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Permit No. 19489 n/1 BUILDING ADDRESS: 14817 KELTY COURT PERMIT NUMBER: 19489 V ( • �� BUILDING INFORMATION APPLICANT INFORMATION I. / 7,,,t, BUILDING PERMIT APPLICATION Address: 14817 KELTY COURT Name• SARKIS NALBANDIAN Community Development APN 11032-592-05 Address. 14817 KELTY COURT 2001Grand Avenue Lot: 113 City,Zip Code. 1CHINO HILLS,CA 91709 Chino Hills,CA 91709 o `-•`_. Cross Streets. Phone/Pager (909)606-6466 I ext. 1 "TM,.,,, „ 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: $8,000.00 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• INA OWNER BUILDER DECLARATION Name SARKIS NALBANDIAN Address. 1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reason. Address. 114817 KELTY COURT City,Zip Code O 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. I compensation,will do the work,and the structure is not intended or offered for sale Phone. (909)606-6466 1 ext. 1 Lic#. I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: 1 _ City Bus Lic# 1 the project. .onstruct am exempt under Section BPC for this reason Bus Exp: I APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By. 1DAWN FORSHA I hereby affirm under penalty of perjury one of the following declarations: Contractor: OWNER BUILDER Date Issued: 12/20/02 Address. Finance Code. 1C7 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 1 ext. Final Date ' I have and will maintain workers'compensation,as required by Section 3700 of the Bus Lic.#. Final By I ' e�� 0 Labor Code,for the performance of the work for which this permit is issued. My Lic.#: Extension workers'compensation insurance earner and policy number are. Exp D``e. Reviewed By MIKE WHITE Lic. r I Approved By MIKE WHITE INSURANCE INFORMATION insurance Company 1EXEMPT 1 PROJECT INFORMATION Policy Number. PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 1 Structure 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. 1 California and agree that if I should become subject to the workers'compensation provisions of Other: RETAINING WALL 585 Section 3700 of the Labor Code. I shall comply with those provisions. 585 SQ FT RETAINING WALL 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 of this City to COMMENTS 585 SQ FT RETAINING WALL enter upon the above mentioned property for inspection purposes ___,-------- Date: --'Date: I I Signature: I OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD 1 Front Yard 15 Over X. 0Issuance $29.00 Electrical $0 00 5/5 Land Use. FR-1 Side Yard• School: I N 1 cur 0 Permit Fees: I $147.80 Plan RETAINING WA Rear Yard 15 Development NI Plan Check. $118 80 Plumbing. $0 00 Fill. 0 SMIP: 1 $0 00 1 Occ R3 1 SSY Total 0 Sewer N 1 Mechanical. $0 00 Structural $0 00 Type: IVN I Water N 1 Geo Review. $0 00 Grading. $0 00 Total Fee Due $147.80 • 411 INSPECTION RECORD Permit Number ispection Date Inspector Inspection Date Inspector Tading: regrade Meeting FINAL INSPECTIONS(Inspector verify following) .ough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL erraces County Environmental .ub Drains Health Dept inish Grading Planning Dept oils Certification Public Works trading Certification Fire Rough Landscape .s Built Approved Inderground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Wilding Sewer Final Grade LG.Waste Plumbing Final Electric Vater Service Final Plumbing itorm Drain/Catch Basins Final Mechanical JIG Conduit/Electrical Final Building/Construchon 00- ;ompaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION 'ootings CERTIFICATE OF OCCUPANCY JFER Ground(Rebar/Copper) -lardware/Hold-Downs )iers/Caissons/Tendons ,OTHER: Slab Grade Ala-- CAA-if Cil< e4-7.c% -& 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 er; &.41?"-DO (-7 1st Lift Bond Beam igroj- 097 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal 12 1/ C.25 C 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