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Permit No. 6179 City of C rl �l ° Hills ip APPLIC*N FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 16283 Street IVORY CT SINGLE FAMILY RESIDENCE APN 1017-412-13 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 21 Block Tract 13507-3 2 _.K--. _.,.„.- ^ Applicant SUMITOMO REALTY AND DEVELOPMENT _.__.. St No. 23046 Street AVENIDA DE LA CARLOTA Type of Project —'- ..-_. u ..--.-..... 714-586-101 1 ` " "`' `J --',.:.=,f7;1•:.-i- `�v " `' r "' " City LAGUNA HILLS Zip 92653 Phone Owner SUMITOMO REALTY AND DEVELOPMENT Project I Location on I Size 23046 AVENIDA DE LA CARLOTA Description Property in Sq. Feet St No. Street LIVABLEI I 2102 City LAGUNA HILLS Zip 92653 Phone 714-586-1011' Engr/Arch Lic No. 2. GARAGE I I 634 St No. Street 3 PATIO I I 65 City Zip Phone 4 I 1 Contractor SUMITOMO REALTY AND Lic No. 678246 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 23046 AVENIDA DE LA CARLOTA Sewer I Min. Depth I S/F/100 I Size St No. Street YES • City LAGUNA HILLS Zip 92653 Phone 714-586-101 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 678246 Date Contractor SAMEASOWNER 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. DUI, 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 ------, ------— Date Initial Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations' ZoningI Land Use PD,IL1,FR1 ❑a I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work 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 I arCode, for the performance of the work for which this penmit is issued My worker's Ry 4I SSY li 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) $132,131.00 ❑ c. I certify that in the performance of the work for which this permit is ssued. I shall PERMIT FEES not employ any person in any manner so as to become subject to the Worker” Compensation Laws of Calif() is and a ree that if I should become su e o the workcompensation provision s.of Section 700 of the Labor Code. If. ,hwith I ply with those $231.2 $996.66 Electrical Structural Date [L� !/OSignature _ _ _____ __ Warning Failure to secure workers' compensation coverage is unlawful, and shall subject an Plumbing $234.0(' Grading $75.00 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 $78.8'I Issuance $29.00 I certify that I have read this application and state that the above Geo Review Plan Check $64.77 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 u n theove mentioned property fo inspe ion I $1,709.46 pure es. �5� I r ^ — ...4---"{:-... Date Issued Permit Number Suture of Applicant or Agent /Mite / 4/19/96 6179 • Print Applicant's/Agent's Name FINANCE CODE C4 CENSUS CODE 101 (.,.,..STRUCTION LENDING AGENCI.. i,.. 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 ADDRESS 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,FALSEWORK,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 OIS I]IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE I INSPECTOR I I DATE I INSPECTOR Setback/Location S/0//6, I �( " I Rough Plumbing I i,e iG ( 9, Temporary Power I Shower Pan Test I I I ,V L v I v , Foundation Reinforcing Steel <2 I (;--,r1 I Stucco Mesh or Exterior Siding , . I °+ ' _D Excavation and Forms �`/ `� vv Insulation ' � 'AMU)MU) I �/) Slab Grade 4/ /e14-, `",z) Sewer Z-Z-A6 I D-? Ground Plumbing Soil S/Zf176 w _ I Interceptor I I Ground Plumbing Water Sl`G/M{a OV I Septic Tank I I Underslab Ducts I Leach Line or Seep Pit Underslab Conduit I Water Service /T /1(p , c•/ V) Underslab Gas Lath or Drywall Nailing < - Fireplace Foundation Gas Line Air Test Sc.77 2S, f Joists and Girders _ Final Energy I / Electrical Ground 5-/Z//(,0v Final PlumbingI Mid-Height Bond Beam Final Heating/A.C. I / / 8-Foot Bond Beam Final Construction I V Final Bond Beam Final On Site Improvements I U /I Fireplace Bond Beam , / _ Final Off Site Improvements I 1 (N, / I / Roof Sheathing /` u/ to/7 /'7L6 G," final Dedication AAV,' / I V/ Framing and Ventilation .7 _ XFinal Zoning I / 1 V Roof Covering / ji,/_ A ( ) / I Final Electrical I / I Rough Heating r7 11$1 `V r 'i id, I Final Gas I / I/ Service and Ground 11 I Z V j I7 Developer Fees Paid ''t I Rough Electrical .07 � 3 Fire Dept. Approval Verified � S(i 3Co �' (, iJ FC1 Bonding I Certificate of Occupancy I _ I Over Head Electrical I I I I ' Fence Height I I I Gates I Heater Pool Drainage I I I r _----. GI ►3Iib I ` 0 1) SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S. . Inspector's Signature and Initials ) ( { 2( DATE OF ISSUANCE PERMIT NUMBER