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Permit No. 10703 CITY OF CHINO HILLS Community Development 2001 Grand Avenue \ -5. Oirk i`/'e_e____ 0 o T cJt‘e _ APPLICATION FOR BUILDING PERMIT Chino Hills,CA 91709 LICENSED CONTRACTOR'S DECLARATION APPLICANT INFORMATION BUILDING INFORMATION Permit Number: f I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Name POWER SANITATION Address 11359 OAK TREE CIRCLE 110703 Section 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect Address 12056 MT VERNON#115 APN 11000-191108 Contractor POWER SANITATION City,State Zip GRAND TERRACE, CA 92313 Lot* Address 12056 MT VERNON #115 City,State Zip GRAND TERRACE,CA 92313 Phone (909)872-1922 Block Phone (909)872-1922 City Bus Lic# Tract License Class C-42 License# 679128 City Bus Exp Valuation $0 00 Date 10-30-97 OWNER INFORMATION al OWNER BUILDER DECLARATION eby affirm that I am exempt from the Contractor's License Law for the following reason Name B A PROPERTIES Proposed Use ISEEPAGE(3) p, I,as the owner of the property,or my employees with wages as their whole Address 333 S BRAUDRY AVE I compensation,will do the work,and the structure is not intended or offered for sale Project Descnption Location on Property Square Feet DI,as owner of the property,am exclusively contracting with licensed contractors to City,State Zip LOS ANGELES,CA 90017 Livable I 0 construct the project Phone I Garage nI am exempt under Section I I BPC for this reason I I I Porch City Bus Lic# Patio I WORKERS'COMPENSATION DECLARATION City Bus Exp Zoning Setbacks I hereby affirm under penalty of perjury one of the following declarations ENGINEER/ARCHITECT INFORMATION Land Use ❑ Name AM/PAC I have and will maintain a certificate of consent to self-insure for workers' FY compensation as provided by Section 3700 of the Labor Code,for the performance Model/Plan SY of the work for which this permit is issued Group RY: Address P 0 BOX 545 Division I have and will maintain workers'compensation, as required by Section 3700 of the SSY Labor Code,for the performance of the work for which this permit is issued My City,State Zip NORCO, CA 91760 Type , workers'compensation insurance carrier and policy number are PERMIT FEES Phone (909)780-0150 0 Insurance Company I Electrical I$0 00 Policy Number I City Bus Lic# Geo Review I$0 00 Expiration Date I APPROVAL INFORMATION Grading 150 00 City Bus Exp Issuance $30 00 X❑ Section need not be completed if the permit is for one hundred dollars($100)or less Approved by IWINSTON WARD Eng/Arc Lic# Mechanical. $0 00 Date Issued 1144 297 I certify that in the performance of the work for which this permit is issued I shall not Plan Check $0 00 employ any person in any manner so as to become subject to the Workers'Compensation Finance Code. Ic a Laws of California and agree that if I should become subject to the workers'compensation Census Code. I Plumbing $135 00 provisions of Section 3700 of the Labor Code I shall comply with those provisions Comments Structural $0 00 v1,� �p� 1 0 Total Permit Fee: $165.00 Date. I /c9A0 // ) I Signature I c) - Z- I FI c , '`V nc pc , ��0 ,c.„1._.. r I certify I have read this application and state that the above information is correct I agree V �/-, ` Itri I, "ems- SMIP: $0 00 to comply with all City Ordinances and state laws and hereby authorize representatives of `�� Total with SMIP. $165.00 / this City to enter upon the above mentioned property for inspection purposes / Date I/6/49// I Signature L(/ r 7 = I / ( CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY 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,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 O 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 O IS O IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING AND SAFETY DIVISION PERMIT !!! Call(909)590-1511 Ext 282 before 3 00 p m for next day inspection. INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Miscellaneous Inspections: Pregrade Meeting Masonry Fireplace Rough Grade ('d applicable) Terraces Plate Ties Throat Damper Sub Drains Shower Pan Temp Power Pole Finish Grading Electric Green Tag(winng to be protected) Soils Certification Ground Rod Grading Certification Gas Test(after drywall) Rough Gas Yellow Tag Final Other As Built Approved Reroof: Underground Site Inspections: Tearoff Building Sewer Line Roof Nail/Existing Conditions Supply Water Line Swimming Pools: Storm Drain/Catch Basins Location on Site U/G Condurt/Electncal Rebar Bonding DO NOT BACK FILL UNTIL ABOVE IS APPROVED Gas Piping/Test Verify Soils Engineering: Predeck Compaction,moisture,conditioning,etc Final - Underfloor/Undersalb Inspection: U/F Waste Plumbing FINAL REQUIRED-POOL NOT TO BE FILLED U/F Water UNTIL FENCING IS COMPLETE U/F Mechanical Fire Protection Equipment. U/F Electrical UG Pipe U/F Framing Thrust Blocks OK to Install Insulation Hydro OK to Install Subfloor Flush Weld Outlet Insp ABOVE IS REQUIRED PRIOR TO FOUNDATION INSP. Overhead Hydro Foundation Inspection: Other Setback Test/Final Perimeter Footings Interior Footings FINAL INSPECTIONS UFER Ground(Rebar/Copper) (NO OCCUPANCY PERMITTED WITHOUT FINAL) Hardware/Hold-Downs County Environmental Piers/Caissons/Tendons Health(if required) OK to Pour Concrete Public Works Fire DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Landscape Shear Inspection(Wood): Building Exterior Walls Interior Walls CERTIFICATE OF OCCUPANCY HardwareMold=Downs OK to Install Lath Connection to Roof(rf required) OK TO SUPPLY Roof Nail Inspection: Frame Inspection: OTHER: Framing Lath 3 0, PA&E-- PI/—S /0-7-' 7 Plumbing Topout ' _--- Rough Mechanical -- --- Multi-Story Waste Test OK to Insulate OK to Place Drywall - - __- COVER NO WORK UNTIL ABOVE IS APPROVED Drywall Inspection: Nail/Screw NOTICE TO OWNER Drywall Shear Nailing Call for FINAL inspection on every pb This permit will expire if work e OK to Tape Drywall suspended or abandoned fora penod of 180 days Can for inspection every 180 days to help kee active OK to Stucco � ,