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Permit No. 6711 Hills of CI �o Hills APPI ICA•N FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino fill's,CA 91709 Z tet v►py 7"' — A// I Building Address: Proposed Use - St No. 2077 Street OAK CANYON STORAGE ADDITION APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot Block Tract ZI Struct ❑ Plumb Applicant AUSTIN CONST LI Mech CI Elect ❑ Gradina St No 2321 Street W PARK ABLVD Type of Project ❑ New ❑Alter ®Addition City SANTA ANA Zip 92706 Phone 714-543-0238 ❑ Repair ❑ Convert ❑Demo ❑ Occupancy Permit Owner GLENN SEKINS ProjectLocation on Size Description I Property in Sq Feet St No 14800 Street BLUEBELL DR City CHINO HILLS Zip 91709 Phone 597-12441 STORAGE ADDN I 1303 Engr/Arch Lic No 2 I I St No. Street 3 I I City Zip Phone 4 I I Contractor AUSTIN CONST Lic No 409487 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min Depth I S/1/100 S17e St No. 2321 Street W PARK ABLVD City SANTA ANA Zip 92706 Phone 714-543-0238 Cubic Yards Excavation Fill Over Excavation City Business License License No Expiration Date ADDITIONAL S.F FOR SFR PERMIT. Licensed Contractor's Declaration - - - I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section µ_ __..__. _ 7000 of Division 3 of the Business and Professions Code)and my license is in full force and fe'rfrni,effect pn �_ w ( li_% License Class B License Number 409487 In. Date 7/31/97 Contractor SAMEASABOVE /I �� 14 P— Ser OnV,1 Address ._._.__ 'Li City and Zip Phone Owner Builder Declaration I hereby affirm that I am exempt from the Contractor's License Law for the following reason ❑ I, 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 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ❑ I am exempt under Sec , B&PC for this reason ,_-- — - - -""-" ""—`—""""" "` `- ""' " "" """" Date Initial_______ .-. -... ... -- . . . . _ . _ Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations Zoning I Land Use Oa I have and will maintain a certificate of consent to self-insure for workers' compensation provide ectton 3700 of the Labor Code, for the performance of the work for whichas ermit is issued Setbacks Model/Plan I have and will maintain worker's compensation, as required by Section 3700 of the I Y I SY LaborCode for the performance of the work for which this peimit is issued My worker's Ry I SSY compensatn insurance carrier and policy number are Ins C : 55 7 r%.--)q Group/Division/Type Policy No: Exp/bate VALUATION (Thins dection need not be completed if the permit is for one hundred dooiars($100) or less) $8,22600 IPc 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 e Labor Code I all forthw th compl with those $129 60 provisions Electrical Structural � �s„. sem] :.4......”: ,—. -- ✓ _✓---- / ---Signature /'s' i-- %:'�.' �7/ IP Warning Failure to secure workers' compensation coverage is unlawful, and shall subject an/ Plumbing Grading 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 fw in Section 3706 of the Labor Code, interest, and attorney's fees Mechanical 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 upon the above mentioned property for inspection DC $158.60 purposes. - A„:5,-e .� •••-7��'��‘ ` Date Issued Permit Number Signature• Applic nt/or AAggerii " Date 77A4 %`v rii� 7/23/96 6711 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 434 '' S— ZZI camW042,0,46,46 p • ISNSTRUCTION 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 ADDREcc 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 0 I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 38 FEET HIGH ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT 015 ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR I I DATE INSPECTOR Setback/Location I I Rough Plumbing I Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade I Sewer Ground Plumbing Soil I I Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas I I Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders I Final Energy I I/ Electrical Ground I Final Plumbing Mid-Height Bond Beam Final Heating/A C 8-Foot Bond Beam Final Construction I Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements / / n Roof Sheathing Final Dedication / / ,( I Framing and Ventilation Final Zoning I / ( /I Roof Covering Final Electrical I / d f--7 Rough Heating Final Gas / 1\1\/ Service and Ground Developer Fees Paid 11 A V Rough Electrical I Fire Dept Approval Verified I If A I V I Bonding Certificate of Occupancy I , I' II I Over Head Electrical A I\ / I V I Fence Height I / I I Gates / I Heater \\\ Pool Drainage I I I SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER 1