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Permit No. 6192 City of Alio Hills APPI_ICA' FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 • Building Address: Proposed Use - St No. 16279 Street IVORY CT SINGLE FAMILY RESIDENCE APN 1017-412-12 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 20 Block Tract 13507-3 - -- Applicant SUMITOMO REALTY AND DEVELOPMENT St No. 23046 Street AVENIDA DE LA CARLOTA Type of Project ---- __, L__,.-----,,,--- : — - . — - . —- — - City -- - - - City LAGUNA HILLS Zip 92653 Phone 714-586-1011 `J "::" v"` L ...'r `_i Y_ "-" ' '- Owner SUMITOMO REALTY AND DEVELOPMENT Project 1 Location on I Size Description Property in Sq. Feet St No. 23046 Street AVENIDA DE LA CARLOTA -N.,.. City LAGUNA HILLS Zip 92653 Phone 714-586-10111 LIVABLE I I 2508 Engr/Arch Lic No. 2. GARAGE I I 642 St No. Street 3 PATIO I I S4 City Zip Phone 4 I I Contractor SUMITOMO REALTY AND Lic No. 678246 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION �\\ Sewer I Mm. Depth I S/F/100 I Size J St No. 23046 Street AVENIDA DE LA CARLOTA YES 0 City LAGUNA HILLS Zip 92653 Phone 714-586-101 1ubic 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 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: DJI, as the owner of the property, or my employees with wages as their whole -----.--.--...--..- .-- .--- "-- - 1compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec ,B&PC for this reason i- ------ Date initial Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: ZoningI Land Use Da. 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 k for which this permit is issued Setbacks Model/Plan b. 1 have and will maintain worker's compensation, as required by Section 3700 of the FY I SY L orCode, for the performance of the work for which this permit rs issued My worker's RY I SSY 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). $154,262.00 ❑ c. I certify that in the performance of the work for whit, is permit is issued. I shall PERMIT FEES not employ any person in any manner so as to become s --e the Worked:' Compensation Laws of Si rnia a agree that if I should become : --work, ' compensation provision Sectr 3 00 ces,of the Labor Code. ��forthwith ' ply with those Electrical $275.8 Structural $1,098.24 provrsro pDateSrgnatured/_ . __ _ Warning: ailure to secure workers' compensation coverage is unlawful, and shall subject an Plumbing $246.00 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 $58.8:• Issuance $29.00 I I certify that I have read this application and state that the above Geo Review I Plan Check $71.3E information is correct. I agree to comply with all City Ordinances and sta laws a :' hereby authorize representatives of this City Issuance Approved I Total Permit Fee to e�0f upon/e 'above mentioned property '.r in .ection ..- $1,854.33 i)� d I1� 'tip Date Issued Permit Number '��a ure of AppTcant or Agent ll a e 4/19/96 6192 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 TRUCTION LENDING AGENCI.,0 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 ADDRESQ 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. ❑ 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, ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. • BUILDING-INSPECTIONS RECORD DATE INSPECTOR I , DATE I INSPECTOR / Setback/Location 31//16 '7)DI Rough Plumbing I I lqi Gtr_ V��P// Temporary Power Shower Pan Test I 11 Y)1_,' /I Foundation Reinforcing Steel 4-/Id/, ' '-k- Stucco-Mesh or Exterior Siding I iZ4 l4. • I -(174,2 Excavation and Forms '7 • LY v `, Insulation I .0 �')(„ Slab Grade / r-- Sewer I S///Z2./q6kT I-17?-5621) Ground Plumbing Soil S7//7�' UCS Interceptor • I I Ground Plumbing Water Septic Tank I I Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service • / �fy Underslab Gas Lath or Drywall Nailing ,-7/ `' ,- c Fireplace Foundation Gas Line Air Test IIf{ �� � '� ` Joists and Girders _ r\ Final Energy I `�, / Electrical Ground 5//7am/ ,. �j ) Final Plumbing I I / / Mid-Height Bond Beam Final Heating/A.C. I I / 8-Foot Bond Beam Final Construction I I Final Bond Beam Final On Site Improvements I i 1 /I ,-"N Fireplace Bond Beam _ / J,., Final Oft Site Improvements I I IIL4' / I,1 ' Roof Sheathing 441 3 / I 6,1111°'11°' I l A Final Dedication i cilli / r 1\ Framing and VentilatioFinal Zoning Roof Covering 1 _ , /r . I Final Electrical I / I V /./ Rough Heating A r4I(1;k/ i)V/ I Final Gas I / I a Service and Ground '7 luvV v/ Developer Fees Paid I / I /1 Rough Electrical ' / / I Fire Dept. Approval Verified I / I/I Bonding r I Certificate of Occupancy I ./, A Over Head Electrical II P. tliI Fence Height I Gates I Heater I Pool Drainage I I SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. • W. E. Inspector's Signature and Initials 4- 2 0 DATE OF ISSUANCE PERMIT NUMBER