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Permit No. 19490 BUILDING ADDRESS: 14817 KELTY COURT • - PERMIT NUMBER: 19490 � BUILDING INFORMATION APPLICANT INFORMATION —,7 : qp� BUILDING PERMIT APPLICATION Address: 14817 KELTY COURT Name. SARKIS NALBANDIAN ;114.5q, Community Development APN 11032-592-05 I Address. 114817 KELTY COURT '%' ` 2001 Grand Avenue '�r ^" Lots 1113 City,Zip Code• ICHINO HILLS,CA 91709 Chino Hills,CA 91709 :: ' Cross Streets. I Phone/Pager 1(909)606-6466 I ext. I n11", 11. LICENSED CONTRACTOR DECLARATION Tract/Parcel. 15723 City Bus Lic# I 1 hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$25,000 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. NA OWNER BUILDER DECLARATION Address. Name- 1SARKIS NALBANDIAN I hereby affirm that I'm exempt from the Contractor's License Law for the following reason• Address 14817 KELTY COURT City,Zip Code: I,as the owner of the property.or my employees with wages as their whole City,Zip Code- ICHINO HILLS,CA 91709 Phone 1 ext. I 0 compensation,will do the work,and the structure is not intended or offered for sale. Phone: 1(909)606-6466 1 ext. I Lic#: Vas owner of the property,am exclusively contracting with licensed contractors toBus Lie# 1 I City Bus Lie# nstruct the project. Bus Exp: I I APPROVAL INFORMATION 0 I am exempt under Section I I BPC for this reason WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By (DAWN FORSHA I hereby affirm under penalty of perjury one of the following declarations Contractor OWNER BUILDER I Date Issued. 12/20/02 Address. Finance Code• 1C7 I have and will maintain a certificate of consent to self-insure for workers'compensation O 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. ext. 1 Final Date. J,/7,y .n Bus.Lic# 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 Lie #: Extension workers'compensation insurance carrier and policy number are: Exp Date• Reviewed By 1MIKE WHITE Lic Class Approved By. IMIKE WHITE INSURANCE INFORMATION insurance Company 1EXEMPT PROJECT INFORMATION Policy Number: 1 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date. Structure. I 1 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage Orcertify that in the performance of the work for which this permit is issued. I shall not employ Patio. y person in any manner so as to become subject to the Workers'Compensation Laws of Porch. I California and agree that if I should become subject to the workers'compensation provisions of Other. POOL AND SPA I 1 528 Section 3700 of the Labor Code. I shall comply with those provisions. POOL AND SPA PROPOSED USE Date: / 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 POOL AND SPA enter upon the above mentioned property for inspection purposes. Date: i i Signature: OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning. 1PD Front Yard 15 Over X 1 0 I Issuance: $29 00 Electrical. I $90 00 I Land Use FR-1 Side Yard 5/5 School I N Permit Fees: $421.40 Cut 0 Plan Check. $0 00 $0 00 Plan IPOOL AND SPA Rear Yard• 15 Fill I 0 I Development 1 N 1 Plumbing 1 SMTP I $0.00 1 Occ 1R3 I SSY Total. 1 0 I Sewer. 1 N I Mechanical: I $0 00 Structural $302 40 1 Type: IVN Water N Geo Review. $0 00 Grading. $0.00 1 Total Fee Due $421.40 • 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 //i3/41 A Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissonsfrendons 9.THER: Slab Grade 1A14 _ DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED '17) 4.)/ Shear pcx - n04._.Zrf.• c=.1- RoZif Nailing Exterior Walls Interior Walls Haittware/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 D f Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCI G LS COMPLETE Fence,Gate&Alarm 7/9-09, ),0 c)„,. Final Pool /43 kl2 Temp Power Pole Electric Release Gas Test