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Permit No. 17468 BUILDING ADDRESS: 16479 PATINA COURT PERMIT NUMBER: 17468 BUILDING INFORMATION APPLICANT INFORMATION .a{ ,\ BUILDING PERMIT APPLICATION Address 16479 PATINA COURT I Name 1QWEST AIR SYSTEMS,INC 10,X, Community Development APN 1017-672-03 Address 112158 SEVERN WAY r r-•::`� 2001 Grand Avenue ' ]"-•=i Lot 15 City,Zip Code 1RIVERSIDE,CA 92503 Chino Hills,CA 91709 ..-: Cross Streets Phone/Pager (909)279-4440 I ext 1 Q"°'a"°, .., LICENSED CONTRACTOR DECLARATION Tract/Parcel 13507-2 City Bus Lic# 01-05800 1 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$3,000 00 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect OWNER INFORMATION Name N/A OWNER BUILDER DECLARATION Name TIGNO Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress 16479 PATINA COURT City,Zip Code I,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS,CA 91709 Phone 1 ext 1 ® compensation,will do the work,and the structure is not intended or offered for sale Phone 1 ext 1 Lie# 40--a I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# City Bus Lie# 'gir' construct the project I am exempt under Section I I BPC for this reason I I 4111 Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By IYVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor QWEST AIR SYSTEMS,INC Date Issued 112/13/00 Address 12158 SEVERN WAY 1 Finance Code 1C4 I have and will maintain a certificate of consent to self-insure for workers'compensation ® as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code RIVERSIDE,CA 92503 Census Code / which this permit is issued Phone or Pager (909)279-4440 ext 1 Final Date ( MO /O_ ( Bus Lie# 101-05800 Final By /?, C,_ I have and will maintain workers'compensation,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Lie # 774821 Extension 1 workers'compensation insurance earner and policy number are Exp D. - 102/28/02 Reviewed By INSURANCE INFORMATION Lie *ass C20,HIC Approved By Insurance Company (STATE FUND Structure PROJECT INFORMATION Policy Number 1604493-00 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 11/11/01 1 1 1 0 Section need not be completed if permit is for one hundred dollars($l00)or less Garage 1 01 I certify that in the performance of the work for which this permit is issued I shall not employ Patio any person in any manner so as to become subject to the Workers'Compensation Laws of Porch 1 1 0California 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.Oa�. � Date: I /j'// /' Signature: /.. �'. A�"/ OTHER FEES REQUIRED ZONING SETBACK S / GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning (PD Front Yard EXIST Over X ( 0Issuance $33 30 1 Electncal $0 00 Land Use 1FR-1 Side Yard Cut 0 School NO 1 Permit Fees: 1 $53.28 1 Plan MECH Rear Yardp NO 1 Plan Check $0 00 Plumbing $0 00 Fill 0 Development SMIP 1 $0 00 1 Occ ( SSY Sewer 1 NO 1 Mechanical 1 $19 98 1 Structural $0 00 Total 0 Total Fee Due 1 $53.28 1 Type NR Water 1 NO 1 Geo Review 1 $0 00 Grading $0 00 • INSPECTION RECORD Permit Number spection Date Inspector Inspection Date Inspector rading: -egrade Meeting FINAL INSPECTIONS (Inspector verify following) ough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL I .irraces County Environmental ub Drains Health Dept finish 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 ,uildrng Sewer Vater Service Final Grade Final Electric storm Drain/Catch Basins Final Plumbing I/G Conduit/Electrical n Final Mechanical 4' .1 :ompaction Report Final Building/Construction ///0(.....2 %BOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Water Meter Number -ootings )FER Ground(Rebar/Copper) CERTIFICATE OF OCCUPANCY 1ardware/Hold-Downs 'f ers/Ca issons/Tendons Slab Grade OTHER: )O NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing Exterior Walls anterior Walls Hardware/Hold-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/Light 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