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Permit No. 2012-26036 �, 0 BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT {)j . , City of Chino Hills 4000 City Center Dc,Chino Hills,CA9t709 / bx Counter Phone (909)364-2780 /// Building Permit 24-Hour Inspection Line (909)364-2790 I If (NOTE You must call before 3p.m.for a next business day inspection) City Hall Main Number (909)364-2600 Lffiffiffilffik.: +Y_ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. I PERMIT No. REPLACE(15)WINDOWS AND(2)SLIDING DOORS 2012-26036 33680 BUILDING ADDRESS I APT.!UNIT NO. ISSUED DATE ISSUED BY 2142 OAK CANYON LN 6)5/2012 Heredia,Monica 03 08120 I TRACT MAIM I 49-1 LT I FLOORS(UNITS I PROJECT PERMITS P.TYPE / CENCUS AESt I CONST. TYPE (ZONING TYPE I OOCCCUPANCY TYPE I VALUATION 54000 00 I TOTAL SOFT 0.001 BLDG.SOFT 434 Res Current Owners: Fees Name:JEANNETTE FUENTES Fee Group l Fee Description Fee Amount Payments Address, 2142 OAK CANYON LANE CHINO HILLS CA 91709 Transaction Type Ph' 626-625-9037 Window $185.50 Email' M@CH.ORG Replacement Contractor THOMPSON'S HOME RESTORATION 8001 Permit Issuance Fee $53.00 53.00 Address: 17087 GROVE DR RIVERSIDE CA 92503 839-853 Residential Structural Fee $78.50 78.50 Ph: (951)232-5779 Email: M@CH ORE Lk.Informatfon936738 E .Date:8131/2013 581473 $t 00 1.00 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION OL-Business License Yearly $53.00 53.00 I hereby afire under penalty of pequry that I am licensed under provisions of Chapter 9(commencing with Sec.7000)of Division 3 of the Business and Professions Code,and my license is in full force and TOTAL FEES $185.50 effect In securing this pent I am acting with the knowledge of and on behalf of the owner of the property. AMOUNT PAID $185.50 ` bate: a G•-G t i 1-6ontractor. 5 BALANCE DUE $0.00 OWNER-BUILDER DECLARATION I hereby affirm under penalty of pequry that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,pnor 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 therefrom and the basis for the alleged exemption Any violation of Sec.7031.5 by any applicant for a permit subjects the applicant to a owl penalty of not more that five hundred dollars($500.00) I,as owner of the propterty,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 improvement is sold within one year of completion,the owner-builder will have the burden of proving that he 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 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 protects with a contractor (s)licensed pursuant to the Contractors License Law) I am exempt under article 3 of the Business and Professions Code. Date. Permittee. Pnnt Full Name: WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of pequry one of the following declarations I have and will maintain a certificate of consent to self-insure lir workers'compensation,as I certify that I have read this application and state that the above information is correct I agree to comply provided for by section 3700 ofthe Labor Code,for the performance of the work for which this permit is with all city and county ordinances and state laws relating to building construction,and hereby authonze issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes I have and will maintain workers'compensation insurance,as required by Section 3700 of the (A Labor Code,for the performance of the work for which this permit is issued. My worker's compensatio? insurance comer and policy number are, `K, 1- "\v r. &—C —7oIa.- Cameo Policy ELICANT SIGNATURE DATE tr Applicant: GREG THOMPSON I certify that in the performance of the work for which this permit is issued,I shall not employ any "person in any manner so as to become subject to the worker's compensation laws of California,and Address' 17087 GROVE DR RIVERSIDE CA 92503 agree that if I should become subject to the worker's compensation provisions of Section 3700 ofthe Ph: 951-232-5779 Email M CH.ORG Labor Code,I shall forthwith comply with those provisions. @ Lic.Information Esq, Date' Date: , ¢ _.,--i --- °IZ clkApplicant" J '$\pq Safety Code,which regulate the storage,handling and use of hazardous materials RNING. Failureto aecure worker'sworker's compensation coverage is unlawful,anb shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of compensation,damages as provided for in section 3706 ofthe labor Code,interest,and I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and attorney's fees