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Permit No. 19282 BUILDING ADDRESS: 14817 KELTY COURT PERMIT NUMBER: 19282 �� • BUILDING INFORMATION APPLICANT INFORMATION t BUILDING PERMIT APPLICATION Address: 14817 KELTY COURT Name: SARKAS NALBANDIAN '; Community Development APN. 1032-592-05 Address• 14817 KELTY CT 4%.1• fms 2001 Grand Avenue Lot 113 City,Zip Code: (CHINO HILLS CA 91709 Chino Hills,CA 91709 Cross Streets. (CHINO HILLS PKWY/HAWK Phone/Pager (909)606-6466 I ext. `gra°``":r.T" LICENSED CONTRACTOR DECLARATION Tract/Parcel: 15723 City Bus Lic#- 1N/A I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation- $6,480 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. N/A OWNER BUILDER DECLARATION Name 1SARKAS NALBANDIAN Address 1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reason City,Zip Code Address 114817 KELTY CT 1 1,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS CA 91709 Phone. I 1 ext 04compensation,will do the work,and the structure is not intended or offered for sale Phone 1(909)606-6466 ext 1 Lic#- I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic 4. N/A City Bus Lic 4. 0 construct the project I am exempt under Section I BPC for this reason I Bus Exp: APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By 1DON FARLEY Contractor: OWNER BUILDER I hereby affirm under penalty of perjury one of the following declarations Date Issued 11/29/01 Address. I I Finance Code. 1C4 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 1 which this permit is issued Phone or Pager 1 1 ext Final Date Bus.Lic# -- I have and will maintain workers'compensation,as required by Section 3700 of the Final By 0 Labor Code,for the performance of the work for which this permit is issued. My Lic # 1 Extension- workers'compensation insurance earner and policy number are: Exp Date. Reviewed By DON FARLEY Lie Class• 1 Approved By 1DON FARLEY INSURANCE INFORMATION Insurance Company EXEMPT PROJECT INFORMATION Policy Number I I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date. Structure 1 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage. I certify that in the performance of the work for which this permit is issued I shall not employ Patio. I I .ny person in any manner so as to become subject to the Workers'Compensation Laws of Porch. California and agree that if I should become subject to the workers'compensation provisions of Other RETAINING WALL REAR/SIDE 540 Section 3700 of the Labor Code. i shall comply with those,p_r_pvicign' 4.5 FT X 120 FT RET.WALL(INCLUDING FOOTING) PROPOSED USE Date: IP—:;19) r'1/I Signatute.:_I_ - 1 I certify I have read this application and state that the above information is correct I agree to (L'// 6, )%je p04 /ei',iu// 191y y comply with all City Ordinances and state laws and hereby authorize representatives of this City to COMMENTS (/ CJ� m enter upon the above mentioned property for w.uon-purp'bses fl • Date: I//—,4.cy- O I I Signature;-__ ___I v ---1-0TAER FEES REQUIRED _.1/Lic Ree,o74 lovfi 1/U Pad ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning: PD Front Yard. 15 Over X. 0 Issuance. 1 $29 00 Electrical 1 $0.00 Land Use. FR coo NO -2 Side Yard. 5/5 $207.20 Cut: o Permit Fees: i I Development NO Plan Check 1 $70.20 Plumbing: $0 00 Plan RET.WALL Rear Yard. 15 Fill 0 p SMIP $0 00 1 Occ SSY- Total. 0 Sewer NO Mechanical- $0.00 Structural $108.00 Type 1NR Water NO Geo Review $0.00 Grading $0.00 Total Fee Due 1 $207.20 • . , INSPECTION RECORD Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS (Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL I Terraces County Environmental Sub Drains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Building Sewer Final Grade U.G.Waste Plumbing Final Electric Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electrical Final Building/Construction Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections : Footing, ReBar 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS : Location/Rebar/Bonding/Light Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence,Gate&Alarm Final Pool Temp Power Pole Electric Release Gas Test