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Permit No. 20242 BUILDING ADDRESS: 5678 KNOLLSIDE WAY PERMIT NUMBER: 20242 BUILDING INFORMATION APPLICANT INFORMATION ,,dor\ BUILDING PERMIT APPLICATION Address: 5678 KNOLLSIDE WAY Name• 1KONTIKI CONSTRUCTION 47_t, Community Devel'''pment•, APN• 11027-532-31 Address: 112761 JALEPENO AVENUE -:,--it., 2001 Grand Avenue Lot: 134 City,Zip Code: 'CHINO,CA 91710 --,:- ,�, Chino Hills,CA 91709 Cross Streets 1 Phone/Pager. (909)717-2457 1 ext. `"°i'r!i . , LICENSED CONTRACTOR DECLARATION Tract/Parcel: 115751-I City Bus Lic#: I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation: 1$864.00 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 DECLARATIONName: EMILY AND HOAN THAI I Address: I hereby affirm that I'm exempt from the Contractor's License Law for the following reason. Address 5678 KNOLLSIDE WAY 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: 1 ext. 0 compensation,will do the work,and the structure is not intended or offered for sale Phone: 1(909)396-2977 ext. 1 Lic#: 0 I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: City Bus Lic# construct the project. Bus Exp. ' APPROVAL INFORMATION I am exempt under Section I BPC for this reasonI WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION issued By 'YVETTE MARTINEZ thereby affirm under penalty of perjury one of the following declarations. Contractor 'KONTIKI CONSTRUCTION I Date Issued 16/19/02 Address• 112761 JALEPENO AVENUE Finance Code: 1C4-SM I have and will maintain a certificate of consent to self-insure for workers'compensation as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code: CHINO,CA 91710 Census Code• which this permit is issued Phone or Pager: 1(909)717-2457 1 ext. 1 Final Date. / /. Bus.Lic# NEW `/[ �% I have and will maintain workers'compensation,as required by Section 3700 of the Final By 1� ✓" /�i C) Labor Code,for the performance of the work for which this permit is issued. My Lic # 1782009 Extension. workers'compensation insurance carrier and policy number are: Exp Date- 17/31/02 I Reviewed By DON FARLEY INSURANCE INFORMATION Lic.Class. IB Approved By DON FARLEY Insurance Company: 1 EXEMPT I PROJECT INFORMATION Policy Number: I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date: I I Structure 1 I 0 Section need not be completed if permit is for one hundred dollars($100)or less GarageI I fcertify that in the performance of the work for which this permit is issued. I shall not employ Patio: 'LATTICE 1REAR I 72 ry person in any manner so as to become subject to the Workers'Compensation Laws of Porch. I I 1 California and agree that if I should become subject to the workers'compensation provisions of Other: Section 3700 of the Labor Code I shall comply with those provisions. PROPOSED USE LATTICE PATIO COVER 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 authonze representatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes. Date: Fr" n Signature: i / s---1 -e L �J j OTHER FEES REQUIRED ZONI G SETBACKS GRADrING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard 10 Over X: 1 0 Issuance 1 $29 00 Electrical: $0.00 Land Use: Side Yard: 5/5 Cut: 0 School: NO ' Permit Fees: $74.54 I Plan ACCESSORY Rear Yard: 15 Development 1 NO I Plan Check $17.94 1 Plumbing $0.00 I Fill 0 I SM IP- $0.50 Occ: R3 SSY- Total: 0 1 Sewer: NO 1 Mechanical- 1 $0 00 1 Structural. $27.60 1 Type: 'VN Water- N 1 Geo Review: 1 $0 00 1 Grading: 1 $0 00 I Total Fee Due $75.04 IISPECTION RECO* Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL! 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 Sbwer 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 _ n DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED PIT IQ /'00//u5 r D/L (o/ro/,)L ZYQ Shear V 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