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Permit No. 5519 City of Ciao Hills APPLICA•N FOR BUILDING PERMIT 1 Community Development 2001 Grand Avenue Chino HUIe,CA 91709 Building Address: Proposed Use - St No. 15418 Street OAKGROVE REROOF RESIDENCE APN 1031-39-109 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot Block Tract ® Struct ,p Plumb t ‘ N. ID Mech ❑ Elect p Gradin 3 V. Applicant WALNUT VALLEY ROOFING St No. 20850 Street CARRIE RD Type of Project ❑New ❑Alter ❑Addition City WALNUT Zip 91789 Phone 597-272) ® Repair ❑Convert ❑Demo ❑Occupancy Permit \ Owner JOEL VALDEZ ProjectLocation on Size Description I Property in Sq Feet St No. 15418 Street OAKGROVE I I City WALNUT Zip 91789 Phone 597_31231 REROOF Engr/Arch Lic No. 2 I I St No. Street 3 I I City Zip Phone 4 I I Contractor WALNUT VALLEY ROOFING Lac No. 678945 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer 1 Min Depth 1 S/F/100 1 Size St No. 20850 Street CARRIE RD �! City WALNUT Zip 91789 Phone 597-272'Icubic Yards Excavation Fill Over Excavation City Business License License No Expiration Date 24 SQUARE TILE REMOV ING EXISTING, REFELTING (� Licensed Contractor's Declaration --- -.___----�-------�--�---------� --__-m�____-' 1 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section &REAPPLYING EXISTING TILE. 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect License Class C-39 License Number 678945 Date 10/31/97 Contractor SAME AS ABOVE Address 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 .D I, as owner of the property, am exclusively contracting with licensed contractors to I 1 construct the project ❑ I am exempt under Sec__--, B&PC for this reason —___—_--__--- Data Initial - Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations ZoningI Land Use ❑ a I have and will maintain a certificate of consent to self-insure for workers' CH/PD,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the I work for which this permit is issued Setbacks 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 compensation insurance tamer and policy number are Ins. Co.: 97- Full) s Group/Division/Type Policy No: 1/07'708 —9y Exp Date: /2 — . -- C VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less) $5,000 00 ❑ c I certify that in the performance of the work for which this permit is issued I shall PERMIT FEES riot 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 ooff7Section 3700 of the Labor Code IIshall fort th comp! wit those Electrical Structural $86.40 provisions G — //1/7 � Date– _—__— ___ –� –_Signature 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 for in Section 3706 of the Labor Code, inteiest, 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 authonze representatives of this City Issuance Approved Total Permit Fee to enter upon the above mentioned property for inspection DC ( $115.40 purposed" `7 /J 01,,Z.: /L /2 5-C— Date Issued Permit Number Signature of Applicant or Agent Date 12/06/95 ( 5519 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 0/S •ONSTRUCIION LENDING AGENCOt I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR I HF i'I-I II OIIMANCE 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 INDUS!RIM SAFE I Y 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 FEE[IN DEPTH,INTO WI IICI I A PFRSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,SI RUC!11RE_,SCAFFOI DING,FAL SEWORK,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 11EOt111a=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 OUES1IONNAIRE AND I HE WORK API'I IED FOR ON I HIS PERMIT DIS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTFI AND SAFELY CODE AND IIIE I OCAI AIR ORAL11Y AGENCY I BUILDING INSPEC PIONS RECORD DATE ' INSPECTOR DATE I INSPECTOR Setback/Location Rough Plumbing I Temporary Power Shower Pan rest - I Foundation Reinforcing Steel Stuco;o Mesh or Exterior Siding Excavation and Forms Insulatini Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Seatic Iank Underslab Ducts ' ' ' Leach Line or Soop Pit Underslab Conduit _ Writer Seivice Underslab Gas Lath or Diywatl Nailing Fireplace Foundation Gas Line Air rest Joists and Girders Final Energy Electrical Ground Final Plumbing I 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 I Roof Sheathing Final Dedication I , Framing and Ventilation Final Zoning I 1 / Roof Covering Final Elects ical �� Rough Heating _ Final Gas / r „ Service and Ground Developer Fees Paid ! i WI X Rough Electrical _ Fire Dept Approval Verified _ �/ -A , \ v Bonding _ _ Certificate of Occupancy . /`V \I I r. - Over Head Electrical 1N -1—' ) Fence Height — — -- — — — / `,\I\ V Gates — — — \ -I` Heater Pool Drainage I SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X F)EP I H OF ROCK N - — -- W E S Inspector's Signature and Initials _ DA 1 E OF ISSUANCE PERMIT NUMBER