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Permit No. 8907 City of C no Hills APPLICATI• FO ' : : LDING PERMIT Community Development (---- ' 2001 Grand Avenuei Chino Hills,CA 91709 Building Address: Proposed Use - St No. 3098 Street OAKCREEK RD ROOM ADDITION APiv 1031-321-53 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 339 Block Tract 12625 ®Struct 0 Plumb. 0 Applicant PREFERRED BUILDERS Mech. ®Elect. ❑Grading Street St No. 15618 ESTHER ST Type of Project 0 New 0 Alter ®Addition City CHINO HILLS Zip 91709 phone 597-4417 0 Repair 0 Convert. ❑Demo ❑Occupancy Permit Owner BRUCE BRAYSHAW Project I Location on I Size St No. 3098 Street OAKCREEK RD Description Property in Sq Feet City CHINO HILLS Zip 91709 Phone 990-9238 i ADDITION I 1186 Engr/Arch Lic No. 2 LOFT I 130 f � , St No. Street 3 I I v" City Zip Phone 4 I I 0 Contractor PREFERRED BUILDERS Lic No. 540331 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min Depth I S/F/100 Size St No. 15618 Street ESTHER ST City CHINO HILLS Zip 91709 Phone 597-4417 Cubic Yards Excavation Fill Over Excavation Qic) City Business License License No NEW Expiration Date Licensed Contractor's Declaration I hereby affirm that I am licensed under the provsions of Chapter 9(commencing with Section 7000 of Division 3 of the Business and Professions Code)and my license is in ful force and effect License (lass a License Number 540331 - Date 9/30/98 Contractor SAME AS ABOVE Address ----- -- City and Zip Phone /� Owner Builder Declaration �� — 1 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. 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project le El1 atm 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 Land Use I o lja I have a maintain a certificate of consent to self-insure for workers' compensation as provided tion 3700 of the Labor Code,for the performance of the work for which this permit I Setbacks ModeV Plan Fr I Sr 5E,10W 1 b I have and will maintain worker's compensation, as required by Section 3700 of the it LaborCode, for the performance of the work for which this permit s Issued My worker's RY 2 I SSY compensation insurance carrier and policy number are Group/Division/Type Ins. Co.: Policy No: _c. / q VALUATION Exp $10,913.00 dectan need not be completed if the permit is for one hundred doobrs(5100)or less) PERMIT FEES c.I certify that in the performance of the work for which this permit is issued I shall not employ any person 'y manner so as to become subject to the Workers'Compensation Laws of California $23 76 $166.32 and that it I should become subject to the workers'compensation provisions of section 3700 Electrical Structural of Labor Code 1 shall forthwith comply with th ovtsioris. Dar. tD 1 1 el 7 sgnatur.� Plumbing Grading Warty 7,• rc'. _ , - - - - -i- --,:_••,..: ' rful,and shall subbec.t an i:.Eao,r, ' to criminal penalties and civil fines up to one hundred thousand dollars($100,000),in addition to Mechanical Issuance $2900 the cost of compensation,damages as provided for In Section 3706 of the Labor code,Interest,and lacer f Y1iat I have read this application and state that the above inforation is correct. I agree to comply with all City Ordinances Geo Review Plan Check m and state-laws and hereby authorize representatives of this City Issuance ApprovedTotal Permit Fee to e, er upon the above mentioned property for inspection DC I $219,08 p I es. I c -4• • xi- Date Issued Permit Number Sign.t re i) AppliIant or Agent Date 6/19/97 I $907 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 434 • ONSTRUCTION LENDING AGENC• 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 ❑ 1 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 36 FEET HIGH ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAT ET f,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 DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE I INSPECTOR Setback/Location 7- 3 a q7 L✓. Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel I �q1 f �/ Stucco Mesh or Exterior Siding C'j-1C- 7 Excavation and Forms Insulation PZ Slab Grade 7- 30-I)1 IZ'l__. Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing /5-15- Fireplace -15-Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A C 8-Foot Bond Beam Final Construction /.D -f,().q 1 / ' Final Bond Beam Final On Site Improvements Fireplace Bond Beam _ Final Off Site Improvements Roof Sheathing p(-i��7/1 b,, Final Dedication Framing and Ventilation L/ - Final Zoning _- Roof Covering Final Electrical /,p -U2'91aef Rough Heating g'- g'' Final Gas Service and Ground Developer Fees Paid Rough Electrical - S -q7 Fire Dept Approval Verified Bonding Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage 5u . i W AL)A-t -X- ` 1 --- SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N t-Y W E. • -, . S Inspector's Signature and Initials O �o - D�ti DATE OF ISSUANCE PERMIT NUMBER