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Permit No. 17465 BUILDING ADDRESS: 16470 PATINA COURT PERMIT NUMBER: 17465 BUILDING INFORMATION APPLICANT INFORMATION 41 BUILDING PERMIT APPLICATION Address 16470 PATINA COURT Name •iiiQWEST AIR SYSTEMS,INC Ai:, Community Development APN 1017-672-21 Address 112158 SEVERN WAY •:f.. 2001 Grand Avenue ^:.i Lot 22 City,Zip Code RIVERSIDE,CA 92503 - t .: Chino Hills,CA 91709 Cross Streets Phone/Pager (909)279-4440 I ext 1 C11110 M `"•°`,,,,,,'�, LICENSED CONTRACTOR DECLARATION Tract/Parcel 113507-2 City Bus Lic# 101-05800 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation $3,000 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 N/A OWNER BUILDER DECLARATION Name 1PAFF Address 1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress 164701PATINA COURT City,Zip Code ' I,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS,CA 91709 Phone I ext ® compensation,will do the work,and the structure is not intended or offered for sale Phone i 1 ext 1 Lic 4 1,as owner of the property,am exclusively contracting with licensed contractors toal Bus Lic# City Bus Lic 4 �� construct the project I am exempt under Section i I BPC for this reason i I Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By YVE1 1E MARTINEZ I hereby affirm under penalty of penury one of the following declarations Contractor QWEST AIR SYSTEMS,INC 1 Date Issued 12/13/00 Address 112158 SEVERN WAY I have and will maintain a certificate of consent to self-insure for workers'compensation Finance Code C4 0 as provided by Section 3700 of the Labor Code,for the performance of the work for Ctty,Zip Code RIVERSIDE,CA 92503 1 Census Code which this permit is issued Phone or Pager (909)279-4440 1 ext Final Date Bus Lic# 01-05800 Final By I have and will maintain workers'compensation,as required by Section 3700 of the C) Labor Code,for the performance of the work for which this permit is issued My Lie # 1774821 Extension workers'compensation insurance carrier and policy number are Exp Date 02/28/02 Reviewed By Lic Class C20,HIC Approved By INSURANCE INFORMATION Insurance Company 1STATE FUND PROJECT INFORMATION Policy Number 1604493-00 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 11/11/01 Structure ® Section need not be completed if permit is for one hundred dollars($100)or less Garage I certify that in the performance of the work for which this permit is issued I shall not employ Patio Eli •any person in any manner so as to become subject to the Workers'Compensation Laws of Porch 1 Califomia and agree that if I should become subject to the workers'compensation provisions of Other HVAC C/O EXISTING Section 3700 of the Labor Code I shall comply with those provisions PROPOSED USE CHANGE OUT EXISTING HVAC UNIT Date: i i Signature. i i I certify I have read this application and state that the above information is correct I agree to comply with all City Ordinances and state laws and hereby authonze representative of this City to COMMENTS enter upon the above mentioned property for inspection purposes A ./ Date: I/ y� Signature: J/ ../ � 4 OTHER FEES REQUIRED PRIOR TO ACTUAL PERMIT ZONING SETBACK S GRADING ISSUANCE PERMIT FEE INFORMATION Zoning 1PD Front Yard EXIST Over X 0 Issuance $33 30 Electncal $0 00 Land Use 1FR-1 Side Yard Cut 0 School NO Permit Fees: $53.28 Plan MECH Rear Yard Development NO Plan Check $0 00 Plumbing $0 00 Fill 0 SMTP $0 00 1 Occ SSYSewer NO 1 Mechanical $19 98 Structural $0 00 Total 0 Total Fee Due $53.28 1 Type NR Water NO Geo Review $0 00 Grading $0 00 INSPECTION RECORD Permit Number 77.95--- spection Date Inspector Inspection Date Inspector rading: •egrade Meeting FINAL INSPECTIONS(Inspector verify following) ough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL! arraces County Environmental ub Drains Health Dept inish Grading Planning Dept oils Certification Public Works ,rading Certification Fire Rough Landscape s Built Approved Inderground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG ,uilding Sewer Final Grade Vater Service Final Electric ;turn Drain/Catch Basins Final Plumbing I/G Conduit/Electrical Final Mechanical kimpaction Report Final Building/Construction 1BOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Water Meter Number ootings JFER Ground(Rebar/Copper) CERTIFICATE OF OCCUPANCY lardware/Hold-Downs 3iers/CaissonsiTendons Slab Grade OTHER: )O NOT POUR CONCRETE UNTIL ABOVE IS APPROVED —,24/J - egs-eru 77— Shear ///0 rr. v(-"0— Roof Nailing Exterior Walls ,nterior Walls HardwareMold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections : Footing, ReBar 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS : Location/Rebar/Bonding/Ught Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence,Gate&Alarm Final Pool Temp Power Pole Electric Release Gas Test ZZ,e711)rg/(,/e?"7/ ,,71/(4) rJ