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Permit No. 20444 BUILDING ADDRESS: 4964 HERITAGE DRIVE PERMIT NUMBER: 20444 BUILDING INFORMATION APPLICANT INFORMATION BUILDING PERMIT APPLICATION Address: 4964 HERITAGE DRIVE Name: 1KONTIKI CONSTRUCTIO ` ,; Community Development APN: 11028-521-51 Address 112761 JALEPENO AVE u 2001 Grand Avenue Lot• 1112 City,Zip Code: 1CHINO CA 91710 .;l7.,0; Chino Hills,CA 91709 era" Cross Streets: 1 I Phone/Pager• 1(909)717-2457 1 ext. I nr......„.",.. LICENSED CONTRACTOR DECLARATION Tract/Parcel- 115769 City Bus Lic#: 1 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation• 1$1,716.00 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• 1NONE OWNER BUILDER DECLARATIONName 1SHANE IRABELO 1 Address 1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress 14964 HERITAGE DRIVE City,Zip Code. O I,as the owner of the property,or my employees with wages as their whole City,Zip Code 1CHINO HILLS,CA 91709 Phone: 1 1 ext 1 compensation,will do the work,and the structure is not intended or offered for sale. Phone: (909)717-2457 ext 1 Lie#- I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie#I 1782009 1 City Bus Lie#. construct the project 17 I am exempt under Section I 1 BPC for this reason I Bus Exp 17/31/02 APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By 1LINDA LAPORTE I hereby affirm under penalty of perjury one of the following declarations: Contractor KONTIKI CONSTRUCTIO Date Issued. 17/24/02 Address- 12761 JALEPENO AVE Finance Code: J', — 5 I have and will maintain a certificate of consent to self-insure for workers'compensation C) as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code: CHINO CA 91710 Census Code I i which this permit is issued. Phone or Pager (909)717-2457 1 ext 1 I Final Date: 1 / /Z r /`, i; Bus.Lie#. NEW Final By: 14.11c„,..--•;:,e_7"-- I have and will maintain workers'compensation,as required by Section 3700 of the 0 Labor Code,for the performance of the work for which this permit is issued My Lie #. 782009 Extension. workers'compensation insurance carrier and policy number are: Exp Date• 7/31/02 I Reviewed By (ROGER MOON INSURANCE INFORMATION Lie.Class: B Approved By. 1ROGER MOON Insurance Company: (Exempt I PROJECT INFORMATION Policy Number: I I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 1 Structure: 1 1 I 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage • I certify that in the performance of the work for which this permit is issued I shall not employ Patio- 1LATTICE 1 1REAR 1 143 any person in any manner so as to become subject to the Workers'Compensation Laws of Porch• I I I California and agree that if I should become subject to the workers'compensation provisions of Other. 1 Section 3700 of the Labor Code. I shall comply with those provisions �/� PROPOSED USE LATTICE PATIO COVER Date: 1 7/"kj2,,h 21— Signature: I ,1/k • /4� i�•tjv /I certify I have read this application and state that the above information i�Co-rect. 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 .✓1 Date: 2j Signature: I i' v•-17 OTHER FEES REQUIRED zO ING SETBACKS ` GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning Front Yard: 10 Over X: 1 0 1 Issuance: 1 $29 00 Electrical: 1 $0 00 Land Use: Side Yard. 5/5School: 1 NO 1 Permit Fees: Cut 0 1 Development. NO Plan Check. 1 $31 98 I Plumbing. 1 $0 00 1 I $110.18 I Plan: Rear Yard 15 Fill 1 0 SMIP 1 $0 50 1 Occ: SSY Total: 1 0 1 Sewer. NO Mechanical 1 $0 00 I Structural $49.20 Type 1 Water. NO Geo Review. 1 $0 00 Grading: $0.00 Total Fee Due $110.68 JSPECTION RECORt Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL ! Terraces County Environmental Sub Drains 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 n / U/G Conduit/Electrical Final Building/Construction Arc- if-t Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground (Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons 0 ER: RTA Slab Grade IPO ; I o'U�► I--1 DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED J Shear Roof Nailing • Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation 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