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Permit No. 11062 APPLICATION FOR BUILDING PERMIT BUILDING INFORMATION was. • Address: 2545 LA SALLE POINTE Permit Number: 111062 Community Development 2001 Grand Avenue APN: 1()3a-1 7-2-5a / ..,� Chino Hills, CA 91709 Lot: 268 / PERMIT FEES .4C°44%-: '''',‘: y/ST Electrical: $0.00 CRY OF CHINO HILTS N ® I" """ LICENSED CONTRACTOR'S DECLARATION Tract: 13792 ` eo Review: $0.00 I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Valuation: $0.00 Grading: $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 Address: 601 S. MILIKEN AVE.,STE.R Plumbing: $0.00 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 L' se#: 585972 City Bus Exp: 1-1-98 OWNER INFORMATION SMIP: $0.00 OWNER BUILDER DECLARATION Name: THIERJUNG Total with SMIP: $53.28 I hereby affirm that I am exempt from the Contractor's License Law for the following reason. Address: 2545 LA SALLE POINTE City,State Zip: (CHINO HILLS,CA 91709 I 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)597-9477 APPROVAL INFORMATION I I,as owner of the roe City Bus Lic#: I property,rty,am exclusively contracting with licensed contractors to City Bus Exp: � Approved by: DEBY CONRAD construct the project Date Issued: I am exempt under Section 1 1 BPC for this reason I ENGINEER/ARCHITECT INFORMATION Finance Code: C-4 WORKERS'COMPENSATION DECLARATION Name: I Census Code: 0/S Address: If I hereby affirm under penalty of perjury one of the following declarations Comments: City,State Zip: I 1-7 I have and will maintain a certificate of consent to self-insure for workers' Phone: _ ( ^ g compensation as provided by Section 3700 of the Labor Code,for the performance City Bus Lic#: l of the work for which this permit is issued. City Bus Exp: CCrrr-:C4 nI have and will maintain workers'compensation,as required by Section 3700 of the Eng/Arc Lic#: 1 (. Labor Code,for the performance of the work for which this permit is issued. My / 41workers'compensation insurance carrier and policy number are: Proposed Use: / HVAC CHANGEOUT I,I Insurance Company: CALIF COMPENSATION INS. Y c/ Policy Number: G971117248 I\ I Expiration Date: 1/1/98 Section need not be completed if the permit is for one hundred dollars($100)or less Project Description: Location on Prop: Sgi] e.Ee Setbacks: n 1 Livable: I I 0 FY I certify that in the performance of the work for which this permit is issued. I shall not employ Garage: 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 of Section 3700 of the Labor Code. I shall comply with those p isions. Porch: n Other: Date: I 12—( 2—1Jul)6I Signature: I i�V ! , �` & Grading: l 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. Plan: Fill: 0 Date: I i_ _J�� J� I Signature: I iv /� I Typ Total: 0 Type: , tt f l U • S INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Miscellaneous Inspections: Pregrade Meeting Masonry Fireplace Rough Grade (if applicable) Terraces Plate Ties Throat Damper Sub Drains Shower Pan Temp Power Pole Finish Grading Electric Green Tag(wiring to be protected) Soils Certification Ground Rod Grading Certification Gas Test(after drywall) Rough Gas Yellow Tag Final Other As Built Approved Reroof: Underground Site Inspections: Tearoff Building Sewer Line Roof Nail/Existing Conditions Supply Water Line Swimming Pools: Storm Drain/Catch Basins Location on Site U/G Conduit/Electrical Rebar Bonding DO NOT BACK FILL UNTIL ABOVE IS APPROVED Gas Piping/Test Verify Soils Engineering: Predeck Compaction,moisture,conditioning,etc. Final Underfloor/Undersalb Inspection: U/F Waste Plumbing FINAL REQUIRED-POOL NOT TO BE FILLED U/F Water UNTIL FENCING IS COMPLETE U/F Mechanical Fire Protection Equipment: U/F Electrical UG Pipe U/F Framing Thrust Blocks OK to Install Insulation Hydro OK to Install Subfloor Flush Weld Outlet Insp. ABOVE IS REQUIRED PRIOR TO FOUNDATION INSP. Overhead Hydro Foundation Inspection: Other Setback Fence&Gate Perimeter Footings Alarm Interior Footings Test/Final UFER Ground(Rebar/Copper) Hardware/Hold-Downs FINAL INSPECTIONS Piers/Caissons/Tendons (NO OCCUPANCY PERMITTED WITHOUT FINAL) OK to Pour Concrete County Environmental Health (if required) 1 DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Public Works � Shear Inspection(Wood): Fire i 4_49 V Exterior Walls Landscape \\ Interior Walls Building '- " Hardware/Hold-Downs OK to Install Lath CERTIFICATE OF OCCUPANCY AyiA, ConnectioniRoof(if required) 1\ /� Roof Nail Inspection: I (/ Frame Inspection: OK TO SUPPLY 1 Framing t I v Lath OTHER: Plumbing Topout Rough Mechanical Multi-Story Waste Test OK to Insulate 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 a-6 ff