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Permit No. 2010-23457 City of Chino Hills BUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT 14000 City Center Dr.,Chino Hills,CA91709 Counter Phone (909)3642780 i ..-. Building Permit 24-Hour Inspection Une (909)364-2790 r�illiv (NOTE:You must call before 3p.m.fora next business day inspection) ~' City Hall Main Number (909)364-2600 NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBtR 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJ CT DESCRIPTION PRO ECT (19)RETRO-FIT WINDOWS THROUGHOUT(E)SFD. 20102-24357No. PERMIT No. B ADDRESS 25166 PA EO ORTUGA- I APT./UNIT NO. I 12/20/2010 ISSUED A�V I WhitemanED ,Y Rosemary 1APN O43104 ITR C 2MAP# 1LOT IFLOORS/UNITS 1PROJECT PERMITS IP.TYPE 110ENCUS CODES 1CONST.TYPE I ZONING TYPE IOCCUPANCY O TYPE I VALUATION $9 OOO.00 I TOTAL SQFT 0.00 1BLDG. SQFT JI 434_Res Add/Alter VB Current Owners: Fees Name:THOMAS SIMERSON ' Fee Group/ Fee Description Fee Amount Payments Address: 2516 PASEO TORTUGA CHINO HILLS CA 91709 Transaction Type Ph: ...._....................... Window ':.. - j- .$188-75 188 75:,:,, Email: m@ch.org Replacement` ' ' Contractor. WIN-DOR INC-WIN-DOR INC B001 Permit Issuance Fee $53.00 53.00 Address: 2220 E ORANGEWOOD AVE ANAHEIM CA 92806 B39-B53 Residential Structural Fee $134.75 134.75 Ph: 714-385-1202 Email: m@ch.org SB1473 $1.00 1.00 Lk.Information545553 Exp.Date:2/28/2011 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION TOTAL FEES $188.75 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sec.7000)of Division 3 of the Business and Professions Code,and my license is in full force and AMOUNT PAID $188.75 effect In securing this permit I am acting with the knowledge of and on behalf of the owner of the property. BALANCE DUE $0.00 p Date: r� 2 !!"m bContractor. _al''tK C� /A'rarar/�]4i m N ((./!A/ 904.-) OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Sec.7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom that five hundred dollars($500.00) I,as owner of the propterty,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code: " The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he she did not build or improve for the purpose of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor (s)licensed pursuant to the Contractors License Law). I am exempt under article 3 of the Business and Professions Code. Date: Owner. WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self insure for workers'compensation,as I certify that I have read this application and state that the above information is correct I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is with all city and county ordinances and state laws relating to building construction,and hereby authorize issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes. /1 I have and will maintain workers'compensation insurance,as required by Section 3700 of the r- \jr---117—>1 abor Codeforthed p licy nu aoftheworkforwhichthispermitisissued. Myworkerscompensation / /� l� /Qinsurance carrier and olio number are: / / O o # IS-6109 SC��rdgF )&-W- Policy APPLICANT DATE / / �7 (i!(0 Applicant DANIEL MATUSZAK 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 subject to the workers compensation laws of California,and Address: 2220 E ORANGEWOOD AVE ANAHEIM CA 92806 agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Ph: 714-385-1202 Email: m ch.o Labor Code,I shall forthwith comply with those provisions. @ r9 / Lic.Information Exp.Date:2282011. )' Date: 1 2/20/2:0/0 . m Applicant: I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and /1 Safety Code,which regulate the storage,handling and use of hazardous materials WARNING: Failure to secure worker's compensation coverage is unlawful,and shall subject an employer to criminal penalities 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,interest,and attorney's fees. CITY OF CHINO HILLS COMMUNITYDEVELOPMENT—BUILDING& SAFETY DIVISION Call(909)364-2790 before 3:00 p.m.for next day inspection Post in a safe, conspicuous place at front of job. Provide permit number when calling for inspection. Have approved plans on job at time of inspection. NO WORK SHALL BE COVERED WITHOUT INSPECTION File this permit with your permanent-records when job is complete. INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grading: Block Wall Inspections: Pregrade Meeting Footing,Rebar Rough Grade 1s1 Lift Bond Beam Terraces 2'ti Lift Bond Beam Sub Drains Std Lift Bond Beam Finish Grading Drain/Seal Soils Certification Grading Certification Rough ReRoaf: Tear-off,Existing Conditions Underground Site Inspections: Sheath Nailing Building Sewer Line .Roof Final Water Supply Line U/G Electrical Service Conduit Swirrrin9 Pools: Storm Drain 1 Catch Basin Location/Rebar 1 Bonding 1 Light DO NOT BACKFILL UNTIL ABOVE IS APPROVED Gas Test Gr.Conduit Verify Soils Engineering: Ro Elect Compaction,moisture,conditioning,etc. POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence,Gate&Alarm UnderfloorlUnderslab Inspection: Final Pool U,F Waste Plumbing UIF Water Fire Protection Equipment: UfF Mechanical UG Pipe UIF Electrical Thrust Blocks UIF Framing Hydro UIF Insulation Flush Subfloor Weld Outlet Insp. ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Overhead Hydra Foundation Inspection: Temp Power Pole Setback!Footing—OK to Pour Electric Release UFER Ground(Rebar/Copper) Gas Test Harciwvare/Hold-Downs Piers/Caissons/Tendons FINAL INSPECTIONS Slab Grade—OK to Pour NO OCCUPANCY PERMITTED WITHOUT FINAL DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED County Environmental Health Dept. (391-7570) Shear Inspection(Wood): Planning Dept:(364-2752) Roof Nailing Public Works (364-2774) Exterior Walls Fire (393-3888) Interior Walls Landscape (364-2766) Hardware/Hold-Downs ALL ABOVE MUST BE APPROVED BEFORE FINAL BLit*._ Final'Grade Coo nspection: Final Electric '\e` / `v Combo Framing Final Plumbing / �/-) Rough Electric Final Mechanical V 1 X Rough Mechanical Final Building/Construction Rough Plumbing 1 Topout Water Meter Number �1 ril \/1 COVER NO WORK UNTIL ABOVE IS APPROVED / CERTIFICATE OF OCCUPANCY Insulation OK TO ISSUE Drywall Inspection: 0TH Intrr Exterior � v EXT LATH �—? O - i' Stucco Scratch / l V Miscellaneous Inspections: • Masonry Freplace Plate Ties,Fire Block Patio/Deck: Footing Frame Access/Light 1 Swtch NOTICE TO OWNER:Call for FINAL INSPECTION on every job. This pemitwill expire if work is suspended or abandoned for a Patio Final period of 180 days.