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Permit No. 16868 BUILDING ADDRESS: 16254 VAN GOGH COURT PERMIT NUMBER: 16868 BUILDING INFORMATION APPLICANT INFORMATION �: ,et BUILDING PERMIT APPLICATION Address: 16254 VAN GOGH COURT ,,,.;, p Name !IAN GRIFFIN .'.,;,Y^� Community Development ApN, Address 17145 MAGNOLIA AVENUE,SUITE 100 ' - 2001 Grand Avenue `_"" Lot 117 City,Zip Code !RIVERSIDE,CA 92504 t Chino Hills,CA 91709 Cross Streets Phone/Pager MI�I�y"'°' g (909)328-0777 1 ext 117 �"°'a"°" LICENSED CONTRACTOR DECLARATION Tract/Parcel 114079 City Bus Lic# 10 1-0477 5 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation. $232,000 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 L 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 reason Address 7145 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. © C compensation,will do the work,and the structure is not intended or offered for sale Phone (909)328-0777 1 ext 117 Lie# (7_,) I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# 01-04775 City Bus Lic# construct the project Bus Exp 6/30/01 ® I am exempt under Section I i BPC for this reason I APPROVAL INFORMATION • \~ib WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor GRIFFIN COMMUNITIES Date Issued 08/18/2000 Address 7145 MAGNOLIA AVENUE,SUITE 100 Finance Code C4-SM I have and will maintain a certificate of consent to self-insure for workers'compensation City,ZipCode RIVERSIDE,CA 92504 ® as provided by Section 3700 of the Labor Code,for the performance of the work for 1 Census Code 101 which this permit is issued Phone or Pager (909)328-0777 1 ext 117 ! Final Date I have and will maintain workers'compensation,as required by Section 3700 of the Bus Lic 01-04775 Final By 1 Qi Labor Code,for the performance of the work for which this permit is issued My Lie 4 638223 Extension workers'compensation insurance earner and policy number are Exp Da 4/30/01 Reviewed By KEITH L PRYOR 1 INSURANCE INFORMATION Lie Clas B Approved By KEITH L PRYOR 1 Insurance Company 1STATE FUND PROJECT INFORMATION Policy Number 1154080-99 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 12/1/01 Structure ILIVIBLE 1 3320 1 © Section need not be completed if permit is for one hundred dollars($100)or less Garage 1GARAGEI 1 ! 666 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 1PORCH 1 1 I 135 California and agree that if I should become subject to the workers'compensation provisions of Other Section 3700 of the Labor Code I shall comply with those provisions os. PROPOSED USE SINGLE FAMILY RESIDENCE Date: i I Signature: I I PLAN 4 W/OPT GARAGE S 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 abov,mentl9ned property for inspection purposes /7/ Date: J / (?/.4, I Signature: / ' . '-- U v� ' OTHER FEES REQUIRED l ' III ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard 22 5 Over X 1 0 1 School 1 YES 1 Issuance 1 $29 00 1 Electrical 1 $365 20 Land Use IFR-2 I Side Yard 5/5 Plan Check $145 40 Plumbing $293 50 Permit Fees: Cut 0 ! $2,470.86 Plan PLAN 4 1 Rear Yard 15 Fill 1 0 1 Development YES ! 1 1 SMIP I $23 20 1 Occ 1R3 SSY Total 1 0 1 Sewer 1 YES 1 Mechanical 1 $108 78 1 Structural 1 $1,453 98 Type 1VN Water 1 YES 1 Geo Review 1 $0 00 1 Grading 1 $75 00 Total Fee Due 1 $2,494.06 1 ill 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 = Swimming Pools: Supply Water Line • /i_� 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 /p/� Fire Protection Equipment: U/F Water ' UG Pipe U/F Mechanical Thrust Blocks U/F Electrical Hydro U/F Framing Flush InsulationWeld Outlet Insp. Subfloor ///4" may— Overhead Hydro ABOVE IS REQUIRED PRIOR TO FOUNDATI0144140ECTIOIC Foundation Inspection: Temp Power Pole Setback/Footing ' _ _— Electric Release 4/�j/j/ tel/ UFER Ground(Rebar/Copper) Gas Test 7..,�/,d�' - - z.- ------ 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 i'1/7"-&-7— �jc/ 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 7 ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Rough Mechanical Final Electnc 6. Rough Plumbing/Topout / Final Grade . / COVER NO WORK UNTIL ABOVE IS APPROVED Final Plumbing (�j,/i" Insulation y5/`/„5``"�R .. Final Mechanical P!" Drywall Inspection: Final Building/Construction Intenor ,2— er �------- Water Meter Number ,-7S--e.6 .,C• ----- Exterior Lath //25-, �`� , CERTIFICATE OF OCCUPANCY Stucco Scratch //�% . /1/ OK TO ISSUE MISCELLANEOUS INSPECTIONS ,/ Masonry Fireplace OTHER: Plate Ties,Fire Block, Patio/Deck: Footing Access/Light/Switch Patio Final 77,-71-0?-,. .,,---- ill 6 ,,,,,Ke--—-