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Permit No. 18001 BUILDING ADDRESS: 2587 LA SALLE POINTE PERMIT NUMBER: 18001 BUILDING INFORMATION APPLICANT INFORMATION nt BUILDING PERMIT APPLICATION Address: 12587 LA SALLE POINTE Name JOHN M.HERNANDEZ ' " Community Y Develo ment P APN. 1032-172-45 Address: 2587 LA SALLE POINTE 2001 Grand Avenue Lot: 261 City,Zip Code. CHINO HILLS,CA 91709 Chino Hills,CA 91709 Cross Streets: Phone/Pager: (909)393-0797 I ext "`"°'0.....XO"„r LICENSED CONTRACTOR DECLARATION Tract/Parcel. 13792 City Bus Lic#: 1 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation. $200.00 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: OWNER BUILDER DECLARATION Name: (JOHN M.HERNANDEZ Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address• (2587 LA SALLE POINTE I City,Zip Code:I I,as the owner of the roe Phone: ext. 0 property,rty,or my employees with wages as their whole City,Zip Code. (CHINO HILLS,CA 91709 compensation,will do the work,and the structure is not intended or offered for sale Phone. 1(909)393-0797 ext. Lic#. O I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: City Bus Lic#: construct the project. • I am exempt under Section i i BPC for this reason i I Bus Exp: APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By ILAURO BUGARIN I hereby affirm under penalty of perjury one of the following declarations Contractor: (JOHN M.HERNANDEZ I Date Issued (3/27/01 Address• 2587 LA SALLE POINTE Finance Code• C4 I have and will maintain a certificate of consent to self-insure for workers'compensation 0 as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code. CHINO HILLS,CA 91709 Census Code: which this permit is issued. Phone or Pager: (909)393-0797 I ext I Final Date: / l-c)...__, Bus.Lic#: Final By: A _ ill yyta I have and will maintain workers'compensation,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Lie.# I Extension: workers'compensation insurance earner and policy number are: Exp Date: I Reviewed By: ILAURO BUGARIN Lic.Class. Approved By: ILAURO BUGARIN INSURANCE INFORMATION Insurance Company: (Exempt 1 PROJECT INFORMATION Policy Number: I I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date: 1 Structure 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage. I certify that in the performance of the work for which this permit is issued I shall not employ Patio: I yperson in any manner so as to become subject to the Workers'Compensation Laws of Porch. alifomia and agree that if I should become subject to the workers'compensation provisions of Other: (ELECTRICAL REAR Section 3700 of the Labor Code I shall comply with ose provisions. . TWO OUTSIDE SECURITY LIGHTS PROPOSED USE Date: I7- -Cr •011 Signature: ( ^ i i I certify I have read this application and state that the ab ve mfo ation is correct. I agree to comply with all City Ordinances and state laws and hereby aumorize representatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes. Date: i i Signature: i OTHER FEES REQUIRED ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning (PD Front Yard: Over X: 1 0 Issuance. $45.00 I Electrical: I $4.50 Land Use: IFR-1 Side Yard: Cut. School. I N I Permit Fees: $49.50 i 0 Plan Check. $0 00 Plumbing. $0.00 Plan. 1Rear Yard Development: 1 N Fill: 0 SMIP: 1 $0.00 Occ. R3 SSY. Total: 1 0 1 Sewer: 1 N Mechanical. $0 00 Structural: $0.00 Type. VN I Water 1 N Geo Review. $0.00 i Grading I $0.00 Total Fee Due I $49.50 I PECTION RECOR[ 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 Sewer Final Grade U.G.Waste Plumbing Final Electric I_a/-da- Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electrical Final Building/Construction ,'-meq-da- Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION /A/ Footings CERTIFICATE OF OCCUPANCY r�' U L�/ � UFER Ground (Rebar/Copper) <::A Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear 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