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Permit No. 4688 City of CIAPio Hills APPLICA#N FOR BUILDING PERMIT Community Development 2001 Grand Avenue Mho Nils,CA 91709 Building Address: Proposed Use - St No. 14142 Street HEATHERVALE PATIO COVER APN 1024-311-02 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 8 Block Tract 13651-15 DiNt.$trotct. f-iPI8tab-ib. Applicant YANKEE PACIFIC C IM h. E1If6sct. �rtmlc dimi a St No. Street P.O. BOX 1710 Type of Project E,17 Mew CDUCIrer ElAdditkivn City UPLAND Zip 91785 Phone 985-2537 Ca eltalliirEiC env9ttct. [Wan=LUD >aycyPdteniti Owner LIN WONG Project Location on Size Description Property in Sq.Feet St No. 14142 Street HEATHERVALE City CHINO HILLS Zip 91709 Phone 628-3736 1, COVER + 200 Engr/Arch Lic No. 2 I St No. Street 3. I J City Zip Phone 4. I I Contractor YANKEE PACIFIC Lic No. 516401 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min. Depth I S/F/100 Size St No. Street P.O. BOX 1710 City UPLAND Zip 91785 Phone 985-2537 Cubic Yards Excavation Fill Over Excavation City Business License License No. Expiration Date Licensed Contractor's Declaration ---.. .-. - ... ............. ........ ..... ............. 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 B License Number 516401 Date Contractor SAME AS ABOVE --- -----------_------._--_. ._.—_..,-__.._,..___ 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: ri I, as the owner of the property, or my employees with wages as their whole lim.1 compensation, will do the work, and the structure is not intended or offered for sale. aI, as owner of the property, am exclusively contracting with licensed contractors to construct the project. _... w_.---..._. .. �......__. ❑ I am exempt under Sec,____, BPC for this reason Date Initial ___^mm Workers' Compensation Declaration �._-T^�`T^__.•�m._"_^�^,-��_...-.�.._� I hereby confirm that I have a certificate of consent to self insure, or a ZoningI Land Use certificate of Workers Compensation Insurance, or a certified copy thereof, CH/PD,lL1,FR1 Company POLIC(NO. Setbacks I Model/Plan Lied copy is hereby furnished Date Expires FY I SY 5,5 I lafi ertified copy is on file with the city City Verified__ __ __ RY za I SSY Group/Division/Type Date Z 5 5 A - 77 pplicant ��// �, _R3/VN Certificate of Exemption from Workers' Compensation Insurance VALUATION I certify that In the performance of the work for which this permit is issued, I shall not employ $2,400.00 any person in any manner, so as to become subject to the Workers Compensation Laws of California. PERMIT FEES Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject Electrical I Structural $65.30 to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above Plumbing I Grading information is correct. I agree to comply with all City Ordinances - and state laws and hereby authorize representatives of this City Mechanical Issuance $29.00 to enter upon the above mentioned property for inspection - - - purposes. Geo Review I Plan Check "Z"07 / Issuance Approved Total Permit Fee 6 —/2 '- '5- I $94.30 - , nature of Applicant or Agent Date Date Issued Permit Number l� c L.. / 6,,,,, , 06/12/95 4688 Print Applicant's/Agent's Name FINANCE CODE 1CENSUS CODE C4 0/S '•ONSTFIUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR TIIE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 19 ISSUED (SEC.3007,CIV.C.). LENDER'S NAME LENDER'S ADDRESS ,�LL DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION tHECALIORNIAHEALTHAND SAFETY CdOEI#EOUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT 110N9 ONE OF THE CERTIFICATES BELOW. O ICERTI14THAT NC k AVATION b FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED AY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH. El AS OWNER/BUILDER I WIL I NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REUI11111- A r'LIIMI I FROM 1'HE DIVISION OF INDUST TIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON IIAS A PERMir FROM THAT DIVISION. DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER - I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK AI'PI IED 1011 ON THIS PERMIT PIIS IllS NOt SUBJECT 10 THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND IRE LOCAL Alli (MAI IIY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOTI DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel ' Stucco Mesh or Fvlorinr Sliilnq Excavation and Forms Insulnt'u Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach line or Soap Pit Underslab _Conduit Water Sorvice Undorslab Gas Lath or Drywall Nailing Fireplace Foundation _ Gas Line Air test Joists and Girders Final Energy Electrical Ground Final Plumbing M_id_Heigh_t Bond Beam Final healing/A.0 8-Foot Bond Beam Final Construction Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Olf Site Improvements Roof Sheathing -_ Final Dedication Framing and Ventilation Final Zoning Roof Covering, Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Paid Rou h Electrical lire Dept Approval Verified Q Bonding Certificate of Occupancy Over Head Electrical Fence Height ----- ---- --- -- -- ---Gates Heater Heater Pool Drainage SEP I IC I MIK GALS • SEEP. PIT X LEACH LINEWIDE LONG X DEP III OF HOCK U • ------------ • W E S. Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER