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Permit No. 2004-1894 • 1 T _ : ' BUILDING DIVISION OF COM DEVELOPMENT DEPARTMENT '''"'H 2001 Grand Avenue,Chino Hills,CA 91709 igt• � Cityof Chino Hills Counter Phone - ,4,rx, (909)364-2780 ! . .$ Building Permit 24-Hour Inspection Line - (909)364-2790 '• i•' (NOTE You must call before 3p m fora next business day inspection) c-iY or crr+uruusi City Hall Main Number (909)364-2600 ro.nye e-ec �0t; NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED PLEASE USE PERMIT NUMBER WITHIN 180 DAYS FROM DATE OF ISSUANCE, OR IF WORK IS SUSPENDED AT ANY BELOW WHEN MAKING TIME FOR MORE THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY INQUIRIES OR REQUESTING OR STATE LAWS RELATING THERETO INSPECTIONS PROJECT DESCRIPTIONPERMIT No ROOM ADDITION 300 SQ I 2004-1894 0 BUILDING ADDRESSAPT/UNIT No ISSUED DATE ISSUED BY /�{/y� 15955 OAK CANYON DR 1 I 03/28/2005 CFRUCT (-J/J�f/,/\.�/ APN 1 PARCEL MAP# 1 TRACT 1 LOT/PARCEL BLOCKCONST TYPE ZONE OCC LAND USE 1031-321-18 TR 12625 318 1 V-N 1 UN I R-3 I Residential CENSUS S CODES OVERLAY DIST I R1 OBLDG SOFT SPA PE I PROJECT T PERMITSL ME SL PETBACC 2KOFY I SETOBACK RY SETBACK SSY I SES BACK SY 4FEES Description Calc Paid w BERG, TIMOTHY Plan Check PC $185 33 $185 33 15955 OAK CANYON DR 0 CHINO HILLS, CA 91709 Total Paid 12/14/2004 $185 33 Issuance/Suppl F $29 00 $29 00 SMIP $2 10 $2 10 Structural $285 12 $285 12 Mechanical $24 42 $24 42 Electrical S $33 00 $33 00 O Plumbing $6 00 $6 00 U gContr Lic. D❑ODEEDO❑LU0D00000000❑❑❑000❑❑❑❑UUDDOODDODOODUUODUE Total Paid 3/28/2005 $379 64 p Expiration. DDDUD00000 U License Type ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑00000D0000000000000UDUULUCDDDUU0[ID❑ , Workers Comp:❑❑❑❑❑0000❑000000000000❑❑❑00000000D0000000000000[IDO Grand Total $564 97 $564 97 Expiration. EDDELD0000 Bus License 00D0000000000000001=000D00100000❑00❑❑❑UUUU❑❑❑U[IDE Expiration 0000000000 • LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect In secunng this permit I am acting with the knowledge of and on the • behalf of the owner of the property I PROJECT DESCRIPTION Date Contractor OWNER-BUILDER DECLARATION i ROOM ADDITION 300 SQ ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason(Sec 7031 5 Business and Professional Code Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt there from and the basis for the alleged exemption Any violation of Section 7031 5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500) 7 ❑ I, as owner of the property,or my employees with wages as their sole compensation,will do the work, and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale If however,the building or improvements is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for the purpose of sale) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct I PROJECT INFORMATION the project(Sec 7044, Business and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such I Desc I Location I Sq Foot I Valuation projects with a contractor(s)licensed pursuant to the Contractors License Law) I ROOM ADDITION REAR 300 $20,190 00 ❑ I am Exempt under Article 3 of the Busines$and l ofessions Code 1 \Date 3p_c I US Owner< (A,L 3LA S>`9i WORKERS COMPENSATION DECLARATION ) I hereby affirm under penalty of perjury one of the following declarations ❑ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Total Valuation $20,190 00 permit is issued I certify that I have read this application and state that the above information — -❑-- I have-and-will maintain workers_compersat.on insurance, as required-by-Sect on-3700-the -is_correct I agree to comply with_allcity and county ordinances and state ____ Labor Code,for the performance of the work for which this permit is issued laws relating to building construction,and hereby authorize representatives of this cpurtoy,to enter upon the above-mentioned property for inspection ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ pur ses any person in any manner soIhaulto becoeme subject tot the worker'ss compensation compensai compensation laws of is / I/ x ��A e n n f !L 3/gi/ocp California,and agree that if I should become subject to the worker's