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Permit No. 11055 APPLICATION FOR BUILDING PERMIT BUILDING INFORMATION {_ ,;'t Address: 2539 LA SALLE POINTE Permit Number: 111055 '} Community Development = ,- 2001 Grand Avenue APN: (032`( -2 —0 PERMIT FEES c �� Chino Hills, CA 91709 Lot: 269 Electrical: $0.00 v;;: ' X/ST: CITY OF CHINO HILLS ,...,.o.....,.,, Geo Review: $0.00 LICENSED CONTRACTOR'S DECLARATION Tract: 13792 Grading: $0.00 I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Valuation: $0.00 Section 7000 of Division 3 of the Business and Professions Code)and my license is in Issuance: $33.30 full force and effect APPLICANT INFORMATION Mechanical: $19.98 Contractor: WEST PAC HEATING AND A/C Name: WEST PAC HEATING AND A/C Plan Check: $0.00 Address: 601 S MILIKEN AVE,STE.R Plumbing: $0.00 Address: 601 S.MILIKEN AVE. STE.R City,State Zip: ONTARIO,CA. 91761 City,State Zip: ONTARIO,CA. 91761 Structural: $0.00 Phone: (909)605-6955 Phone: (909)605-6955 Total Permit Fee: $53.28 License Class: C-20 City Bus Lic#: 9702995 License#: 585972 City Bus Exp: 1-1-98 OWNER INFORMATION SMIP: I$o.00 OWNER BUILDER DECLARATION Name: LYCET Total with SMIP: $53.28 I hereby affirm that I am exempt from the Contractor's License Law for the following reason Address: 2539 LA SALLE POINTE ❑ City,State Zip: CHINO HILLS,CA 91709 I,as the owner of the property,or my employees with wages as their whole compensation,will do the work,and the structure is not intended or offered for sale. Phone: (909)393-8148 APPROVAL INFORMATION City Bus Lic#: I,as owner of the property,am exclusively contracting with licensed contractors to Approved by: DEBY CONRAD construct the project. City Bus Exp: Date Issued: n I am exempt under Section I I BPC for this reason I ENGINEER/ARCHITECT INFORMATION Finance Code: C-4 WORKERS'COMPENSATION DECLARATION Name: Census Code: 0/S Address: I hereby affirm under penalty of perjury one of the following declarations: Comments: City,State Zip: nI have and will maintain a certificate of consent to self-insure for workers' Phone: compensation as provided by Section 3700 of the Labor Code,for the performance City Bus Lic#: of the work for which this permit is issued. City Bus Exp: nI have and will maintain workers'compensation,as required by Section 3700 of the Eng/Arc Lic#: Labor Code,for the performance of the work for which this permit is issued. My 0 workers'compensation insurance carrier and policy number are:y� Proposed Use: Insurance Company: CALIF COMPENSATION INS. HVAC CHANGEOUT Policy Number: G971117248 Expiration Date: 1/1/98 D Section need not be completed if the permit is for one hundred dollars($100)or less. Project Description: Location on Prop: Square Feet: Setbacks: Livable: 10 FY I certify that in the performance of the work for which this permit is issued. I shall not employ Garage: 1 I SY: any person in any manner so as to become subject to the Workers'Compensation Laws of Patio I RY California and agree that if I should become subject to the workers'compensation provisions Porch: I I of Section 3700 of the Labor Code. I shall comply with those pr isions. Other: Date: I tzl yl 9 Signature: (41/�d/ 1 VGrading: Zoning: 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 Land Use: Cut: 0 City to enter upon the above mentioned property for inspection purposes. .------- urposes. / Plan: Fill: to Occ: Total: Date: 1-2-12-11,-? I Signature: I iti/ ' /� ( � "� �\ I Type: • INSPECTION RECORD INSPECTION DATE INSPECTOR (if applicable) Grading: Plate Ties Pregrade Meeting Throat Damper Rough Grade Shower Pan Terraces Temp Power Pole Electric Green Tag(wiring to be protected) Sub Drains Ground Rod Gas Test(after drywall) Finish Grading Gas Yellow Tag Soils Certification Other Grading Certification Reroof: Rough Tearoff Final Roof Nail/Existing Conditions As Built Approved Swimming Pools: Underground Site Inspections: Location on Site Building Sewer Line Rebar Supply Water Line Bonding Storm Drain/Catch Basins Gas Piping/Test U/G Conduit/Electrical Predeck Final DO NOT BACK FILL UNTIL ABOVE IS APPROVED Verify Soils Engineering: FINAL REQUIRED-POOL NOT TO BE FILLED Compaction,moisture,conditioning,etc. UNTIL FENCING IS COMPLETE Underfloor/Undersalb Inspection: Fire Protection Equipment: U/F Waste Plumbing UG Pipe U/F Water Thrust Blocks U/F Mechanical Hydro U/F Electrical Flush U/F Framing Weld Outlet Insp. OK to Install Insulation Overhead Hydro OK to Install Subfloor Other Fence&Gate ABOVE IS REQUIRED PRIOR TO FOUNDATION INSP. Alarm Foundation Inspection: Test/Final Setback Perimeter Footings FINAL INSPECTIONS Interior Footings (NO OCCUPANCY PERMITTED WITHOUT FINAL) UFER Ground(Rebar/Copper) County Environmental Hardware/Hold-Downs Health(if required) Piers/Caissons/Tendons Public Works OK to Pour Concrete Fire Landscape DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Building Shear Inspection(Wood): Exterior Walls CERTIFICATE OF OCCUPANCY Interior Walls Hardware/Hold-Downs OK to Install Lath OK TO SUPPLY Connection to Roof(if required) Roof Nail Inspection: OTHER: Frame Inspection: " Framingr Lui•� u v C/✓/ r L. /1113-0--PrP.&e d r Lath 41-443-2--6470.!!'" Plumbing Topout Rough Mechanical Multi-Story Waste Test 4''3o-ger 1.9642 *' 1C eim,virgO Ji OK to Insulate ia' /4-r77C- ©/e OK to Place Drywall COVER NO WORK UNTIL ABOVE IS APPROVED Drywall Inspection: Nail/Screw Drywall Shear Nailing OK to Tape Drywall OK to Stucco • INSPECTION DATE INSPECTORj) C=1 /n Miscellaneous Inspections: Masonry Fireplace