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Permit No. 19990 BUILDING ADDRESS: 15904 OAK CANYON DRIVE PERMIT NUMBER: 19990 r� BUILDING INFORMATION APPLICANT INFORMATION BUILDING PERMIT APPLICATION Address: 15904 OAK CANYON DRIVE Name 'COASTLINE INSTALLERS -•_7 ts„�ws Community Development APN 11031-341-12 Address 3301N STATE COLLEGE#102 ~ `e 2001 Grand Avenue Lot 1297 City,Zip Code ANAHEIM,CA 92806 Chino Hills,CA 91709 ,A: Cross Streets 1PEYTON DRIVE Phone/Pager (714)780-0278 1 ext 1 WY„.... °13, LICENSED CONTRACTOR DECLARATION Tract/Parcel 12625 I City Bus Lic#. 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 N/A OWNER BUILDER DECLARATION BERG I Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 115904 OAK CANYON DRIVE City,Zip Code I,as the owner of the property,or my employees with wages as their whole City,Zip Code 1CHINO HILLS,CA 91709 Phone I ext 0 compensation,will do the work,and the structure is not intended or offered for sale Phone (909)597-8474 I ext I Lie# I,as owner of the property,am exclusively contracting with licensed contractors to6 Bus Lie# City Bus Lie# construct the project I am exempt under Section BPC for this reason I I Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By 'DAWN FORSHA I hereby affirm under penalty of penury one of the following declarations Contractor COASTLINE INSTALLERS I Date Issued 15/8/02 Address 330 N STATE COLLEGE#102 Finance Code 106 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 ANAHEIM,CA 92806 Census Code which this permit is issued Phone or Pager I(714)780-0278 I ext I Final Date Bus Lie# 02-05646 Final By 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 # 771152 Extension workers'compensation insurance earner and policy number are Exp Date 11/30/03 Reviewed By INSURANCE INFORMATION Lie Ciass 1C36-HIC I Approved By Insurance Company State Fund PROJECT INFORMATION Policy Number 11589483-02 PROJECT DESCRIPTION LOCATION SQUARE FT. R Expiration Date 108/01/02 Structure © 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 yperson in any manner so as to become subject to the Workers'Compensation Laws of Porch I 1 alifomia and agree that if I should become subject to the workers'compensation provisions of Other WATER HEATER CHANGE GARAGE 50 GAL Section 3700 of the Labor Code I shall comply with those provisions WATER HEATER C/O IN GARA�r PROPOSED USE Date: i I Signature: i I s ._.- , I certify I have read this application and state that the above information is correct I agree to 50 GALLON WATER HEATER . PERMIT EXPIRED BY LIMITATION comply with all City Ordinances and state laws and hereby authonze representatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes '\ ,sar Date: i ti=j /p. /2_1_ Signature: 1_44 -1-- d--4/(;( I OTHER FEES REQUIRED Datb iratial u I PRIOR TO ACTUAL PERMIT ZONING SETBACK S GRADING PERMI ''r ISSUANCE Zoning PD Front Yard 1XISTINC Over X I 0 Issuance $30 00 I Electrical I $0 00 Land Use FR-1 Side YardSchool 1 N i Cut 0 Permit Fees: I $45.00 Development N Plan Check $0 00 Plumbing $15 00 Plan WATER HEATS Rear Yard p Fill 0 SMTP $0 00 Occ SSY Sewer N Mechanical $0 00 Structural $0 00 Total 0 Type NR Water N Geo Review I $0 00 Grading $0 00 I Total Fee Due 1 $45.00 '4 NSPECTION RECORD , Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL l 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 Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electrical Final Building/Construction Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground (Rebar/Copper) Hardware/Hold-Downs • ' Piers/Caissons/Tendons OTHER: Slab Grade ��� S.-k �� 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 eie, Voll b...\