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Permit No. 2012-26613 City of Chino Hills BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT r'So;;dcix' 14000 City Center Dc,Chino Hills.CA91709 Counter Phone (909)364-2780 :gargr . Buildin Permit 24Hour Inspection Line (909)3642]90 (NOTE You must call before 3p.m.for a next business day inspection) }, � City Hall Main Number (909)364-2600 intyfKt f(iikbs;.. NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. I PERMIT No. WATER HEATER CHANGE OUT 2012-26613 34244 BUILDING ADDRESS I APT./UNIT NO. I ISSUED DATE ISSUED BY 5439 KNIGHT CT 12/3/2012 Beeler,Melissa APN 102860160 ITRACT TR15748APN I LOT I FLOORS/UNITS I PROJECT PERMITS I P.TYPE CENCUS CODES I CONST.TYPE I ZONING TYPE I OCCUPANCYOTYPE I VALUATION $500.00 I TOTAL SOFT 0.00!BLDG.SOFT 434_Res Add/Alter Current Owners: 'Fees Name:STEVE MORRILL Fee Group/ Fee Description Fee Amount Payments Address. 5439 KNIGHT CT Chino Hills CA 91709 Transaction Type Ph 909-606-7718 Water Heater C10 $71.25 Emelt M@ch org Contractor. OWNER BUILDER-OWNER!BUILDER 8001 Permit Issuance Fee $54.00 54.00 Address: N/A CHINO HILLS CA 91709 8141 Water Heater $1625 16.25 Ph. N/A Email: Lic.Information Exp.Date 581473 $1.00 1 00 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION TOTAL FEES $7125 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sec 7000)of Division 3 of the Business and Professions Code,and my license is in full force and AMOUNT PAID $71.25 effect In securing this permit I am acting with the knowledge of and on behalf of the owner of the property. BALANCE DUE $0.00 Date Contractor OWNER-BUILDER DECLARATION I hereby affirm under penalty of penury that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code. Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Sec 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more that five hundred dollars($500.00) 1,as owner of the propterty,or my employees with wages as their sole compensation,will do the work,and the structure is not Intended or offered for sale(Sec.7044,Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale. H however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he she did not build or imprg4e for the purpose of sale) I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor (s)licensed pursuant to the Contractors License Law). I am exempt under article 3 of the Business and Professions Code. Date. Permittee Print Full Name' (// An �/' %// / WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of penury one of the following declarations. I have and will maintain a certificate of consent to self-insure for workers'compensation,as I certify that I have read this application and state that the above information is correct I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is with all city and county ordinances and state laws relating to building construction,and hereby suthonze issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes. I have and twill prormaineofthworkers'compensationrwhinsurance,ermias required by Section co00 of methe Labor surancCode,for radedoicy tae work for which this permit is issued My workers compensation /Z /� insurance carrier and policy number are a �� Carver Policy APPLICANT SIGNATURE DATE Applicant. SIEVE MORRILL I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers compensation laws of California,and Address' 5439 KNIGHT CT Chino Hills CA 91709 agree that if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Ph: 909-606-7718 Email' M@ch.org Lie.Information Exp.Date' Date' Applicant I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and Safety Code,which regulate the storage,handling and use of hazardous materials WARNING: Failure to secure workers compensation coverage is unlawful,and shall subject an employer to criminal penalities and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of compensation,damages as provided form section 3706 of the Labor Code,interest,and attomeys fees.