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Permit No. 6176 City of Cho Hills APPI_ICAIIN FOR BtJII_DING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 16282 Street IVORY CT SINGLE FAMILY RESIDENCE APN 1017-412-05 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 13 Block Tract 13507-3 L-.-::--!...:..:t. ! - =-- Applicant SUMITOMO REALTY AND DEVELOPMENT w n,_�>: - •_:........2.. -- 23046 AVENIDA DE LA CARLOTA Type of Project -- •--•- • - •-=-•----• St No. Street _ _ — City LAGUNA HILLS Zip 92653 Phone • 714-586-101!1 L'__ ..- '._:.7...-:. _z.. -- -- - . Owner SUMITOMO REALTY AND DEVELOPMENT Project Location on Size 23046 StreetAVENIDA DE LA CARLOTA Description I Property in Sq. Feet St No. LIVABLE 1830 City LAGUNA HILLS Zip 92653 Phone 714-586-1011' Engr/Arch Lic No. a GARAGE ( I 632 9 ) St No. Street 3 PATIO I I 56 City Zip Phone 4. I Contractor SUMITOMO REALTY AND Lic No. 678246 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min. Depth I I S/F/100 I Size St No. 23046 Street AVENIDA DE LA CARLOTA YES City LAGUNA HILLS Zip 92653 Phone 714-586-101 lubic 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 .0 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. License Class B License Number 678246 Data Contractor SAME AS OWNER 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. rl I, as the owner of the property, or my employees with wages as their whole lJ compensation, will do the work, and the structure is riot intended or offered for sale ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project 0 I am exempt under Sec. , B&PC for this reason __.__-...V__.�.___ 44Date Initial__ Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: Zoning Land Use ❑a I have and will maintain a certificate of consent to self-insure for workers' PD,ILI,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the I wor for which this permit is issued Setbacks Model/Plan b. I have and will maintain worker's compensation, as required by Section 3700 of the FY I SY aborCode, for the performance of the work for which this penma is issued My warker's Ry I ssr 1 compensation insurance carrier and policy number are: Ins. CO.: Group/Division/Type Policy No: R3/VN Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less). $117,199.00 ❑ c. I certify that in the performance of the work for which this permit is issued. I shall PERMIT FEES not employ any person in any manner so as to become subjec to the W 'or s' Compensation Laws of Calif rnra and ogre that if I should become subje4 o thew rscompensation provisions o S tion 37 0 of the Labor Code. I ` fort wit omply with those Electrical $200.9 Structural $927.30 provisions. --F— L Date_ _ C Signature/ �� Warning: F ure t 'secure workers' compensation coverage is unlawful, and shall subject an Plumbing $234.O( Grading $75.0(,' 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 $88.8( Issuance $29.00 I certify that I have read this application and state that the above Geo Review I Plan Check $60.27 information is correct. I agree to comply with all City Ordinances and state laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to ente on the above mentioned property o insp ion I $1,615.34 p7 s.. 7)(>7, /9 Date Issued Permit Number Signa ii a of Applicant or Agent D e 7 4/19/96 6176 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 (A•STRUCTION LENDING AGENCY,,. I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.3097,CIV.C.). LENDER'S NAME LENDER'S ADDREPc 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. O 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,FALSE WORK,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 I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS LIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD • I DATE I INSPECTOR I I _ /DATE INSPECTOR Setback/Location 12 �,h1i 1 c w I Rough Plumbing I'1/1!-; kr., / Temporary Power Shower Pan Test I • ktc'I `x L/C/7' Foundation Reinforcing Steel /,. jam, �� Stucco Mesh or Exterior Siding I, l,Ill!tt(t 1 Excavation and Forms //'/i,J l/ Insulation U2I°lco moi%/ . Slab Grade ckg:,. 00 Sewer SYZz/gam -fD� Ground Plumbing Soil / � ,..„50C � Interceptor �' �J/ Ground Plumbing Water cfrlIct(,, 9) I Septic Tank• I Underslab Ducts -` Leach Line or Seep Pit I / I_ Underslab Conduit Water Service -(3[4 . Underslab Gas I Lath or Drywall Nailing I 11-IGit© l I )/ ) Fireplace Foundation I Gas Line Air Test 17, /01 I 2 • Joists and Girders I Final Energy =`—It Electrical Ground • / s///1� Z.> I Final Plumbing / /7 Mid-Height Bond Beam li Final Heating/A.C. I / 8-Foot Bond Beam i Final Construction I Final Bond Beam Final On Site Improvements / I V Fireplace Bond Beam I I r� Figal Off Site Improvements 1 / Roof Sheathing (.12ohle + 11(� inal Dedication -"II " I mo. Framing and Ventilation if / Final Zoning I / It AV\ Roof Covering t / / I Final Electrical I . IA/1 // Rough Heating ,‘1 \U1i/ _y)/ I Final Gas I / I (/t'/ Service and Ground 4'\'—/ ti-/ I Developer Fees Paid / I Rough Electrical / / I Fire Dept. Approval Verified V /V/ Bonding I Certificate of Occupancy / Over Head Electrical I / IA Fence Height I I Gates II Heater • Pool Drainage I 8/ d i ei,(, a- / r-L_ a') SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK - . N • - , W. E. S. Inspector's Signature and Initials -441 5 DATE OF ISSUANCE PERMIT NUMBER