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Permit No. 8863 6- N- City of COno Hills APPLICATIS FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 16282 Street IVORY CT PATIO COVER 1017-412-05 APN THE FOLLOWING WORK IS AUTHQEIZED BY THIS PERMIT Lot 13 Block Tract 13507-3 0 Struct. LI Plumb. IGNACIO R LUGO ❑Mech. 0 Elect. 0 Grading Applicant ❑New ❑Alter ❑Addition St No. 16282 Street IVORY CT Type of Project City CHINO HILLS Zip 91709 Phone 597-5660 ED Repair 0 Convert. 0 Demo 0 Occupancy Permit Owner IGNACIO R LUGO Project I Location on I Size St No. 16282 Street IVORY CT Description Property in Sq. Feet City CHINO HILLS Zip 91709 Phone 597-5660 1. PATIO COVER ( I 384 Engr/Arch Lic No. 2. 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 Licensed Contractor's Declaration I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000 of 1 Division 3 of the Business and Professions Code)and my license rs in furl force and effect. License Class License Number Date Contractor I1 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: \ / ` FiI,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 (--11 I,as owner of the property,am exclusively contracting with licensed contractors to 1 .16J construct the project. [] I urn exempt under Sec._,_,BPC for this reason 4��t r Date c//(P(el) Initial . lei'°Y \ Workers' Compensation Declaration I thereby affirm under penalty of perjury one of the following declarations: Zoning Land Use n Da. 1 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 I Setbacks ModeVPlan . I .5.5 I b. I fiave'and will maintain worker's compensation, as required by Section'3700 of the LaborCode, for the performance of the work for which this permit rs ssrld. My workers RY 15 I ss compensation insurance carrier and policy number are: Group/Division/Type Ins. Co.: Policy No: VALUATION Exp Date: $4,608.00 Us dection need not be completed if the permit is for one hundred doolars($100)or less). PERMIT FEES e I certify that in the performance a 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 $86.40 and agree that if I should become subject to the workers'compensation provisions of Section 3700 Electrical Structural of the Labor Code. I shall forthwith comply with those provisions. Date Signature Plumbing Grading 14,--",-,-- r _ V:•.i.s'corn tsastion n''..-..r• « ' ' ' -.hall subje.:t an e;-ipki,ei to cnminal 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 lacer fsyr`t'tiat 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 ApprovedTota! Permit Fee to enter upon the above m ntioned property for inspection DC 1 $115.40 p u osis. 6// 67?) I ,.\ '.'ems- - f •5:P" Date Issued Permit Number I 5i r ure of Applicant or Ager Date 6/16/97 8863 1 Print Applicant's/Agent's Name FINANCE CODE C4 CENSUS CODE Of S ' 2ONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE IS A CONSTRUCTii)N LENDING AGENCY FOR THE PERFORMANCE 0 ..iE 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,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 DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD 1 DATE I INSPECTOR 1 DATE I INSPECTOR Setback/Location Rough Plumbing I Temporary Power Shower Pan Test ( Foundation Reinforcing Steel Stucco Mesh or Exterior Siding I Excavation and Forms Insulation _i - Slab Grade Sewer I - Ground Plumbing Soil Interceptor I Ground Plumbing Water Septic Tank _ I Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing I Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy I 1 Electrical Ground Final Plumbing I Mid-Height Bond Beam Final Heating/A.C. I A /1 ./i1r I ,,, I 8-Foot Bond Beam Final Construction I W�7Y/l ? /��_ _ .) Final Bond Beam - Final On Site Improvements I (V 7- I+ Fireplace Bond Beam . - Final Off Site Improvements I - I Roof Sheathing - Final Dedication I Framing and Ventilation Final Zoning I I 1 Roof Covering Final Electrical I /I I / //-) i7 Rough Heating Final Gas - _—II A_ A/I 1 / 'V 0 - Service and Ground Developer Fees Paid I II A III r l/ Rough ;Electrical - - Fire Dept. Approval Verified _I(FA(/V' ( - Bonding Certificate of Occupancy I v /4,(,,--� Over Head Electrical - - I _I I - ____ v v Fence Height I I I - Gates .I I Heater I V -- - - Pool Drainage I A -- .,,�� 7 f - A jl-lta/ Z4�L,. —14.1A -C- (-A 1-01,4SLW c ATCJ /� .- /K.oQ ^ __.X.A we .,te bli .�.�G-e- crz_bga-v cr=f4 12 atev f `-I 10 ' - >9 /lam( 1�f co" K r SEPTIC TANK GALS. - - - - SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. - - W. E. - a. r, S. Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER