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Permit No. 20384 BUILDING ADDRESS: 4166 VALLE VISTA DRIVE PLAN CHECK NUMBER: 20384 , 1:-� BUILDING INFORMATION APPLICANT INFORMATION y� o$\ BUILDING PLAN CHECK Address 4166 VALLE VISTA DRIVE I Name PETE VOLBEDA lit ,•s,4 Community Development APN 11028-031-14 Address 1615 N BENSON DRiVE#D '�"""^ 2001 Grand " ,�': AvenueLot 14 BLOCK 27 City,Zip Code IUPLAND,CA 91786 1 ' • Chino Hills,CA 91709 : +i;::' , Cross Streets 1DEL NORTE/PIPELINE 1 Phone/Pager 1(909)373-1150 I ext CRY OF..;q,us, LICENSED CONTRACTOR DECLARATION Tract/Parcel 11932 I City Bus Lic# N/A I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation $97,282 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 1PETE VOLBEDA OWNER BUILDER DECLARATION Name J&A OLSNIEWiCZ Address 1615 N BENSON#D I hIereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 1461 BUD CIRCLE City,Zip Code IUPLAND,CA 91786 I,as the owner of the property,or my employees with wages as their whole City,Zip Code UPLAND,CA 91786-2528 Phone (909)373-1150 1 ext I compensation,will do the work,and the structure is not intended or offered for sale Lic# C13077 P Phone (909)946-6488 ext 1 I 1,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic# City Bus Lie# construct the project I am exempt under Section I BPC for this reason I i Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By 1DAWN FORSHA Contractor TO BE DETERMINED i Date Issued 17/17 I hereby affirm under penalty of perjury one of the following declarations Address Finance Code I 1 I have P.d will maintain a certificate of consent to self-insure for workers'compensation I Census Code �L./....F" �_ Q as' uvided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code 1-1------- ,t., � ' which thispermit is issued Phone or Pager ext 1 Final Date // \ I, J� '! Bus Lic# Final By 1 / 1 ry —� I have and will maintain workers'compensation,as required by Section 3700 of the Extension " � Labor Code,for the performance of the work for which this permit is issued My Lic # workers'compensation insurance carrier and policy number are Exp Date I Reviewed By • Lie Class I Approved By I INSURANCE INFORMATION PROJECT INFORMATION Insurance Company IT B D • Policy Number I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 1 Structure 1SFR ILOT 1215 .Section need not be completed if permit is for one hundred dollars($100)or less Garage (TWO CAR 1LOT 461 Patio I I 1 1 1 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 Porch California and agree that if I should become subject to the workers'compensation provisions of Other I I Section 3700 of the Labor Code I shall comply with those provisions PROPOSED USE SFR WITH 2 CAR GARAGE Date. i i Signature: i I ---"" I certify I have read this application and state that the above information is correct I agree to COMMENTS comply with all City Ordinances and state laws and hereby authonze representatives of this City to _ enter upon the above mentioned property for inspection purposes�/ Date: 1 -7-17 Z / —0 I Signature: / 16hi/A-, a-#0717,7(--)1 OTHER FEES ZONING SETBACKS GRADING REQUIRED PRIOR TO PLAN CHECK FEE INFORMATION ACTUAL PERMIT Zoning IRS/SL I Front Yard 1 15 1 Over X I 0 1Initial Plan Check I $540 97 ( • Land-Use IFR-1 I Side Yard I 5/5 I Cut 0 School I N Initial Structural 1 $0 00 Plan ISFT I Rear Yard I 15 I Fill 0 Development I N 1 Initial Geo Review $0 00 Total Fee Due $540.97 Occ 1R3 SSY 1 Total 0 Waterer N Initial Grading $0 00 - Type IVN DUCO El` INEERING, INC PORATED . / 41, 20938 CURRIER ROAD I !� WALNUT, CALIFORNIA 91789 (800) 650-4910 (909) 594-7414 FAX(909) 594-3853 REPORT OF FIELD INSPECTION CLIENT Mi nkav Rnrrlatt DATE 0. (3 zaza Al Aar P1 ana JOB NUIVIBER 02-101 Chino Hills, CA 91709 VENDOR NUMBER V-1016 JOB IDENTIFICATION 41FA Va11A Vi ata Drives : ,t Chino Hills, CA. The footing excavations listed below have been inspected by a member of this firm and are properly founded into material for which the bearing values recommended are applicable The cast-in-place drilled friction-piles,/ belled caissons listed below have been inspected by a member of this firm and are imbedded into, or are founded upon material for which the allowable supporting capacities recommended are applicable The diameter and depth of the excavation meets the minimum requirement specified on the approved Foundation,Plans The swimming pool excavation has been inspected by a member of this firm and was found to be imbedded into approved soils as anticipated in our previous report dated The swimming pool excavation is therefore approved for constructidn The expansive soils for the locations listed below were found to be properly saturated to the required depth and are hereby approved for the pouring of the concrete floor slabs COMMENTS �� _.�� /.SAI 1Zx:1 cr►� o 111-' �i444,40,/9/4/ed .1f/ .09-€.4.4,4,,f' 1 ��� 7 / , , 1)a..4)-4 / - • Note The obse e• +i r. • above do not constitute an approval of the location, design, or reinforcement of the foundation or swi •.6 T •11 loose, soft or disturbed soils must be removed from the excavation prior to the placement of ,f Oi&r/eo p eeF UCO ENGINES .NG, INC. oc No 891 n T Exp * r 7'17lF F CAl1F�� U . , 6 . . . - I _ PETE VOLBEDA, ARCHITECT :� March 24, 2003 Jim Burdett 13190 McKinley Chino, Ca 91710 Re. Valle Vista, Chino Hills 2' x 8' rafters may be installed at 24" on center. Sincerely, M Pete Volbeda, Architect ^d; 31 b1S rzl i-z. S\'' irj 0 '40 :41: * 1.4 2121 -� i © �� ld 615 N. BENSON AVE., UNIT D • UPLAND, CA 91786 • PH 909-373-1150 • FAX 909-373-1152