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Permit No. 16856 BUILDING ADDRESS: 16257 VAN GOGH COURT PERMIT NUMBER: 16856 �- BUILDING INFORMATION APPLICANT INFORMATION / ,. BUILDING PERMIT APPLICATION Address 16257 VAN GOGH COURT I Name 11AN GRIFFIN -,i?* � Community Development APN I Address 17145 MAGNOLIA AVENUE,SUITE 100 -. .r4-.4. 2001 Grand Avenue Lot 20 City,Zip Code 'RIVERSIDE,CA 92504 ,- ' Chino Hills,CA 91709 1 'N'.i.`4 Cross Streets 1 Phone/Pager 1(909)328-0777 I ext 117 "°`."°""S LICENSED CONTRACTOR DECLARATION Tract/Parcel 114079 City Bus Lic# 101-04775 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$193,000 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 IL D KING OWNER BUILDER DECLARATION Name GRIFFIN COMMUNITIES Address 2151 CONVENTION CENTER WAY I hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress 17145 MAGNOLIA AVENUE,SUITE 100 City,Zip Code 'ONTARIO,CA 91764-4464 I,as the owner of the property,or my employees with wages as their whole City,Zip Code 'RIVERSIDE,CA 92504 Phone 1(909)937-0200 I ext I compensation,will do the work,and the structure is not intended or offered for sale Phone 1(909)328-0777 1 ext 117 Lie# 1 © i,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic# 101-04775 City Bus Lie# I construct the projectI • Bus Exp 16/30/01 APPROVAL INFORMATION I am exempt under Section J .'PC for this reason WORKERS'COMPEA.S.:""'TONDC.;LARATION CONTRACTOR INFORMATION Issued By YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the fo, rig declarations Contractor 'GRIFFIN COMMUNITIES Date Issued 08/18/2000 Address 17145 MAGNOLIA AVENUE,SUITE 100 Finance Code C4-SM 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 IRIVERSIDFi 92504 I Census Code 101 which this permit is issued Phone or Pager 1(909)328,77 1 I ext;,117 1 Final Date Bus Lic# 01-047 , / / Final By I have and will maintain workers'compensation,as required by Section 3700 of the / .•1111'' Q Labor Code,for the performance of the work for which this permit is issued My Lie # 63822 Extension workerscompensation insurance earner and policy number are Exp Date 14/30/01` 1 Reviewed By KEITH L PRYOR INSURANCE INFORMATION Lic Class 1B I Approved By KEITH L PRYOR Insurance Company 'STATE FUND PROJECT INFORMATION Policy Number 1154080-99 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 2/1/01 Structure 1LIVIBLE I 1 I I 2774 I ® Section need not be completed if permit is for one hundred dollars($100)or less Garage 'GARAGE I 1 575 1 I certify that in the performance of the work for which this permit is issued I shall not employ Patio 1 1 I any person in any manner so as to become subject to the Workers'Compensation Laws of Porch 'PORCH ' ' 35 I California and agree that if I should become subject to the workers'compensation provisions of Other 1 1 1 1 iii Section 3700 of the Labor Code I shall comply with those provisions PROPOSED USE SINGLE FAMILY RESIDENCE Date: i i Signature: i I PLAN 2 STANDARD 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 r reser atives of this City to COMMENTS enter upon the above mentioned property for inspection purposes Date: I R//2,/4'1 Signature: i l'j e**---./19 I IA L OTHER FEES REQUIRED 7ZONING SETBACK GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard 21 Over X 0Issuance $29 00 1 Electrical 1 $305 14 1 Land Use IFR-2 1 Side Yard 5/5 Cut 0 School 1 YES 1 Permit Fees: $2,155.11'I Plan 'PLAN 2 1 Rear Yard 15 Fill 0 Development YES Check $127 38 Plumbing $246 00 SMIP $19 30 Occ 1R3 1 SSY Total 1 0 Sewer 1 YES I Mechanical 1 $98 79 1 Structural I $1,273 80 Type 1VN 1 Water YES 1 Geo Review $0 00 Grading 1 $75 00 Total Fee Due $2,174.41 1 it alioINSPECTION RECORD 11114 INSPECTION DATE INSPECTOR Grading INSPECTION DATE INSPECTOR Pregrade Meeting Block Wall Inspections Rough Grade Footing, ReBar Terraces 1st Lift Bond Beam Sub Drains 2nd Lift Bond Beam Finish Grading 3rd Lift Bond Beam Soils Certification Drain/Seal Grading Certification ReRoof Rough Tear-off, Existing Conditions As Built Approved Sheath Nailing Underground Site Inspections Roof Final Building Sewer Line ,....„ eg;002 Swimming Pools Supply Water Line r .. ��� Location/Rebar/Bonding/Light Storm Drain/Catch Basins Gas Test U/G Conduit/Electrical Gr Conduit/Ro Elect DO NOT BACKFILL 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 ��/l, Fire Protection Equipment U/F Water " i' / — UG Pipe U/F Mechanical Thrust Blocks U/F Electrical Hydro U/F Framing Flush Insulation Weld Outlet Insp Subfloors Overhead Hydro ABOVE IS REQUIRED PRIOR TO FOUNDATION SP CTION Foundation Inspection Temp Power Pole _ Setback/FootingElectric Release 1//-3i`" ../ UFER Ground(Rebar/Copper) G//` Z77 Gas Test //x/ Hardware/Hold-Downs / i� i — " // Piers/Caissons/Tendons FINAL INSPECTIONS DO NOT POUR CONCRETE UNTIL ABOVE APPROVED NO OCCUPANCY PERMITTED WITHOUT FINAL I Shear Inspection(Wood). / County Environmental Roof Nailing j/ Z ten/ Health Dept (391-7570) Exterior 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 Electric /� ALL ABOVE MUST BE APPROVED BEFORE F/NAIIBLDG� Rough Mechanical Final Electric J q� Com`/ Rough Plumbing/Topout i Final Grade / COVER NO WORK UNTIL ABOVE IS APPROVED , Final Plumbing Insulation i — / --Final Mechanical F Drywall Inspection Final Building/Construction s Interior //�/ �y Water Meter Number <7'- 75"-Z Exterior -, Lath J/_ J 1/ CERTIFICATE OF OCCUPANCY Stucco Scratch 7%— / OK TO ISSUE MISCELLANEOUS INSPECTIONS Masonry Fireplace OTHER* Plate Ties, Fire Block, Patio/Deck Footing Access/Light/Switch Patio Final � � � •