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Permit No. 20411 BUILDING ADDRESS: 3453 VALLE VISTA DRIVE PERMIT NUMBER: 20411 ,. BUILDING INFORMATION APPLICANT INFORMATION BUILDING PERMIT APPLICATION Address 3453 VALLE VISTA DRIVE Name ISLAND PACIFIC ROOFING -,#�; Community Development APN 1017-541-24 Address 9169 EL VERDE '%""s� 2001 Grand Avenue t A•)` Lot 73 City,Zip Code FOUNTAIN VALLEY,CA 92708 Chino Hills,CA 91709 g (714)579-7663 ext .;:.`: Cross Streets Phone/Pager ""°""'"°""'S LICENSED CONTRACTOR DECLARATION Tract/Parcel 19231 City Bus Lic# NEW I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$3,400 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 Name DAVE CLARK Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 3453 VALLE VISTA DRIVE City,Zip Code 1 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 O compensation,will do the work,and the structure is not intended or offered for sale Phone (909)991-1211 1 ext 1 Lie# O I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic# City Bus Lic# construct the project 0 I am exempt under Section I I BPC for this reason I i Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor 1ISLAND PACIFIC ROOFING Date Issued 7/18/02 Address 9169 EL VERDE 1 Finance Code Jc.1/g-A I have and will maintain a certificate of consent to self-insure for workers'compensation 0 as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code FOUNTAIN VALLEY,CA 92708 Census Code f V ' which this permit is issued Phone or Pager (714)579-7663 1 ext I Final Date ( l //l /' p required by Final Bus Lic# NEW 7," 2 Oft' 2-- A I have and will maintain workers'compensation,as rered Section 3700 of the By Lic # 631472 1 f 1 ,7, Labor Code,for the performance of the work for which this permit is issued My Extension et workers'compensation insurance earner and policy number are Exp Date 10/01/03 Reviewed By 1 V INSURANCE INFORMATION Lic Class C39 Approved By 1 J Insurance Company STATE FUND PROJECT INFORMATION — Policy Number 1576654-01 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 10/01/02 Structure O' Section need not be completed if permit is for one hundred dollars($100)or less Garage 1 I certify that in the performance of the work for which this permit is issued I shall not emplo Patio 1 any person in any manner so as to become subject to the Workers'Compensation Laws of Porch 1 California and agree that if I should become subject to the workers'compensation provisions o Section 3700 of the Labor Code I shall comply with those provisions Other RE-ROOF ROOF 1700 PROPOSED USE REMOVE EXISTING WOOD SHAKE AND REPLACE WITH(1)LAYER CLASS A 25-YEAR Date• i i Signature: i I COMP SHINGLES I certify I have read this application and state that the above inform. • is corre t I agree to (f p.v/C(oG jCs.. (q(• �� comply with all City Ordinances and state laws and hereby aut��.y ,resentatives of this City to COMMENTS ��2 Vol r / ," `'S �� enter upon the above mentioned property for inspection purps. / �2. - 'f f S 6-e--4-'(-e-t- 44.-r..(� (J .•P • - • Date. 11-/Y- i Signature: I ( e/�� I U ,Wl,C.- R,s,/-- 3;4 "e ez. vl 4. `� OTHER FEES REQUIRED ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION 6`' t ISSUANCE Zoning RS Front Yard EXIST Over X 1 0 1 Issuance $29 00 1 Electrical $0 00 Land Use FR-1 Side Yard School NO 1 Cut 0 Plan Check $0 00 Plumbing $0 00 Permit Fees: $104.60 Plan RE-ROOF Rear Yard Development NO Fill 0 SMIP $0 00 1 Occ R3 SSY Total 1 0 Sewer NO Mechanical $0 00 Structural $75 60 Type VN Water NO Geo Review $0 00 Grading $0 00 Total Fee Due $104.60 1 INSPECTION RECORD Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL.I Terraces County Environmental Sub Drains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Building Sewer Final Grade U.G.Waste Plumbing Final Electnc Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical l / U/G Conduit/Electrical Final Building/Construction 744)'4 Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing Q_ • Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electnc Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Intenor/Extenor Lath Stucco Scratch Roof Covenng 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