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Permit No. 6182 City of C!o Hills APPI_ICAT• FOR R11I1-DING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 16275 Street IVORY CT SINGLE FAMILY RESIDENCE APN 1017-412-11 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 19 Block Tract 13507-3 ,.._2.; --- - • " SUMITOMO REALTY AND DEVELOPMENT Applicant _u z 23046 AVENIDA DE LA CARLOTA Type of Project u u u' `""--'""" -- St No. Street , ._ r, LAGUNA HILLS Zip 92653 714-586-101 1 `' r.i. ;; `-i ""`r"'` `" `J :.:' .. .... .;ma r " ,. City Phone - A Owner SUMITOMO REALTY AND DEVELOPMENT Project I Location on I Size 23046 AVENIDA DE LA CARLOTA Description Property in Sq. Feet v` St No. Street LIVABLEI I 2160 ,A...)City LA(.iUNA HILLS Zip 92653 Phone 714-586-1011' 2 GARAGE I I 634 Engr/Arch Lic No. St No. Street 3 PATIO I I 65 City Zip Phone 4 I I SUMITOMO REALTY AND 678246 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION �� Contractor Lic No. ` Sewer I Min. Depth I S/F/100 I Size St No. 23046 Street AVENIDA DE LA CARLOTA YES City LAGUNA HILLS Zip 92653 Phone 714-586-10 I &ubic Yards Excavation F it I 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. r i I, as owner of the property, am exclusively contracting with licensed contractors to ima construct the project. ❑ 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 I 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 LaborCode, for the performance of the work for which this permit is issued My worker's Ry I SSY 1 compensation insurance carrier and policy number are' Ins. Co.: Group/Division/Type R3/VN Policy No: Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100) or less). $135,280.00 ❑ c. I certify that in the performance of the work for which this permit is issued. I shall PERMIT FEES not employ an person in any manner so as to become subje o the Wo, ers' Compensation Laws of Cali rnia and ogre that if I should become j- to the Jr-kers compensation provisions tion 37 of [he Labor Code I rth•. omply with those $237.6 $1,010.46 provisions. Electrical Structural Date__ _ _. _ (_____Signatur Warning: Failure to secure workers' compensation coverage is unlawful, and shall subject an $234.0( Grading Plumbing $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 $78.81 Issuance $29.00 I certify that I have read this application and state that the above Geo Review I Plan Check $65.68 information is correct. I agree to comply with all City Ordinances and state I.ws andhfeby authorize representatives of this City Issuance Approved Total Permit Fee to ent eon thZ above mentioned property r in pection I $1,730.55 yi% / \ Date Issued Permit Number Siure of Applicant or Agent .date 4/19/96 6182 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 ( STRUCTION LENDING AGENCI, a I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE VilORK 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. 17 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 DS (DS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE IINSPECTOR I I DATE INSPECTOR Setback/Location S//7,6 I 'DC) I Rough Plumbing I I •,lc,( , ) i Temporary Power I Shower Pan Test 1-'7117 1 �1 V V Foundation Reinforcing Steel <//kc 7"/- A, •tucco,ivie)h or Exterior Siding 11•—�3 gi c- Excavation and Forms —7 - ' ✓vwn 17117-NU UL Slab Grade 'j�/G I cjl Sewer I t-/ZZ/C/y l�j� Ground Plumbing Soil 5/i//t- I / Interceptor li Ground Plumbing Water A/q(o I ,-.6„2 6", I Septic Tank I Underslab Ducts I I Leach Line or Seep Pit Underslab Conduit Water Service , i Underslab Gas Lath qfail N III g '7—1 --?.r. �,/ Fireplace Foundation Gas Lin ? Q/ze,frt I (-1//), Joists and Girders Final Energy I I / / Electrical Ground S7/1am �� Final Plumbing I I / I Mid-Height Bond Beam Final Heating/A.C. I I / I 8-Foot Bond Beam Final Construction I I / I Final Bond Beam Final On Site Improvements I 1,1_1 I Fireplace Bond Beam / �� Final Off Site Improvements I ,I V(2 / ,r1 Roof Sheathing /ai,,G7,- l L/2`�/' L, ' /,v Final Dedication /)1I'�y( 1 / (1 1 Framing and Ventilation l+ ,I/ / Final Zoning /�,` / H I U/ Roof Covering I , I- , V r-N ,/ Final Electrical I / I/ v// Rough Heating I /11.1111W r;) f) / I Final Gas v ii Service and Ground Ill. .Z V 1/ I Developer Fees Paid / // Rough Electrical I l / 1 Fire Dept. Approval Verified I / /./ Bonding I I Certificate of Occupancy ,t // Over Head Electrical I V Fence Height I I Gates I Heater I Pool Drainage I I IM CN'�i3 I I ( x" SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials .--iii- I .ci .DATE OF ISSUANCE PERMIT NUMBER i