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Permit No. 5565 City of Cio Hills APPLICA•N FOR BUILDING,PEr• Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 1410 Street HEATHERIDGE FTGS FOR FUTURE PATIO COVER/ELECT LINE APN 1000-451-08 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 24 Block Tract 13915-9 CI Struct. ❑Plumb. Applicant ROBERT DUNHAM ❑Mech. �� Elect. ID Grading St No. 1410 Street HEATHERIDGE Type of Project ® New 0 Alter 0 Addition City CHINO HILLS Zip 91709 Phone 597-5039 ❑ Repair ❑Convert. ❑Demo ❑Occupancy Permit Owner ROBERT DUNHAM Project I Location on I Size N. Description Property in Sq. Feet St No. 1410 Street HEATHERIDGE I IN. CityCHINO HILLS 1. FOOTINGS O Zip 91709 Phone 597-5039 I I Engr/Arch Lic No. 2. ELECT UNE St No. Street 3. I I City Zip Phone 4. 1 Contractor REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Lic No. Sewer I Min_ Depth I S/F/100 I Size St No. Street (�„n\ City Zip Phone Cubic Yards Excavation Fill Over Excavation City Business License .�� License No. Expiration Date ONE INTERIOR FOOTING 12 X 12 X 16. Licensed Contractor's Declaration t�, 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 v effect. License Class License Number • Date Contractor 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- ❑ I, 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, owner of the property, am exclusively contracting with licensed contractors to onstruct the project. ❑ I am exempt under Sec.______, B&PC for this reason_____________________ -...�' Date 12-/ 2- q1615 Initial ga- Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: Zoning Land Use Ela. I have and will maintain a certificate of consent to self-insure for workers' CH/PD,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Setbacks I Model/Plan ❑ b. I have and will maintain worker's compensation, as required by Section 3700 of the FY 20 I SY 5,5 LaborCode, for the performance of the work for which this permit is issued. My worker's compensation insurance camer and policy number are: RY 20 I SSY Ins. Co.: Group/Division/Type Policy No: . Exp Date: / . VALUATION (lhis dectio eed not be completed if the permit is for one hundred doolars($1U0)or less). $1,600.00 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-Section 3 00 of the Labor Code. I sh-II f. hwit comp/with those provisio V� Electrical $22.50 Structural $44.40 \,. ... P 1`2-'1 IrG 1,'t 5+ Signature 0 ' it,.i., / - r 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 Labor 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 Total Permit Fee to enteupon the abov- mentioned property for inspection DC $95.90 L p/S ' " " t 4v (1 Date Issued Permit Number Signature of Applicant or Agent Dat- 12/19/95 5565 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 0/S 1,..1 -0 LENDING AGENC\ • I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR TI IE PERFORMANCE 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 INDUST RIAL 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. 0 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 DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND TI IE LOCAL AIR QUALITY AGENCY. • BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE I INSPECTOR Setback/Location Rough Plumbing I 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 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 Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing Final Dedication Framing and Ventilation Final Zoning Roof Covering Final Electrical Rough Heating Final Gas n Service and Ground Developer Fees Paid 1 Rough Electrical Fire Dept. Approval Verified Bonding Certificate of Occupancy ,� �\ V ' Over Head Electrical 'Y f / Fence Height Gates HeaterolDrainage it I ,/ 1Pool D Y 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