compensation provisions VN/t �'J.t�G�Y S[ V _ �1�L)Snv"�"1 I of Section 3700 of the Labor Code,I shall forthwith comply with those provisions APPLICANT SIGNATURE DATE LAPPLICANT INFORMATION (f BERG, TIMOTHY 115955 OAK CANYON DR 1CHINO HILLS, CA 91709 Date Applicant 1714-680-4181 WARNING Failure to secure worker's compensation coverage is unlawful,and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars($100,000),in I certify that the use of this facility shall comply with sections 25505,25533, addition to the cost of compensation,damages as provided for in Section 3706 of the Labor Code, and 25534 of the Health and Safety Code,which regulate the storage, interest,and attorney's fees handling and use of hazardous materials 1 • • CITY OF CHINO HILLS COMMUNITY DEVELOPMENT—BUILDING &SAFETY DIVISION Call (909)364-2790 before 3.00 p m for next day inspection " Post in a safe, conspicuous place at front of job Provide permit number when calling for inspection Have approved plans on job at time of inspection NO WORK SHALL BE COVERED WITHOUT INSPECTION File this permit with your permanent records when job is complete INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading Block Wall Inspections Pregrade Meeting Footing, Rebar Rough Grade 1s`Lift Bond Beam Terraces 2nd Lift Bond Beam Sub Drains 3'd Lift Bond Beam Finish Grading Drain/Seal Soils Certification Grading Certification Rough ReRoof Tear-off, Existing Conditions Underground Site Inspections Sheath Nailing Building Sewer Line Roof Final Water Supply Line U/G Electrical Service Conduit Swimming Pools Storm Drain/Catch Basin Location/Rebar/Bonding/Light DO NOT BACKFILL UNTIL ABOVE IS APPROVED Gas Test Gr Conduit Verify Soils Engineering Ro Elect Compaction,moisture,conditioning,etc POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence, Gate&Alarm Underfloor/Underslab Inspection Final Pool U/F Waste Plumbing U/F Water Fire Protection Equipment. ▪ U/F Mechanical UG Pipe U/F Electrical Thrust Blocks U/F Framing Hydro • U/F Insulation Flush Subfloor Weld Outlet Insp ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Overhead Hydro Foundation Inspection ���� Temp Power Pole Setback/Footing—OK to Pour ) Electric Release UFER Ground(Rebar/Copper) - // Gas Test Hardware/Hold-Downs Piers/Caissons/Tendons / FINAL INSPECTIONS Slab Grade—OK to Pour NO OCCUPANCY PERMITTED WITHOUT FINAL DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVEt- County Environmental Health Dept (391-7570) Shear Inspection(Wood) Planning Dept (364-2752) Roof Nailing 1—lc-z9j e Public Works (364-2774) Exterior Walls 5—'23 S Fire (393-3888) Interior Walls Landscape (364-2766) Hardware/Hold-Downs /,�1�f ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Final Grade Combo inspection Final Electric Framing / Final Plumbing ,/ 1/ Rough ElectricFinal Mechanical j Rough Mechanical 6/7" Final Building/Construction 1/ if/V Rough Plumbing/Topout Water Meter Number COVER NO WORK UNTIL ABOVE IS APPROVEDRO /� 5 CERTIFICATE OF OCCUPANCY Insulation OK TO ISSUE Drywall Inspection OTHER Interior Exterior / 9 � EXT LATH Stucco Scratch Miscellaneous Inspections Masonry Fireplace Plate Ties,Fire Block Patio/Deck Footing Frame Access/Light/Switch NOTICE TO OWNER Call for FINAL INSPECTION on every job This permit will expire if work is suspended or abandoned for a period of Patio Final 180 days 05/24/2005 13:28 7147777773 INLAND ENG PAGE 02 • 0 I E. INLAND ENGINEERING & CONSULTING, INC. Structural Design •Planning- Consulting 4883 E. La Palma Ave. Suite 501.A Anaheim, California 92807-1957 (714) 777.7700 May 24,2005 Chino Hills Building Department Chino Hills,CA RE: Berg Residence 15955 Oak Canyon Drive Chino Hills,CA 91709 To Whom It May Concern: Our office deems it acceptable that 15/32 OSB plywood struc. I be used for the roof and shearwall sheeting in lieu of'A"CDX plywood. Also,the HUC46 hangers used at the gar.header to post are an acceptable form in making the header connection. ...„, ,..,_ Please call us wi Vitali°, c•-, Ga it* , Sincerely, c:6 ‘e-rN t'e4 NO. EXP. 6-60..0; 4. : -6 ,:A.e) r - '77r .1& Shawn Nikjoo,P.E. ---- Inland Engineering&Consulting,Inc. ..-