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Permit No. 18279 BUILDING ADDRESS: 15910 OAK CANYON DRIVE PERMIT NUMBER: 18279 1-- BUILDING INFORMATION APPLICANT INFORMATION ,e$\ BUILDING PERMIT APPLICATION Address: 15910 OAK CANYON DRIVE Name KEITH AND LORI DUNBAR 1 •I,tr, Community Development APN 11031-341-13 Address 115910 OAK CANYON DRIVE """ 2001 Grand Avenue Lot 298 City,Zip Code CHINO HILLS,CA 91709 ^• .,� Chino Hills,CA 91709 M e: ' Cross Streets PEYTON DRIVE/BAYBERRY 1 Phone/Pager (909)597-0774 I ext .,e., ."410. 44 °". LICENSED CONTRACTOR DECLARATION Tract/Parcel 12625 City Bus Lic# N/A 1 ..°..4. 44 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation $4,277 20 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 1N/A OWNER BUILDER DECLARATION Name 1KEITH AND LORI DUNBAR 1 Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 115910 OAK CANYON DRIVE City,Zip Code 1 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 1 1 0 compensation,will do the work,and the structure is not intended or offered for sale Phone (909)597-0774 1 ext 1 Lic# 1 O I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic 4 N/A City Bus Lic# J construct the project ® I am exempt under Section i i BPC for this reason i Bus Exp APPROVAL INFORMATION 11. WORKERS'COMPENSATION DECLARATION I CONTRACTOR INFORMATION issued By YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor (OWNER BUILDER Date Issued 5/15/01 Address 1 Finance Code C4 1 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 Census Code i 1 which this permit is issued Phone or Pager ext Final Date jn, /t7 4.-, Bus Lic# Final By I have and will maintain workers'compensation,as required by Section 3700 of the F ----t-- , 0 Labor Code,for the performance of the work for which this permit is issued My Lic # 1 Extension 1 workers'compensation insurance carrier and policy number are Exp Date Reviewed By KEITH L PRYOR Lic Class Approved By KEITH L PRYOR INSURANCE INFORMATION Insurance Company !EXEMPT t PROJECT INFORMATION Policy Number 1PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 1 • Structure 1CONVERSION GARAGE 1 136 ® 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 • 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 GARAGE CONVERSION TO BEDROOM Date: 15-I 5_11 Signature: 1,------- --:„.,--_,...74.,,e,----- I' —� (2)CAR COVERED PARKING IS TO BE MAINTAINED 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 City to enter upon the above mentioned property for inspection purposes COMMENTS Date: I��5._d' I Signature: If. ,-°; %'1.'/�� i 4 OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard EXIST Over X 0 1 Issuance $29 00 Electncal $14 96 Land Use FR-1 Side Yard Cut 0 School NO Permit Fees: $206.50 Plan ADDITION Rear YardDevelopment NO Plan Check $56 16 Plumbing $0 00 Fill 0 SMTP $0 00 Occ R3 SSY Sewer NO Mechanical $19 98 Structural $86 40 Total 0 Total Fee Due $206.50 Type VN Water NO Geo Review $0 00 Grading $0 00 INSPECTION RECORD 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 Water Service Final Electric Storm Drain/Catch Basins Final Plumbing ' 4- U/G Conduit/Electrical Final Mechanical Compaction Report Final Building/Construction tl/,/-/ ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Water Meter Number Footings UFER Ground (Rebar/Copper) CERTIFICATE OF OCCUPANCY Hardware/Hold-Downs Piers/Caissons/Tendons Slab Grade OTHER: DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing Exterior Walls Interior Walls Hardware/Hold-Downs -/744 ��!f Rough Electric Rough Mechanical I I Rough Plumbing/Topout I Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation t'11-1/0/ /t, Drywall ���� Interior/Exterior �,/'!T, 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 •