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Permit No. 14310 BUILDING ADDRESS:, 15967 OAK CANYON PERMIT NUMBER: 14310 r.-- 4*, BUILDING INFORMATION APPLICANT INFORMATION r� BUILDING PERMIT APPLICATION Address: 15967 OAK CANYON Name C&A CONSTRUCTION ..* CommunityDevelopment ,..1• P APN 1031-321-16 Address 13235 ARMSLEY DRIVE 1 I 2001 Grand Avenue • Lot 1316 City,Zip Code (CHINO HILLS,CA 91709 1 Chino Hills,CA 91709 Cross Streets 1PEYTON/BAYBERRY Phone/Pager (909)606-6315 I ext 1 CM' OFCFP°KILLS LICENSED CONTRACTOR DECLARATION Tract/Parcel 12625 City Bus Lic# NEW I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation $9,469 60 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 1C&A CONSTRUCTION OWNER BUILDER DECLARATION Name AMMENTORP Address 3235 ARMSLEY DRIVE I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 15967 OAK CANYON City,Zip Code CHINO HILLS,CA 91709 I,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS,CA 91709 Phone (909)606-6315 1 ext O compensation,will do the work,and the structure is not intended or offered for sale Phone 1 ext Lie# O I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# City Bus Lie# 1NEW construct the project I Bus Exp APPROVAL INFORMATION ® I am exempt under Section I I BPC for this reason I illi WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By DORIS CARPENTER I hereby affirm under penalty of perjury one of the following declarations Contractor 1C&A CONSTRUCTION Date Issued 6/21/99 Address 3235 ARMSLEY DRIVE 1 Finance Code 1C4 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 1CHINO HILLS,CA 91709 Census Code 1 which this permit is issued Phone or Pager 1(909)606-6315 1 ext 1 Final Date `*�7 — G---0Bus Lie# NEW I have and will maintain workers'compensation,as required by Section 3700 of the Final By ® Labor Code,for the performance of the work for which this permit is issued My Lie # 546664 Extension workers'compensation insurance carrier and policy number are Exp Date. 11/99 1 Reviewed By 1KEITH L PRYOR INSURANCE INFORMATION Lie Class 1B Approved By 1KEITH L PRYOR -Insurance Company 1 EXEMPT1 PROJECT INFORMATION Policy Number. e PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date Structure 1FAMILY ROOM REAR 152 OO 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 any person in any manner so as to become subject to the Workers'Compensation Laws of Porch /41, 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 provisions Other FAMILY ROOM ADDITION PROPOSED USE Date: I i Signature: II I certify I have read this application and state that the above information is correct I agree to ' comply with all Cm. Ordinances and state laws and hereby au •. z-r-. ntatwes of this City to enter upon the:.ove mentioned property for mspectio� .ose. COMMENTS Date: i1DJ�� OA Signature: '// 1\ /I`� i OTHER FEES REQUIRED Lb ZON G SETBACKS ( ®RING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PUD Front Yard 20 Over X 0 Issuance $29 00 Electrical $16 72 La?md Use 1FR-1 Side Yard 5/5 Cut 0 1 School NO Permit Fees: 1 $186.12 Plan Check $0 00 Plumbing $0 00 Plan ADDITION Rear Yard 20 Development NO Fill 0 SMTP 1 $0 00 Occ 1R3 SSY Total 0 1 Sewer NO Mechanical 1 $0 00 Structural $140 40 Type 1VN Water NO Geo Review 1 $0 00 Grading $0 00 Total Fee Due $186.12 INSPECTION RECORD INSPECTION DATE INSPECTOR Grading: INSPECTION DATE INSPECTOR Pregrade Meeting Block Wall Inspections: Rough Grade Footing, ReBar Terraces 1st Lift Bond Beam Sub grans 2nd Lift Bond Beam Finish Grading 3rd Lift Bond Beam Soils Certification Drain/Seal Grading Certification ReRoof: Rough Tear-off,Existing Conditions As Built Approved Sheath Nailing Underground Site Inspections: Roof Final Building Sewer Line Swimming Pools: Supply Water Line Location/Rebar/Bonding/Light Storm Drain/Catch Basins Gas Test/Gr Condwt/Ro Elect U/G Conduit/Electncal Pre-Deck DO NOT BACKFILL UNTIL ABOVE IS APPROVED POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Verify Soils Engineering: Fence, Gate&Alarm Compaction,moisture,conditioning,etc Final Pool Underfloor/Underslab 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. Insulation Overhead Hydro Subfloor ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION TEMP. POWER POLE Foundation Inspection: ELECTRIC RELEASE Setback/Footing GAS TEST UFER Ground(Rebar/Copper) Hardware/Hold-Downs FINAL INSPECTIONS Piers/Caissons/Tendons NO OCCUPANCY PERMITTED WITHOUT FINAL I DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED County Environmental Shear Inspection(Wood): Health Dept (391-7570) Roof Nailing fFP Planning Dept (364-2790) Exterior Walls Public Works (364-2770) Intenor Walls Fire (393-3888) Hardware/Hold-Downs Landscape (364-2797) Combo Inspection: i ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Framing Final Electric Rough Electric -c_[..j ' 1� Final Grade Rough Mechanical / s Final Plumbing Rough Plumbing/Topout / Final Mechanical COVER NO WORK UNTIL ABOVE IS APPROVED _a� Final Building/Construction Insulation Drywall Inspection: CERTIFICATE OF OCCUPANCY g Q Intenor ") l ( n OK TO ISSUE Exterior , e Lath _96OTHER: Stucco Scratch 1 MISCELLANEOUS INSPECTIONS: Masonry Fireplace: Plate Ties,Fire Block, Patio/Deck: Footing Access/Light/Switch Patio Final rf • •