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Permit No. 8780 11 City of Clio Hills APPLICATIO FOR BUILDING PERMIT Community Development 2001 Grand Avenue t Ino Hills,CA 917097/0772 Building Address: Proposed Use - St No. 16279 Street IVORY CT PATIO COVER/ELECT LINE APN 1017'412-12 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 20 Block Tract 13507-3 ® Struct. ❑Plumb. Applicant VINCENT GAETA 0 Mech. ®Elect. 0 Grading St No. 16279 Street IVORY CT Type of Project 0 New 0 Alter ®Addition City CHINO HILLS Zip 91709 Phone 597-8969 0 Repair 0 Convert. 0 Demo 0 Occupancy Permit in S Owner VINCENT GAETA \ Project I Location on I Size St No. 16279 Street IVORY CT \., Description Property q. Feet City CHINO HILLS Zip 91709 Phone 597_8969 1. PATIO I 364 Engr/Arch Lic No. 2. ELECT LINE I I St No. Street 3. I I City Zip Phone 4. I I Contractor Lic No. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min.Depth I S/F/100 I Size St No. Street City Zip Phone Cubic Yards Excavation Fill Over Excavation City Business License License No. Expiration Date ELECT LINE FOR FUTURE SPA. POOL BARRIER Licensed Contractor's Declaration I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000 of RFT IIRFMFNTS APPI Y Division 3 of the Business and Professions Code)and my license is in full force and effect. License Class License Number Date Contractor Address ------ City and Zip Phone __.._..v._. .._ Owner Builder Declaration I hereby affirm that I am exempt from the Contractor's License Law for the following reason: DI,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. EllIE ,as owner of the property,am exclusively contracting with licensed contractors to , the project. DI am exempt u der Sec._ ,,B&PC for this reasoonn y( Date Zo ��/C 7 Initial eAkr Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: Zoning I Land Use pa. 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 Setbacks I ModeV Wan sued. I FY I SY 5.5 b. I have and will maintain worker's compensation, as required by Section 3700 of the RY LaborCode, for the performance of the work for which this permit is Issued. My worker's 20 I SSY compensation insurance corner and policy number are: Group/Division/Type • Ins. Co.: Policy No: Exp Date: VALUATION $4,368.00 Us dection need not be completed if the permit is for one hundred doolars($100)or less). PERMIT FEES c.I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California Electrical $22.50 Structural $86.40 and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those provisions. Dar,. Signature Plumbing Grading Warning: Faure to secure workers'compensation coverage is unlawful,and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars($100,000),in addition to Mechanical Issuance $29.00 the cost of compensation,damages as provided for in Section 3706 of the Labor Code,interest,and I daRT6fAttiat I have read this application and state that the above information is correct. I agree to comply with all City Ordinances Geo Review Plan Check and state laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to enter upon the above mentioned property for inspection DC J $137.90 purposes /7�.. --7 , -7....0— .> 7;/C; 7 Date Issued Permit Number Signature of Applicant or Agent Date 6/9/97 I 8780 "ziGz`e?'eit ,A: �'' €71:24- FINANCE CODE CENSUS CODE 0/S Print Applicant's/Agent's Name lir.s LENDING AGENCI HEREBY AFFIRM THAT THERE IS A CONSTRUØONSTRUCTIONN LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WI4IC'.I THIS PERMIT IS•"SSUED (SEC. 3097.CIV.C.). M I LENDER'S NAME LENDER'S ADDRESS - DIVISION OF INDUSTRIAL SAFETY PERMIT CERTI _........_...._... FICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL S/,sfY 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,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 IDS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD pAT/E INSPECTOR +_ . ._.._.DATE L. .. �//q �/� INSPECTOR / Setback/Location , //I, ! 7 I AOtA Rough Plumbing I Temporary Power Shower Pan Test Foundation Reinforcing Steel / .zlStucco Mesh or Exterior Siding Excavation and Forms {e�li/�J, e.t'CAJ Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts / I I Leach Line or Seep Pit Underslab Conduit V/a%/ 14 t,i Water Service Underslab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing i Mid-Height Bond Beam Final Heating/A.C. / / , �•� � . i 8-Foot Bond Beam Final Constructor 4? ' &//o/J 7 Final Bond Beam _I Final�n Stta-tmprovenents / ( Fireplace Bond Beam L. ,/ Final Off Site Improvements 40/../0475)Roof Sheathi40/../0475) C-�/VV Final Dedication Framing and Ventilation ` Final Zoning Roof Covering Final Electrical Rough Heating Final Gas Service and Ground , / / I� I Developer Fees Paid Rough Electrical (0/tt/j"7 j.Sl�(/t/ Fire Dept. Approval Verified Bonding / 4 / Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W E. .. S. Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER