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Permit No. 7306 r City of Cno Hills APPLICMON FOR BUILDING PERMIT Community Development 2001 Grand Avenue -0 Chino Hills,CA 91709 Building Address: Proposed Use - St No. 16530 Street QNYX RD RESIDENCE APN 1017-762-66 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 1 Block Tract 13507-6 N Struct, IN Plumb IN Applicant SI IMITOMO REALTY & DEVELOPMENT CA INC Mech LSI Elect LJ Gradina St No. 15707 Street ROCKFIELD BLVD STE 300 Type of Project l� New U Alter LJ Addition City IRVINE Zip 92718 Phone714-586-101 1 LI Repair L Convert LI Demo LI Occupancy Permit Owners IMITOMO R A TY & DEVELOPMENT CA INC Project 1 Location onSize Description Property I in Sq. Feet St No. 15707 Street ROCKFIELD BLVD STE 300 CitYIRVINE ZIP92718 Phone714-586-1011 1 LIVABLE I 11942 Engr/Arch Lic No. 2 GARAGE 1 1450 St No. Street 3 PATIO ,I 149 City Zip Phone 4 r I` .y I Contractor REMARKS/SPECIAL- CONDITIONS/PROJECT DESCRIPTION SUMITOMO REALTY & Lic No. 678246 Sewer I "Min`Depch I S/F/100 I Size St No. 15707 Street ROCKFIELD BLVD STE 300 YES City IRVINE Zip 92718 Phone714-586-101 1 Cubic Yards Excavation Fill Over Excavation , r City Business License License No 1315 Expiration DateO8/31/97 Licensed Contractor's Declaration 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 A License Number A7A94A , Date- ContractorsAMP ACAPltve C 'y 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 T ElElI, as the owner of the property, or my employees with wages as their whole w_.r....,. 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 Da I have and will maintain a certificate of consent to self-insure for workers' PD,IL1,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 compensation insurance carrier and policy number are Ins. Co.: Group/Division/Type Policy No: R3/VN Exp Date. VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less) $118,387 00 ❑ c I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become sub ect to the orkers' Compensation PERMIT FEES Laws of California and agree that if I should become su to the rkers' compensation provisions of Sectio 3700 of the Labor Code I II forth ith those Electrical $21362 ( Structural $943.82 provisions 1 Date �G d ___Signature - Warning F ilure to secure workers' compensation coverage is unlawful, and shall subject an Plumbing $234.00 Grading employer to cnminal 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 _:.bor Code, interest, and attorney's fees Mechanical $6882 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 $6057 and st.te law and hereby authonze representatives of this City Issuance Approved� I Total Permit Fee to e -r up.?j the above mentioned property for inspection $1,54983 pU r� 'a _...--.4 (/ 0 6 A Date Issued Permit Number Sig�ia�Gre- J^uof Applicant or Agent Dat 10/18/96 7306 (/-fit FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 jNSTRUCTION LENDING AGENC* 1- I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF fHE WORK FOR WHICH THIS PERMIT IS.„SUED (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 ❑ 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 D 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 IIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY + l BUILDING_INSPECTIONS RECORD L I DATE INSPECTOR PATE I INSPECTOR Setback/Location p tW-11.) W Rough Plumbing / /7279? / Temporary Power I Shower Pan Test // ]/ Foundation Reinforcing Steel It.I I —�"') Stucco Mesh or-Exterior Siding //7' • '. \i‘40Nik Excavation and Forms I ' II,�'; Insulation ., • I/ C•CJ/// AfjY Slab GradeI Sewer I I k'Z,(,, ilia �1O T Ground Plumbing Soil w (/II _ I r ) Interceptor Ground Plumbing Water i Septic Tank Underslab Ducts I Leach Line or Seep Pit Underslab Conduit I Water Service . 1,11/.61C4., 'L. 1 Underslab Gas Lath or Drywall Nailing -'w-�-- ') /°97./ Fireplace Foundation Gas Line Air Test Z—/9----Q'7 ,8– ' Joists and Girders -�, _ Final Energy -, V- Electrical Ground tiIte Di-)Di-) Final Plumbing SI0V Mid-Height Bond Beam Final Heating/A C V 8-Foot Bond Beam Final Construction 7 e- Final Bond Beam Final On Site Improvements / tie—YA a _7) Fireplace _7) Fireplace Bond Beam / , Final Off Site Improvements 1 / 1 I, _ - h Roof Sheathing �>4'�pl` I / el /r? � Q r� Final Dedication I � I /I I/ ()Iv v Framing and Ventilation r A / Final Zoning I ly 7' 1 ^ U i 1 Roof Covering A „I / L / Final Electrical I V / ^ IL �{ ` Rough Heating / r y rt/j' / Final Gas II / 1 j. I Service and Ground / � '` I' / ti 1/ V Developer Fees Paid /I J I rx,0______ Rough Electrical V / I Fire Dept Approval Verified I Bonding ,/ V Certificate of Occupancy Over Head Electrical ,7 dv Fence Height Gates Heater Pool Drainage SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE - LONG X DEPTH OF ROCK N W .„ E S Inspector's Signature and Initials - y I DATE OF ISSUANCE PERMIT NUMBER