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Permit No. 13726 BUILDING ADDRESS: 14820 KELTY CT PERMIT NUMBER: 13726 • BUILDING INFORMATION APPLICANT INFORMATION 4 BUILDING PERMIT APPLICATION Address: 148201KELTY CT • 1 Name. JOHN WELCH Community Development �. <, . APN. 11032-592-01 Address 114820 KELTY CT 2001 Grand Avenue Lot 112 I City,Zip Code (CHINO,CA 91710 Chino Hills,CA 91709 Cross Streets 1 Phone/Pager: 1(909)597-0408 1 ext °T^°'^""°HILLS". LICENSED CONTRACTOR DECLARATION Tract/Parcel: 115723 City Bus Lic# 1 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation: 1$4,080.00 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. OWNER INFORMATION Name: 1N/A OWNER BUILDER DECLARATION Name: JOHN WELCH Address. I I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address. 14820 KELTY COURT City,Zip Code: I,as the owner of the property,or my employees with wages as their whole City,Zip Code: CHINO HILLS,CA 91709 Phone: I I ext. 1 0 compensation,will do the work,and the structure is not intended or offered for sale. Phone: (909)597-0404 ext. Lic# 1,as owner of the property,am exclusively contracting with licensed contractors toCity Bus Lic#: Bus Lic#: N/A construct the project. I ® I am exempt under Section I i BPC for this reason i Bus Exp: APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations. Contractor: OWNER BUILDER Date Issued- 5/21/99 Address: I Finance Code: C4-SM I have and will maintain a certificate of consent to self-insure for workers'compensation 0 as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code: Census Code which this permit is issued. Phone or Pager: ext. Final Date: 7o�eg- a v Bus.Lic.#: 1 i Final By: I have and will maintain workers'compensation,as required by Section 3700 of the 0 Labor Code,for the performance of the work for which this permit is issued. My Lic #: Extension: workers'compensation insurance carner and policy number are: Exp Date Reviewed By: KEITH L.PRYOR Lic Class: Approved By KEITH L.PRYOR INSURANCE INFORMATION Insurance Company. EXEMPT 1 PROJECT INFORMATION Policy Number I I& PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date I Structure: 1 1 ' Section need not be permit 10 if completedis for one hundred dollars$ 0 orless p dollars($100) Garage: 1".. I certify that in the performance of the work for which this permit is issued. I shall not employ Patio: LATTICE REAR 340 • any person in any manner so as to become subject to the Workers'Compensation Laws of Porch: 1 California and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code. I shall comply with those provisions. Other: 17 X 20 FREESTANING LATTICE PATIO COVER PROPOSED USE Date: I i Signature: i I I certify I have read this application and state that the above information is correct. I agree to comply with all City Ordinances and state laws and hereby authorize representatives oft is City COMMENTS to enter upon the above mentioned property for inspection/loses. o,es. / / A Date: I C/ f`g4 I Signature: 1- d/ L mt-.%/11 OTHER FEES REQUIRED ZONING SETBACI_f/S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning. RSFront Yard. 22 1 Over X: 0 1 Issuance• $29.00 1 Electrical. $0.00 1 Land Use. FR-1Side Yard: 5/5 School. 1 NO Permit Fees: 1 Cut 01 $115.40 I Plan: Rear Yard. 15 Development: 1 NO 1 Plan Check $0 00 Plumbing $0.00 1 Fill1 0 1 SMIP: I $0 50 I Occ• ACCESSORY I SSY: Total. 0 1 Sewer: I NO I Mechanical: $0 00 Structural $86.40 1 Total Fee Due $115.90 Type: TO R3 VN 1 Water: 1 NO Geo Review: 1 $0 00 1 Grading. $0.00 1 • INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Block Wall Inspections: Pregrade Meeting Footing,ReBar Rough Grade 1st Lift Bond Beam Terraces 2nd Lift Bond Beam Sub Drains 3rd Lift Bond Beam Finish Grading Drain/Seal Soils Certification ReRoof: Grading Certification Tear-off, Existing Conditions Rough Sheath Nailing As Built Approved Roof Final Underground Site Inspections: Swimming Pools : Building Sewer Line Location/Rebar/Bonding/Light Supply Water Line Gas Test Storm Drain/Catch Basins Gr Conduit/Ro Elect U/G Conduit/Electrical Pre-Deck DO NOT BACKFILL UNTIL ABOVE IS APPROVED POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Verify Soils Engineering: Fence,Gate&Alarm Compaction,moisture,conditioning,etc. Final Pool Underfloor/Underslab Inspection: Fire Protection Equipment: U/F Waste Plumbing UG Pipe U/F Water Thrust Blocks U/F Mechanical Hydro U/F Electrical Flush U/F Framing Weld Outlet Insp. Insulation Overhead Hydro Subfloor ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Temp Power Pole Foundation Inspection: Electric Release Setback/Footing Gas Test UFER Ground(Rebar/Copper) Hardware/Hold-Downs FINAL INSPECTIONS Piers/Caissons/Tendons NO OCCUPANCY PERMITTED WITHOUT FINAL! DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED County Environmental Shear Inspection(Wood): Health Dept (391-7570) Roof Nailing Planning Dept (364-2750) Exterior Walls Public Works (364-2770) Interior Walls Fire (393-3888) Hardware/Hold-Downs Landscape (364-2797) Combo Inspection: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Framing Final Electric Rough Electric Final Grade Rough Mechanical Final Plumbing Rough Plumbing/Topout Final Mechanical COVER NO WORK UNTIL ABOVE IS APPROVED Final Building/Construction Il(J I�G I�n Insulation Water Meter Number �'�"" Drywall Inspection: Interior CERTIFICATE OF OCCUPANCY Exterior OK TO ISSUE Lath Stucco Scratch OTHER: MISCELLANEOUS INSPECTIONS Masonry Fireplace Plate Ties, Fire Block, Patio/Deck: Footing _ Access/Light/Switch /_ Patio Final (lf/rJi(%/ CA) . •