITY OF CHINO HILLS 001 Grand Avenluement 9 A„ , Q 1Z1 L DGE /0 APPLICATION FOR BUILDING PERMIT 0Chino Hills, CA 91709 LICENSED CONTRACTOR'S DECLARATION Permit Number: 110139I 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 APPLICANT INFORMATION OWNER INFORMATION CONTRACTOR INFORMATION ENGINEER/ARCHITECT INFORMATION License Class: 1B I Address: 19880 Via Pasar Ste A First Name: Hammon/Masmg First Name: 'John First Name: Hammon/Masing First Name: 1n/a License#: 1680754 I City: 'San Diego I Last Name: Last Name: Hunt Last Name: Last Name: Contractor: Hammond/Masing I State: 1Ca I Address: 9880 Via Pasar Address: 11393 Heathendge Lane Address: 9880 Via Pasar Address: I City: San Diego City: �Chino Hills City: San Diego City: I Date: 111/30/97 I Zip: 192126 I I State: Ca State: ICa State: Ca State: I Phone: 1(619)536-2440 I I 11 Zip: 92126 Zip: 191709 Zip: 92126 Zip: 111 OWNER BUILDER DECLARATION Phone: (619)336-2440 Phone: 1(909)606-0538 Phone: (619)536-2440 Phone: I hereby affirm that I am exempt from the Contractor's License Law for the following reason City Bus Lic#: 97-02976 City Bus Lic#:1n/a Cont. Lic#: 680754 Eng/Arc Lic#: 'n I,as the owner of the property,or my employees with wages as their whole City Bus Exp: 09/30/97 City Bus Exp: I City Bus Lic#: 97-02976 City Bus Lic#:I 1 compensation,will do the work,and the structure is not intended or offered for sale nI,as owner of the property,am exclusively contracting with licensed contractors to construct BUILDING INFORMATION City Bus Exp: 09/30/97 City Bus Exp: the project nI am exempt under Section BPC for this reason I Address: 1393 Heather Ridge Lane I Lot: Block: Tract: WORKERS'COMPENSATION DECLARATION ! I I I I PERMIT FEES APN: 1000-451-04 9020 13915-8 Electrical: $0.00 PROJECT INFORMATION I hereby affirm under penalty of perjury one of the following declarations' Geo Review: $0.00 ElI have and will maintain a certificate of consent to self-insure for workers'compensation as Proposed Use: (Replace Windows I PROJECT TYPE WORK AUTHORIZED provided by Section 3700 of the Labor Code,for the performance of the work for which thisElBY THIS PERMIT Grading: $0.00 permit is issued Project Description: Location on Property: Square Feet: Alter: Issuance: $29.00 ❑ I have and will maintain workers'compensation,as required by Section 3700 of the Labor #1 (Replace Windows I I I 1O I New: n Electrical: Code,for the performance of the work for which this permit is issued. My workers' Mechanical: $0 00 Ank compensation insurance carrier and policy number are #2 II I I I I Demo: n Grading: lipPlan Check: $0.00 Insurance Company: Westland Insurance #3 I I I I I I Repair: n Mechanical: 1-7 Policy Number: WN96-590700-03 Plumbing: $0.00 Expiration Date: 7/1/98 #4 I I I I I I Addition: ri Plumbing: E1 Structural: $18 00 n Section need not be completed if the permit is for one hundred dollars($100)or less Zoning: Land Use: Convert: n Structural: X❑ Total Permit Fee: $47 00 I certify that in the performance of the work for which this permit is issued I shall not employ any I I I person in any manner so as to become subject to the Workers'Compensation Laws of California Valuation: 1$500 00 and agree that if I should become subject to the workers'compensation provisions of Section 3700 Setbacks Model/Plan of the Labor Code I shall comply with those provisions FY: I I RY: I I I I APPROVAL INFORMATION Date: Signature: I I SY: 1 I SSY: I I I I Approved by: !Yvette Martinez I certify I have read this application and state that the above information is orrect I agree to Group: I I Division: I I Type: I I Date Issued: 17/25/97 comply with all City Ordinances and state laws and hereby authorize rep ntatives o his City to enter upon the above mentioned property for inspection purposes Finance Code: 1C4 i Comments: Date: I 7.3.2zz-1.2 I Signature: 1 ///..1/C .I1 Census Code: I /vZiA CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE ISA 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. • 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. • 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 l'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 I- PERMIT# 1 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) 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 Roof Nail/Existing Conditions Supply Water Line 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 FINAL REQUIRED-POOL NOT TO BE FILLED U/F Water 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 Test/Final Perimeter Footings Interior Footings FINAL INSPECTIONS UFER Ground(Rebar/Copper) (NO OCCUPANCY PERMITTED WITHOUT FINAL) Hardware/Hold-Downs County Environmental Piers/Caissons/Tendons Health(if required) OK to Pour Concrete Public Works Fire DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Landscape • Shear Inspection(Wood): Building Y-1-5-67:( -117.0 Exterior Walls Interior Walls CERTIFICATE OF OCCUPANCY Hardware/Hold-Downs OK to Install Lath Connection to Roof(if required) OK TO SUPPLY Roof Nail Inspection: Frame Inspection: OTHER: Framing Lath Plumbing Topout • Rough Mechanical Multi-Story Waste Test OK to Insulate OK to Place Drywall COVER NO WORK UNTIL ABOVE IS APPROVED Drywall Inspection: Nail/Screw NOTICE TO OWNER Drywall Shear Nailing -Call for FINAL inspection on every lob_ This permit will expire if work is . suspended or abandoned for a penod of 180 days. Call for inspection OK to Tape Drywall every 180 days to help keep permit active OK to Stucco •