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Permit No. 14807 BUILDING ADDRESS: 3230 PAISLEY PERMIT NUMBER: 14807 i'll � � BUILDING INFORMATION APPLICANT INFORMATION or BUILDING PERMIT APPLICATION Address 13230 PAISLEY Name 1DUSTIN CAMPBELL • a;,x Community Development APN 11017-881-22 Address 12750 PERRIS BLVD i'..-1. 2001 Grand Avenue '''r" Chino Hills,CA 91709 Lot IG,GTE City,Zip Code 1Pems,Ca 92571 1. L ''' Cross Streets 'WILLOW RUN I Phone/Pager 1(909)657-0431 I ext I °"°'°O°® ' LICENSED CONTRACTOR DECLARATION Tract/Parcel 115736 1 City Bus Lic# 1n/a I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$5,000 00 — ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect OWNER INFORMATION Name OWNER BUILDER DECLARATION Name JOHN LAING Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 10737 LAUREL ST,STE 2 City,Zip Code I,as the owner of the property,or my employees with wages as their whole City,Zip Code 1RANCHO CUCAMONGA,CA 91730 Phone I ext I © O compensation,will do the work,and the structure is not intended or offered for salePhone 1(909)481-7700 ext I I Lie# I,as owner of the property,am exclusively contracting with licensed contractors toCity Bus Lie# construct the project Bus Lie# I Bus Exp 1 1APPROVAL INFORMATION © I am exempt under Section BPC for this reason WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By 1DORIS CARPENTER I hereby affirm under penalty of perjury one of the following declarations Contractor Power Plus 1 Date Issued 08/25/1999 Address 5026 PERRIS BLVD Finance Code C4 I have and will maintain a certificate of consent to self-insure for workers'compensation © as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code Pems,Ca 92571 Census Code 1 which this permit is issued Phone or Pager (909)657-0431 ext i Final Date I 8-_a?-Tci---1 Bus Lic# Final By I have and will maintain workers'compensation,as required by Section 3700 of the I (rnS/ © Labor Code,for the performance of the work for which this permit is issued My Lic # 523596 Extension 1 workers'compensation insurance earner and policy number are Exp Date 1-00 1 Reviewed By 1 1 INSURANCE INFORMATION Lie Class C-10 I Approved By Insurance Company State Fund 1 PROJECT INFORMATION / Policy Number 1555110-99 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date I3-31-01 Structure ITPP I 1 1 1 0 1 © Section need not be completed if permit is for one hundred dollars($100)or less Garage 1 1 I I i I certify that in the performance of the work for which this permit is issued I shall not employ Patio 1 I I I 1 •any person in any manner so as to become subject to the Workers'Compensation Laws of Porch I I • California and agree that if I should become subject to the workers'compensation provisions of 1 1 1 1 1 Section 3700 of the Labor Code I shall comply with thos-p •••• sions I Other __!�`. ,` A PROPOSED USE 19-sub Temporary Power Poles Date. i�—a-9 Signature. \'' PE 1 i ' I certify I have read this application and state that the •: � .- — • e information is correct I agree to comply with all City Ordinances and state laws and hereby autho ze epresentativjs of this City to enter upon the above mentioned property for i ctitKprp es f �t I COMMENTS Date. I j--0-5- Signature- \ OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning Front Yard Over X I 0 issuance $45 00 Electrical $427 50 Land Use 1 Side Yard Cut School N I I Permit Fees: $472.50 1 Plan Rear Yard Development 1 N Plan Check $0 00 Plumbing $0 00 i Fill I I SMIP $0 00 Occ SSY Total 0 Sewer I N I Mechanical I $0 00 Structural I $0 00 1 Type 1 Water 1 N 1 Geo Review I $0 00 Grading 1 $0 00 Total Fee Due I $472.50 INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Block Wall Inspections Pregrade Meeting Footing,ReBar Rough Grade 1st Lift Bond Beam Terraces 2nd Lift Bond Beam Sub Drains 3rd Lift Bond Beam Finish Grading Drain/Seal Soils Certification ReRoof Grading Certification Tear-off,Existing Conditions Rough Sheath Nailing As Built Approved Roof Final Underground Site Inspections Swimming Pools Building Sewer Line Location/Rebar/Bonding/Light Supply Water Line Gas Test Storm Drain/Catch Basins Gr Conduit/Ro Elect U/G Conduit/Electrical Pre-Deck DO NOT BACKFILL UNTIL ABOVE IS APPROVED POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Verify Soils Engineering Fence,Gate&Alarm Compaction,moisture,conditioning,etc Final Pool Underfloor/Underslab Inspection Fire Protection Equipment U/F Waste Plumbing UG Pipe U/F Water Thrust Blocks U/F Mechanical Hydro U/F Electrical Flush U/F Framing Weld Outlet lnsp Insulation Overhead Hydro Subfloor ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Temp Power Pole _7")/_ Foundation Inspection Electric Release Setback/Footing Gas Test UFER Ground(Rebar/Copper) Hardware/Hold-Downs FINAL INSPECTIONS Piers/Caissons/Tendons NO OCCUPANCY PERMITTED WITHOUT FINAL DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED County Environmental Shear Inspection(Wood) Health Dept (391-7570) Roof Nailing Planning Dept (364-2750) Exterior Walls Public Works (364-2770) Intenor Walls Fire (393-3888) Hardware/Hold-Downs Landscape (364-2797) Combo Inspection ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Framing Final Electric Rough Electric Final Grade Rough Mechanical Final Plumbing Rough Plumbing/Topout Final Mechanical COVER NO WORK UNTIL ABOVE IS APPROVED Final Budding/Construction Insulation Water Meter Number Drywall Inspection. Intenor CERTIFICATE OF OCCUPANCY Exterior OK TO ISSUE Lath Stucco ScratchOTHER � J" MISCELLANEOUS INSPECTIONS a. / • Masonry Fireplace Plate Ties, Fire Block, Patio/Deck Footing Access/Light/Switch Patio Final 1 i • S t