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Permit No. 16771 BUILDING ADDRESS: 1 13092 SAN RAFAEL DRIVE I PERMIT NUMBER: 1 16771 BUILDING INFORMATION APPLICANT INFORMATION ,4eweit BUILDING_PERMIT APPLICATION Address 113092 SAN RAFAEL DRIVE 1 Name 1GEORGE BRAZIL ,,....4 Community Devclopment APN 11023-601-22 Address 19405 W JEFFERSON BLVD -.1-ri`' 2001 Grand Avenue ' ll;,Y=,, Lot 128 ( City,Zip Code ICULVER CITY,CA 90232 `^"a''.`` Chino Hills,CA 91709 Cross Streets 1 Phone/Pager 1(800)225-5436 I ext CITY MGM HILLS LICENSED CONTRACTOR DECLARATION TractfParcel 113249 City Bus Lic# 00-03168 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 1N/A OWNER BUILDER DECLARATION 'JANET LOERA I Address 1 1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 113092 SAN RAFAEL DRIVE City,Zip Code 1 I 1,as the owner of the property,or my employees with wages as their whole City,Zip Code 1CHiNO HILLS,CA 91709 I Phone 1 ext 1 ® compensation,will do the work,and the structure is not intended or offered for sale Phone 1(909)590-9873 1 ext I 1 Lie# I I ® 1,as owner of the property,am exclusively contracting with licensed contractors to Rus i is# ( City Bus Lie# 1 �i construct the project Bus Exp 1 APPROVAL INFORMATION ® I am exempt under Section 1 1 BPC for this reason WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By IYVETTE MARTINEZ i hereby affirm under penalty of perjury one of the following declarations Contractor 'GEORGE BRAZIL I Date Issued 108/01/2000 Address 19405 W JEFFERSON BLVD 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 ICULVER CI I'Y,CA 90232 I Census Code I 1 which this permit is issued Phone or Pager 1(800)225-5436 1 ext I I Final Date I I I have and will maintain workers'compensation,as required by Section 3700 of the Bus Lie# 100-03168 Final By 1 1 C) Labor Code,for the performance of the work for which this permit is issued My Lic # 1679898 ^1 Extension I 1 workers'compensation insurance carrier and policy number are Exp Date 111/30/01 4 f' ' " Reviewed By Lie Class 1C-36 t 1 ) I Approved By I INSURANCE INFORMATION 1—__— Insurance Company IC N A 1 PROJECT INFORMATION Policy Number IWC 1059521841 I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 101/01/01 I I ( 1 1 I Structure O Section need not be completed if permit is for one hundred dollars($100)or lessGarage 1 I I i certify that in the performance of the work for which this permit is issued 1 shall not employ Patio I I any person in any manner so as to become subject to the Workers'Compensation Laws ofd Porch 1 I I I IIII- California and agree that if I should become subject to the workers'compensation provisions of, Section 3700 of the Labor Code 1 shall comply with those provisions Other MECHANICAL PROPOSED USE 5 TON CONDENSOR CHANGE OUT Date. J 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 representatives of this City to COMMENTS enter upon the above mentioned property for inspection purpose ^ / t / ' Date. l 8/i /c'o I Signature: - - I OTHER FEES REQUIRED IA ZONING ( SETBACKS RADING PRIOR TO ACTUAL PERM/T PERMIT FEE INFORMATION ISSUANCE Zoning 1PD 1 Front Yard EXIST__ Over X 1 0 1Issuance 1 $33 30 1 Electrical 1 $0 00 1 Land Use 1FR-1 Side Yard Cut 0 School 1 NO I Permit Fees: I $53.28 1 Plan Check $0 00 Plumbing $0 00 Plan IMECH I Rear Yard Fill 1 0 1 Development I NO 1 I 1 SMTP 1 $0 00 1 Sewer i NO 1 Mechanical 1 $19 98 1 Structural 1 $0 00 1 OccI 31 SSY Total 0 1 Water 1 NO I Gee Review I $0 00 1 Grading I $0 00 ' Total Fee Due I $53.28 I Type INSPECTION RECORD INSPECTION DATE INSPECTOR Grading INSPECTION DATE INSPECTOR Pregrade Meeting Block Wall Inspections Rough Grade Footing,ReBar Terraces4 1st Lift Bond Beam Sub Drains t 2nd Lift Bond Beam Finish Grading 3rd Lift Bond Beam Soils Ce.tification Drain/Seal Grading Certification ReRoof• Rough Tear-off, Existing Conditions As Built Approved Sheath Nailing Underground Site Inspections Roof Final Building Sewer Line Swimming Pools Supply WateL Line Location/Rebar/Bonding/Light Storm Drain/Catch Basins Gas Test U/G Conduit/Electrical Gr Conduit/Ro Elect DO NOT BA(tKFILL UNTIL ABOVE IS APPROVED Pre-Deck Verify Soils Engineering: POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Compaction,moisture,conditioning,etc Fence,Gate&Alarm Underfloor/Underslab Inspection Final Pool U/F Waste Plumbing Fire Protection Equipment U/F Water UG Pipe U/F Mechanical Thrust Blocks U/F Electrical Hydro U/F Framing Flush Insulation Weld Outlet lnsp Subfloor Overhead Hydro ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Foundation Inspection Temp Power Pole Setback/Footing Electric Release UFER Ground(Rebar/Copper) Gas Test Hardware/Hold-Downs Piers/Caissons/Tendons FINAL INSPECTIONS DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED NO OCCUPANCY PERMITTED WITHOUT FINAL Shear Inspection(Wood): County Environmental Roof Nailing Health Dept (391-7570) Extenor Walls Planning Dept (364-2750) Interior Walls Public Works (364-2770) Hardware/Hold-Downs Fire (393-3888) Combo Inspection Landscape (364-2797) Framing Trust Accounts (364-2769) Rough Electnc ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Rough Mechanical Final Electric Rough Plumbing/Topout Final Grade COVER NO WORK UNTIL ABOVE IS APPROVED Final Plumbing Insulation Final Mechanical gY/7 3 Drywall Inspection Final Building/Construction �� /may Intenor Water Meter Number Extenor Lath CERTIFICATE OF OCCUPANCY Stucco Scratch OK TO ISSUE MISCELLANEOUS INSPECTIONS Masonry Fireplace OTHER Plate Ties, Fire Block, Patio/Deck: Footing Access/Light/Switch Patio Final •