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Permit No. 16862 BUILDING ADDRESS: 16270 VAN GOGH COURT PERMIT NUMBER: 16862 BUILDING INFORMATION APPLICANT INFORMATION 4.4 BUILDING PERMIT APPLICATION Address 16270 VAN GOGH COURT Name 1IAN GRIFFIN ' Community Y Develo ment P APN 1 Address 17145 MAGNOLIA AVENUE,SUITE 100 ,,r1; 2001 Grand Avenue ".: =� Lot 113 City,Zip Code 'RIVERSIDE,CA 92504 •y.,. Chino Hills,CA 91709 Cross Streets I Phone/Pager 1(909)328-0777 1 ext 17 °"°'EV°°" 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$208,000 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 Address 2151 CONVENTION CENTER WAY Name 1GRIFFIN COMMUNITIES 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 (909)937-0200 1 ext 1 © compensation,will do the work,and the structure is not intended or offered for sale Phone 0909)328-0777 1 ext 117 Lie# 1 © I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# 101-04775 City Bus Lie# 1 construct the project Bus Exp 16/30/01 ;' 1 © I am exempt under Section i i BPC for this reason I APPROVAL INFORMATION • Alio WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By 1YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor GRIFFIN COMMUNITIES 1 Date Issued 108/18/2000 Address 7145 MAGNOLIA AVENUE,SUITE 100 I Finance Code 1C4-SM I have and will maintain a certificate of consent to self-insure for workers'compensation Op as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code RIVERSIDE,CA 92504 I Census Code 1101 which this permit is issued Phone or Pager (909)328-0777 1 ext 117 I Final Date Bus Lic# 01-04775 , Final By 1 I have and will maintain workers'compensation,as required by Section 3700 of the Ci Labor Code,for the performance of the work for which this permit is issued My Lie # 638223 Extension workers'compensation insurance carrier and policy number are Exp Date 4/30/01 Reviewed By 1KEITH L PRYOR Lie Class B Approved By 'KEITH L PRYOR INSURANCE INFORMATION Insurance Company 'STATE FUND 1PROJECT INFORMATION Policy Number 1154080-99 1 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 12/1/01 ' tructure 1LIVIBLE 1 3010 © Section need not be completed if permit is for one hundred dollars($100)or less Garage 1GARAGE I I 563 I certify that in the performance of the work for which this permit is issued I shall not employ Patio 1 1 any person in any manner so as to become subject to the Workers'Compensation Laws of Porch 'PORCH I I 52 ii California and agree that if I should become subject to the workers'compensation provisions of Other 1I 1 Section 3700 of the Labor Code I shall comply with those provisions PROPOSED USE SINGLE FAMILY RESIDENCE Date: / i Signature: i i PLAN 3 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 representatives of this City to COMMENTS enter upon the above Jnentio ied property for inspection purposes Date. i $//d/�- i Signature: t ( 7 G „ OTHER FEES REQUIRED ZONING SETBACKS GRADIN PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD I Front Yard 23 Over X 1 0 IIssuance 1 $29 00 I Electrical $331 10 1 $2,258.80 Land Use IFR-2 I Side Yard 5/5 Cut 0 School 1 YES I Permit Fees: Development YES I Plan Check 1 $134 31 1 Plumbing I $247 50 I Plan (PLAN 3 Rear Yard 15 Fill I 0 ' SMIP 1 $20 80 1 Occ 1R3 I SSY Total 0 1 Sewer I YES 1 Mechanical 1 $98 79 1 Structural I $1,343 10 1 Type 1" Water 1 YES 1 Geo Review 1 $0 00 1 Grading $75 00 I Total Fee Due I $2,279.60 I 10 INSPECTION RECORD 4 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 ,7 /21 Swimming Pools Supply Water Line ' /jam 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 Plumbing11/11 .P/ 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 IfISPECTION Foundation Inspection „ Temp Power Pole „ Setback/Footing -4' - Electric Release 4Y 5,' / UFER Ground(Rebar/Copper) DI/ /// Gas Test //,c/l „ l Hardware/Hold-Downs // i — Piers/Caissons/Tendons FINAL INSPECTIONS DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED NO OCCUPANCY PERMITTED WITHOUT FINAL I Shear Inspection(Wood) County Environmental Roof Nailing ,,, Health Dept (391-7570) / Exterior Walls /7 T / Planning Dept (364-2750) Interior Walls 7 sem— 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 FI[iYA}OL,Q6 Rough Mechanical ' ',V Final Electric .• (� Rough Plumbing/Topout Z'` Final Grade Wi COVER NO WORK UNTIL ABOVE IS APPROVED / / Final Plumbing / Insulation ��f/��,� / Final Mechanical Drywall Irispection Final Building/Construction / Intenor r/_' ,ly - Water Meter Number .4.-7 5�, 7g— Extenor Lath /1/ t.�� CERTIFICATE OF OCCUPANCY 2 Stucco Scratch , OK TO ISSUE MISCELLANEOUS INSPECTIONS / Masonry Fireplace OTHER: Plate Ties, Fire Block, Patio I Deck: Footing Access/Light/Switch Patio Final ,(5, 711401 /19 : • • /