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Permit No. 10756 CITY OF CHINO HILLS Community Development 2001 Grand Avenue APPLICATION FOR BUILDING PERMIT Chino Hills,CA 91709 LICENSED CONTRACTOR'S DECLARATION APPLICANT INFORMATION BUILDING INFORMATION Permit Number: I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Name: VAN DAELE DEV.CORP Address: 14825 KELTY COURT 110764 Section 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. Address: 2900 ADAMS ST. STE.C-25 APN: 10b2.--.51 a— (h) Contractor: IVAN DAELE DEV.CORP. City,State Zip: RIVERSIDE, CA. 92504 Lot: 14 Address: 12900 ADAMS ST. STE.C-25 Zoning: IPD City,State Zip: RIVERSIDE, CA. 92504 Phone: (909)354-2121 X/ST: I Land Use: IFR1 Plan: IPLAN 3BRM Phone: 1(909)698-0433 City Bus Lic#: 2168 Tract: 15723 Occ: IR-3 License Class: IB License#: 1518827 City Bus Exp: 1/31/97 Valuation: $165,133.65 Type: IV-N •Date: I Setbacks OWNER INFORMATION OWNER BUILDER DECLARATION FY: Name: VAN DAELE DEV.CORP. ISM affirm that I am exempt from the Contractor's License Law for the following reason: SY: I, as the owner of the property,or my employees with wages as their whole Address: SAME AS ABOVE RY: compensation,will do the work, and the structure is not intended or offered for sale E I, as owner of the roe City,State Zip: p p rty,am exclusively contracting with licensed contractors to construct the project. Phone: I Proposed Use: 'SINGLE FAMILY RESIDENCE n I am exempt under Section 1 1 BPC for this reason 1 1 City Bus Lic#: I Project Description: Location on Property: Square Feet: WORKERS'COMPENSATION DECLARATION City Bus Exp: Livable: (LIVABLE 2750 Garage: 'GARAGE 571 I hereby affirm under penalty of perjury one of the following declarations: Patio 'PATIO 25.5 I have and will maintain a certificate of consent to self-insure for workers' ENGINEER/ARCHITECT INFORMATION Porch: I compensation as provided by Section 3700 of the Labor Code,for the performance Name: THIELMANN ENG. of the work for which this permit is issued. • Address: 1078 TOWN&COUNTRY I have and will maintain workers'compensation,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My City,State Zip: ORANGE, CA. 92668 workers'compensation insurance carrier and policy number are: PERMIT FEES Phone: (714)647-0595 Insurance Company: 'CALIFORNIA COMPENSATI Electrical: $302.50 a • Policy Number: 1W957109153 City Bus Lic#: Geo Review: $0.00 Expiration Date: 17/1/98 APPROVAL INFORMATION Grading: $75.00 City Bus Exp: Issuance: $29 00 n Section need not be completed if the permit is for one hundred dollars($100)or less. Approved by: IDEBY CONRAD Eng/Arc Lic#: 25742 Mechanical: $58 83 I certify that in the performance of the work for which this permit is issued. I shall not Date Issued: 110/13/97 Plan Check: $114 91 employ any person in any manner so as to become subject to the Workers'Compensation Finance Code: IC a/SM Plumbing: p58.00 Laws of California and agree that if I should become subject to the workers'compensation Census Code: 1101 provisions of Section 3700 of the Labor Code. I shall comply with those provisions. Comments: Structural: /$1,149.06 Total Permit Feel $1,987.30 Date: I Jam/ 1_5 lC11 I Signature: 4 ,!`� 1 I certify I have read this application and state that the above information is correct I agree SMIP: I$16 60 to comply with all City Ordinances and state laws and hereby authorize representatives of Total with SMIP: $2,003.90 this City to enter upon the above mentioned property for inspection purposes. Date: 11045> 0 1 Signature: I� OA CONSTRUCTION LENDING AGENCY111 I HEREBY AFFIRM THAT THERE IS A CONSTRUCTIO 'LENDING AGENCY OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097 CIV C). LENDER'S NAME LENDER'S ADDRESS 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. O 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 O 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 0 IS 0 IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING AND SAFETY DIVISION PERMIT# I Call(909)590-1511 Ext.282 before 3:00 p.m.for next day inspection INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Miscellaneous Inspections: Pregrade Meeting Masonry Fireplace Rough Grade (if applicable) Terraces Plate Ties Throat Damper Sub Drains Shower Pan Temp Power Pole Finish Grading Electric Green Tag(wiring to be protected) Soils Certification Ground Rod Grading Certification Gas Test(after drywall) 3-- 3 —qg (z..-. Rough Gas Yellow Tag Final Other As Built Approved Reroof: Underground Site Inspections: Tearoff Building Sewer Line ( I gt Gig? Roof Nail/Existing Conditions Supply Water Line Swimming Pools: Storm Drain/Catch Basins Location on Site U/G Conduit/Electrical Rebar Bonding DO NOT BACK FILL UNTIL ABOVE IS APPROVED Gas Piping/Test Verify Soils Engineering: Predeck Compaction, moisture,conditioning,etc. Final Underfloor/Undersalb Inspection: U/F Waste Plumbing ----- 7=,4 meg , FINAL REQUIRED-POOL NOT TO BE FILLED U/F Water 11 . S UNTIL FENCING IS COMPLETE U/F Mechanical Fire Protection Equipment. U/F Electrical UG Pipe U/F Framing Thrust Blocks OK to Install Insulation Hydro OK to Install Subfloor Flush Weld Outlet Insp. ABOVE IS REQUIRED PRIOR TO FOUNDATION INSP. Overhead Hydro Foundation Inspection: - 'i Other Setback 1'," Test/Final Perimeter Footings P. Interior Footings `( / I FINAL INSPECTIONS • UFER Ground(Rebar/Copper) � I (NO OCCUPANCY PERMITTED WITHOUT FINAL) Hardware/Hold-Downs (.77'' County Environmental Piers/Caissons/Tendons t(X' � Health(if required) r)V OK to Pour Concrete I I Public Works ,,. TA/ Fire .,1 p" r v DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Landscape '-f` • _M Shear Inspection(Wood): ,, ,,,r Building V/ Exterior Walls A l/ I" Interior Walls �,,/� CERTIFICATE OF OCCUPANCY " Hardware/Hold-Downs OK to Install Lath � \ Connection to Roof(if required) \ OK TO SUPPLY Roof Nail Inspection: 1) Frame Inspection: / OTHER: Framing \ s.,\; f 3"/�—�1 j° Ed,/So tic/401(6- OZ. Lath \ X � Plumbing Topout Rough Mechanical %\ Multi-Story Waste Test 1 OK to Insulate OK to Place Drywall Ir COVER NO WORK UNTIL ABOVE IS APPROVED Drywall Inspection: , ( r1•/Z/� Nail/Screw 6 "� — / NOTICE TO OWNER Drywall Shear Nailing , n I Call for FINAL inspection on every job This permit will expire if work is • OK to Tape Drywall , p— I suspended or abandoned for a period of 180 days Call for inspection OK to Stucco I every 180 days to help hermit active .