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Permit No. 16714 BUILDING ADDRESS: 2211 HEDGEROW LANE PERMIT NUMBER: 16714 / BUILDING INFORMATION APPLICANT INFORMATION '"'fit°. BUILDING PERMIT APPLICATION Address: 2211 HEDGEROW LANE Name: 1KIM SANG Community Development APN. 11024-201-42 Address 12211 HEDGEROW LANE µ ` 'ms` 2001 Grand Avenue `'{^ ? Lot• 141 City,Zip Code• 1CHINO HILLS,CA 91709 ,t Chino Hills,CA 91709 •Ic' ::' Cross Streets: 1 I Phone/Pager: 1(909)465-0268 I ext. I �"......•y.., LICENSED CONTRACTOR DECLARATION Tract/Parcel. 113651-9 1 City Bus Lic#• N/A I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation• 1$500.00 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. OWNER INFORMATION Name: N/A OWNER BUILDER DECLARATION Name: IKIM SANG Address. I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address: 2211 HEDGEROW LANE City,Zip Code. property, P Y g yZip Phone: ext. O I,as the owner of theor myemployees ees with wages as their whole City, Code CHINO HILLS,CA 91709 • compensation,will do the work,and the structure is not intended or offered for sale. 1 I Lie#: Phone: (909)465-0268 ext. , I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie 4iN/A I City Bus Lic#. construct the project 0 1 am exempt under Section i i BPC for this reason I I Bus Exp: I APPROVAL INFORMATION III WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: 1YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations• Contractor: OWNER BUILDER Date Issued• 107/24/2000 Address. I Finance Code. 1C4 I 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 City,Zip Code: I Census Code. 1 which this permit is issued. Phone or Pager 1 ext. I I Final Date I /J_ Z�'-a V Bus.Lic#. IFinal I have and will maintain workers'compensation,as required by Section 3700 of the By. ff--- -_✓ fD E13 - Labor Code,for the performance of the work for which this permit is issued. My Lic.#: Extension: workers'compensation insurance earner and policy number are: Exp Date: I Reviewed By: 1 Lic Class: I Approved By: I INSURANCE INFORMATION Insurance Company: 1 EXEMPT 1 PROJECT INFORMATION Policy Number: I I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date I I 1 Structure: 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage: 1 I I certify that in the performance of the work for which this permit is issued. I shall not employ Patio: any person in any manner so as to become subject to the Workers'Compensation Laws of Porch. I I Ilik California and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code. I shall comply with those provisions. Other. 1WATER HEATER C/O 1 1GARAGE 1 WATER HEATER CHANGE OUT PROPOSED USE Date: i i Signature: 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 authonze representatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes Date: i71/22,1 /pp i Signature: i /.......-7 I OTHER FEES REQUIRED ZONING SETBACKS ( GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning: 1PD I Front Yard EXIST. Over X: 1 0 1issuance: 1 $30 00 1 Electrical. I $0.00 1 Land Use: 1FR-1 I Side Yard: Cut: 0School: 1 NO 1 Permit FeesII: I Development NO I Plan Check. 1 $0.00 I Plumbing: I $15.00 I $45.00 Plan: PLUMB Rear Yard. P Fill. 0 SMIP 1 $0.00 I Occ: 1R3 I SSY: Total 0 Sewer: 1 NO 1 Mechanical. 1 $0.00 I Structural• 1 $0.00 I Type: 1VN Water: 1 NO I Geo Review: 1 $0.00 1 Grading. 1 $0.00 ITotal Fee Due 1 $45.00 INSPECTION RECORD INSPECTION DATE INSPECTOR Grading: INSPECTION DATE INSPECTOR Pregrade Meeting Block Wall Inspections : Rough Grade Footing, ReBar Terraces 1st Lift Bond Beam Sub Drains 2nd Lift Bond Beam Finish Grading 3rd Lift Bond Beam Soils Certification Drain/Seal Grading Certification ReRoof: Rough Tear-off, Existing Conditions As Built Approved Sheath Nailing Underground Site Inspections: Roof Final Building Sewer Line Swimming Pools : Supply Water Line Location/Rebar/Bonding/Light Storm Drain/Catch Basins Gas Test U/G Conduit/Electrical Gr Conduit/Ro Elect DO NOT BACKFILL UNTIL ABOVE IS APPROVED Pre-Deck Verify Soils Engineering: POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Compaction,moisture,conditioning,etc. Fence,Gate&Alarm Underfloor/Underslab Inspection: Final Pool U/F Waste Plumbing Fire Protection Equipment: U/F Water UG Pipe U/F Mechanical Thrust Blocks U/F Electrical Hydro U/F Framing Flush Insulation Weld Outlet Insp. Subfloor Overhead Hydro ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Foundation Inspection: Temp Power Pole Setback/Footing Electric Release UFER Ground(Rebar/Copper) Gas Test Hardware/Hold-Downs Piers/Caissons/Tendons FINAL INSPECTIONS DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED NO OCCUPANCY PERMITTED WITHOUT FINAL! Shear Inspection(Wood): County Environmental Roof Nailing Health Dept (391-7570) Exterior Walls Planning Dept (364-2750) Interior Walls Public Works (364-2770) Hardware/Hold-Downs Fire (393-3888) Combo Inspection: Landscape (364-2797) Framing Trust Accounts....(364-2769) Rough Electric ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Rough Mechanical Final Electric Rough Plumbing/Topout Final Grade , Plumbing �/ '7 rt - /1 COVER NO WORK UNTIL ABOVE IS APPROVED rl Insulation Final Mechanical Final Building/Construction Drywall Inspection: g Interior Water Meter Number Exterior Lath CERTIFICATE OF OCCUPANCY Stucco Scratch OK TO ISSUE MISCELLANEOUS INSPECTIONS Masonry Fireplace OTHER: Plate Ties, Fire Block, Patio/Deck: Footing Access/Light/Switch Patio Final • •