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Permit No. 2012-26462 ,a /4 • City of Chino Hills BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT 14000 City Center Dc,Chino Hliis,CA91709 '1~` - - Counter Phone (909j 364-2780 Building Permit 24-Hour inspection Line (909)364-2790 (NOTE:You must call before 3p.m.for a next business day inspection) City Hall Main Number (909)364-2600 NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING ENQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. I PERMIT No. WATER HEATER CIO 2012-26462 34100 BUILDING ADDRESS I APT./UNIT NO. I ISSUED DATE ISSUED BY 17419 KELSEY WY 10/252012 Heredia,Monica APN ITR CT MAP/ IB LOT I FLOORS I UNITS I PROJECT PERMITS I P.TYPE 103331103 CENCUS CODES I COONST.TYPE I ZONING TYPE I OCCUPANCY TYPE I VALUATION $500 W I TOTAL SOFT tam BLDG.SOFT 434_Res Add/Alter Current Owners: Fees Name:MICHAEL HEINZ Fee Group! Fee Description Fee Amount Payments Address: 17419 KELSEY WY CHINO HILLS CA 91709 Transaction Type Pb. 909-393-5514 Water Heater C!O - $71.25 Email' M•CH.ORG Contractor. ALL STAR WATER HEATERS INC-ALL STAR WATER HEATERS B001 Permit Issuance Fee $54.00 54.00 Address: 30300 PUERTO VALLARTA MENIFEE CA 92584 6141 Water Heater $16.25 16.25 Ph: 800-727-0977 Email. M@CH.ORG Lie.lnformation812894 Exp.Date:9/3012012 581473 $1.00 100 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION TOTAL FEES S71.25 I hereby affirm under penalty of pequry that 1 am licensed underprovisions of Chapter 9(commencing with Sec.7000)of DMsion 3 of the Business and Professions Code,and my license is in full force and AMOUNT PAID $7125 effect In securing this permit I am acting with the knowledge of and on behalf of the owner of the property. //,/ J�J DALANCE DUE $0.00 Date/0—kr (- Contractor // / // CQ* RS1&DERDECLARAPON I hereby affirm under penalty of perjury that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter9 commencing with Section 7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Sec.7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more that five hundred dollars($500.00) I,as owner of the propterty,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code. The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If however,the building or improvement is sold within one year of completion,the owner-builder vall have the burden of proving that he she did not build or improve for the purpose of sale) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code: The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such projects with a contractor (s)licensed pursuant to the Contractors License Law). 1 am exempt under article 3 of the Business and Professions Code. Date' Permittee. Print Full Name: WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for workers'compensation,as I certity that I have read this application and state that the above information is correct I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work forwhich this permit is with a0 city and countyordinances and state laws relating toe building construction,and hereby authorize Issues representatives of this cityto enter upon the above-mentioned prapteryfor inspection purposes. Com,/I have and will maintain workers'compensation insurance,as required by Section 3700 of the /Labor Code,for the performance of the work for which this permit is issued. My workers compensation �/� �,„ i 7 Insurance camerand policy number are: 2 / / /�( a��" "` Gamer Policy \k' LICANTSI DATE # (2-12N90(• ��d 4 7 w `OffirierKENNETH BLOCK I certify that in the performance of the work forwhich 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,and Address: 30300 PUERTO VALLARTA MENIFEE CA 92584 agree that if I should become subject to theworkers compensation provisions of Section 3700 of the Labor Code,I shall forthwith w my with those provisions. Ph- 800-727-0977 Email: --a�/01- 1 J/- LW.intormaeon Exp.Date: Applicant' /. X I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and _ Safety Code,which regulate the storage,handling and use of hazardous matenals WAR v Failure to s-,re._ ' s compensation coverage is unlawful,and shall subject an emp a er to crimin.;•• .i les and civil fines up to one hundred thousand dollars($100,000),in addition to ,- 0•6.—pensation,damages as provided for in section 3706 of the Labor Code,interest,and att•..' ees.