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Permit No. 10757 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: 14817 KELTY COURT 110757 1 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: Contractor: IVAN DAELE DEV. CORP. City,State Zip: RIVERSIDE,CA 92504 Lot: 13 Zoning: IPD Address: 12900 ADAMS ST. STE C-25 City,State Zip: RIVERSIDE,CA. 92504 Phone: (909)354-2121 )UST: Land Use: IFR1 Plan: PLAN 3C Phone: I(909)698-0433 City Bus Lic#: 2168 Tract: 15723• Occ: R-3 License Class: B __,License#: 518827 City Bus Exp: 1/31/97 Valuation: $154,000.00 Type: V-N Date: Setbacks OWNER INFORMATION OWNER BUILDER DECLARATION FY: I Name: VAN DAELE DEV.CORP. 1111 Ilkby 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: I` compensation,will do the work, and the structure is not intended or offered for sale City,State Zip: X❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project Phone: I Proposed Use: 'SINGLE FAMILY RESIDENCE [1 I am exempt under Section I 1 BPC for this reason I I City Bus Lic#: I Project Description: Location on Property: Square Feet: Livable: LIVABLE 2278 WORKERS'COMPENSATION DECLARATION City Bus Exp: Garage: GARAGE 398 I hereby affirm under penalty of perjury one of the following declarations. Patio PATIO 27 ENGINEER/ARCHITECT INFORMATION I have and will maintain a certificate of consent to self-insure for workers' Porch: compensation as provided by Section 3700 of the Labor Code,for the performance Name: ITHIELMANN ENG. of the work for which this permit is issued. Address: 1078 TOWN&COUNTRY E 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 Insurance Company: (CALIFORNIA COMPENSATI Phone: 1(714)647-0595 • Electrical: 1$279 18 ilk Policy Number: IW957109153 City Bus Lic#: Geo Review: 1$0.00 Expiration Date: 17/1/98 APPROVAL INFORMATION Grading: 1$75.00 City Bus Exp: Issuance: 1$29.00 1] Section need not be completed if the permit is for one hundred dollars($100)or less. EnglArc Lic#: 25742 Approved by: DEBY CONRAD Mechanical: 1$58.83 Date Issued: 10/13/97 I certify that in the performance of the work for which this permit is issued. I shall not Plan Check: 1$109.36 employ any person in any manner so as to become subject to the Workers'Compensation Finance Code: C 4l5/77 Laws of California and agree that if I should become subject to the workers'compensation Census Code: 101 Plumbing: p258.00 provisions of Section 3700 of the Labor Code. I shall comply with those provisions. Comments: Structural: $1,093.62 Date: I (0/17(41 O 1`i/R I Signature: 11Wil JVC.I/VVV I Total Permit Fe $1,902.99 I certify I have read this application and state that the above information is correct. I agree SMIP: I$15 40 to comply with all City Ordinances and state laws and hereby authorize representatives of Total with SMIP: I$1,918.39 this City to enter upon the above mentioned property for inspection purposes . Date: It*/0I9 I Signature: te5Warifii I CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION 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-q g gt„ Rough Gas Yellow Tag Final Other As Built Approved Reroof: • Underground Site Inspections: Tearoff Building Sewer Line 1 , ,q +vim— Roof Nail/Existing Conditions Supply Water Line Swimming Pools: Storm Drain/Catch Basins Location on Site U/G Conduit/Electncal 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 (1 o - Q FINAL REQUIRED-POOL NOT TO BE FILLED U/F Water t � `�� .. 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: Other Setback //t/�� Test/Final Perimeter Footings V / Interior Footings / FINAL INSPECTIONS UFER Ground(Rebar/Copper) (NO OCCUPANCY PERMITTED WITHOUT FINAL) Hardware/Hold-Downs t I County Environmental Piers/Caissons/Tendons 1 Health(if required) OK to Pour Concrete / Public Works 0 / Fire . .n1/ / DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Landscape ' . Shear Inspection(Wood): 17 ,3-3- Building 7 Exterior Walls ; k I I" Interior Walls CERTIFICATE OF OCCUPANCY OK to Install Downs OK to Install Lath 1 Connection to Roof(if required) ► OK TO SUPPLY Roof Nail Inspection: I -1 . Zb,Cr) Frame Inspection: p OTHER: Framing t 1p/�j� . /2-`?>r" 2/S�o• /t ,g-IC Lath � CI Plumbing Topout r MLS/ Rough Mechanical la 1 Multi-Story Waste Test OK to ate / ` V OK to Place Drywall �,� �' COVER NO WORK UNTIL ABOVE IS APPROVED Drywall Inspection: Nail/Screw � NOTICE TO OWNER Drywall Shear Nailing ` ° Call for FINAL inspection on every job. This permit will expire if work is OK to Tape Drywall I suspended or abandoned for a period of 180 days. Call for inspection every 180 days to help kermit active OK to Stucco