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Permit No. 8327 I IP _ City of Chino Hills / \ APPLIC,4TON FOR BUILDING PERMIT Community Development \/ 2001 Grand Avenue „."Chino Hills,CA 91709 BuildingAddress: Proposed Use - St No. 7373 Street KELSEY WAY SINGLE FAMILY RESIDENCE APN 1033-331-37 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 27 Block Tract 13880-2 v S€ru-LA. e:w.trr;. Applicant CENTEX HOMES `' -b. = Gradm St No. 2280 Street WARDLOW CR STE #150 Type of Project 0-New r j After Li Addition City COKUNAZip 91720 Phone 279-4000 0 Repair 01 convert. 0 Demo 0 anv Pent Owner CENTEX HOMES - Project I Location on I Size WARDLOW CR STE#150 Description Property I in Sq. Feet 2280 St No. Street I Cityt'UKUNA 279-4000 Zip91720 Phone 1 LIVABLE 2165 Engr/Arch Lic No. 2. GARAGE I 1609 St No. Street 3 I I City Zip Phone 4 I I Contractor CENTEX HOMES Lic No. 526964 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 2280 WARDLOW CR STE #150 Sewer I Min. Depth I S/F/100 Size St No. Street City CORONAZip 91720 Phone 279-4000 Cubic Yards Excavation Fill Over Excavation City Business License License No. Expiration Date :IRE SPRINKLERS INCLUDED. 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 526964 Date Contractor sAMeAsaBove 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: �L'1 I, as the owner of the property, or my employees with wages as their whole • L'1 , compensation, 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 ~� W v – 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,FR 1 Da. 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 is issued. Setbacks I Model/Plan ❑ b. I have and will maintain worker's compensation, as required by Section 3700 of the FY I SY I LaborCode, for the performance of the work for which this permit is issued My worker's Ry I SSY compensation insurance carrier and policy number are: Ins. Co.: Group/Division/Type • Policy No: t3/vN Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less) 6136,000.00 ❑ 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 PERMIT FEES Laws of California and agree that if I should become subje t to the workers' compensation provisions of Section 3700 of the Labor •.. A s� fort it corn y with those $238.15 $1,010.46 provisi ym. ' Electrical Structural Date- -- Signet --- II --- II/1K Plumbin $308.40 Gradin $75.00 Warning Failure to secure workers' compensation coverage is unlawful, nd shall subject an g 9 employer to criminal penalties and civil fines up to one hundred thousan 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 $98'79 Issuance $29.00 I certify that I have read this application and state that the above $65.68 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 Imuance Approved Total Permit Fee to enter r po he bove mentioned property for inspection ( $1,825.48 .ur .- — —AIL I //� Date Issued Permit Numb r Signature of Applicant ,A ent Date 4/10/97 I 837 FINANCE CODE C4 CENSUS CODE 101 Print Applicant's/Agent's Name CONSTRUCTION LENDING AGENc ) 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. 0 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. 0 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 I DATE L,LNSPEC DATE, ) INSPECTOR Setback/Location L/ / / I Rough Plumbing n ( 01 4/- Temporary Power ! I///� /1 /A i Shower Pan Test L---1--....,i i I Foundation Reinforcing Steel 721/ 7 / J 41 N Stucco Mesh or Exterior Siding "`I I i 9 0�\ Excavation and Forms IV I V. ki ' Insulation ' l 13 1 1 q / U/(,1, Slab Grade JTZ Z.1-4i 7 lc'tff Sewer I Ground Plumbing Soil ‘ .7,- Pr' Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit / / / Underslab Conduit Water Service 4/71./c') /-8/4 Underslab Gas Lath or Drywall Nailing f?- 8 —q7 r-(✓ Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy C.1/L/,<— Electrical l/Electrical Ground Final Plumbing l/> 2 Mid-Height Bond Beam Final Heating/A.C. 8-Foot Bond Beam Final Construction 1 ,,,( A' I Final Bond Beam Final On Site Improvements A -1 V/ Fireplace Bond,-am .,,- _ ' 1 ,/Final Off Site Improvements VANV I okl Roof Sheathini Lil • ‹!',i' '1' gl°I'1 c-ivv q,.Einal Dedication IrA Framing and Ventilation NA,(� `~ Final Zoning A Y I Roof Covering / n .vv, Final Electrical .1/Rough Heating I JG' x •4 Final Gas / Service and Ground 16.9V I 16., IA Developer Fees Paid V ' Rough Electrical 1 V I ,t Fire Dept. Approval Verified A I Bonding Vl `' Certificate of Occupancy / Over Head Electrical Fence Height Gates Heater Pool Drainage _ ,9-Jt.4-G --- - ,44-i-3 3-129 icr) c ,1.) WATOL Sic.. 'if- r I ALI `4,.116/fi7 n ,, / _AO .Vol. .off, %/0/<-7 72 c44.-1--- - / I n A Il SEPTIC TANK GALS. ll c \/ SEEP. PIT X i 1 A LEACH LINE WIDE I,. d �t 4 LONG X DEPTH OF ROCK l ! N. I / / v W. E. S. Inspector's Signature and Initials. DATE OF ISSUANCE PERMIT NUMBER J