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Permit No. 6281 City of *lino Hills 0oPP,I-ieTION FOR RIJII_DING PERMIT 'i• Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St Nod 5998 StreePAK CANYON DR C ARAGE CONVERSION TO OFFICE APN 1031-321-10 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot Bleck Tract El Struct El Plumb ApplicantMARK RIGGAN Mech ®Elect El Grading St No.15998 StreetOAK CANYON DR Type of Projec❑ New 0 Alter ❑Addition Cit,9HINO HILLS Zi 91709 Phone 597-7031 Li Repair ® Convert III Demo III Occupancy Permit OwnekAARK RIGGAN Project I Location on I Size Description Property in Sq Feet ---Z St No15998 StreeOAK CANYON DR ,-Z Cit f HIND HILLS 491709 Phone 597-7031 BAR CONVERT I 2 35 )% Engr/Arch Lic No 2 I I cp St No. Street 3 I I City Zip Phone 4 I I Contractor Lic No. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min Depth I S/F/100 I Size c--- St No. Street City Zip Phone Cubic Yards Excavation Fill Over Excavation City Business License License No Expiration Date R(i0M NOT TO BE USED AS A SLEEPING AREA C::>< Licensed Contractor's Declaration - - - — . .. 1 I hereby affirm that I am licensed under the 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 License Class License Number T y Data Contractor -17 Address City and Zip Phone Builder Declaration I hereby affirm -I am exempt from the Contractor's License Law for the following reason , as the owner of the property, or my employees with wages as their whole compensation, will do the work, and the structure is not intended or offered for sale r,--` I, as owner of the property, am exclusively contracting with licensed contractors to L.1 construct the project 0 I am exempt under Sec_____,B&PC for this reason m- ________ D / atea_ _Initial /r'!,K-4,-- Workers' Compensation Declaration i hereby affirm under penalty of perjury one of the following declarations Zoning Land Use Da I have and will maintain a certificate of consent to self-insure for workers' PD,FR1 �. compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued Setbacks I Model/Plan ❑ b I have and will maintain worker's compensation, as required by Section 3700 of the FY I SY I LaborCode, for the performance of the work for which this permit is issued My worker's Ry I SSY li compensation insurance carrier and policy number are Ins. Co: Group/Division/Type Policy No. Exp Date VALUATION (This dectro not be completed if the permit is for one hundred doolars($100) or less) $1,,380 00 c I certify that in the performance of the work for which this permit is issued I shall PERMIT FEES not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code I all forthwi • comply with those Electrical $20 25 Structural $118.80 provision � Z' odic_— -- __—_Srgnat — Warning Failure to secure workers' compensation coverage is u l.;"ul, and shall subject an Plumbing Grading employer to criminal penalties and civil fines up to one hundred t •usand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees Mechanical $9 99 Issuance $29 00 I certify that I have read this application and state that the above information is correct. I agree to comply with all City Ordinances Geo Review Plan Check and state laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to enter u on the- above mentioned property for inspection )c $178 04 pu C_. f 4�/� /,_ Date Issued Permit Number Signature of Applicantgent Date 5/3/96 6281 ,. FINANCE CODE CENSUS CODE Print Applicant's/lnt's Name C4 434 INSTRUCTION LENDING AGENCI , I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) • LENDER'S NAME LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW O I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,IN1 O WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK V. WOULD REQUIRE A PERMIT,IFRO,M THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAI"DIVISION i_ wr DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER • I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT NOT SUBJECT-TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND-SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY , - -' r BUILDING INSPECTIONS RECORD DATE INSPECTOR I DATE I INSPECTOR Setback/Location I I Rough Plumbing I I Temporary Power I Shower Pan Test I I Foundation Reinforcing Steel I I Stucco Mesh or Exterior Siding I I Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor I Ground Plumbing Water Septic Tank Underslab Ducts "' Leach Line or Seep Pit I I Underslab Conduit Water Service Underslab Gas Lath or(all Naili z —' ' '43-/ Fireplace Foundation Gas Line Air Test I Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A C I 8-Foot Bond Beam Final Construction (TU Final Bond Beam I Final On Site Improvements Fireplace Bond Beam I Final Off Site Improvements Roof Sheathing Final Dedication Framing and Ventilation /,3/1J•�, �j CJ Final Zoning Roof Covering + 5j Final Electrical ' 11(4(61(b, Rough Heating Final Gas Service and Ground _ Developer Fees Paid Rough Electrical Fire Dept Approval Verified I Bonding I I Certificate of Occupancy I I Over Head Electrical I I I I Fence Height I Gates I -, Heater Pool Drainage 7.Y//4 7tV Zdel -e1;4-c a) 44,z/Aa i.✓J SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S'z • - Inspector's Sign- ature and Initials DATE OF ISSUANCE PERMIT NUMBER