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Permit No. 18733 (2) t BUILDING ADDRESS: 16257 VAN GOGH COURT PERMIT NUMBER: 18733 A(7- et BUILDING INFORMATION APPLICANT INFORMATION . BUILDING PERMIT APPLICATION Address 116257 VAN GOGH COURT I Name BELL-AIRF `�--�_ ,,#1 p","�, Community Development APN 11017-703-35 Address 112356 OLEANDER " "`w` 2001 Grand Avenue I''''."i Chino Hills,CA 91709 Lot 20 1 City,Zip Code ICHINO,CA 91710 +::`: Cross Streets 1 Phone/Pager (090)_265-5962 I ext 1 �",,,, ,.., LICENSED CONTRACTOR DECLARATION Tract/Parcel 114079 1 City Bus Lic# 1 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$5,000 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 IICBO STANDARD OWNER BUILDER DECLARATION Name MIKE&DEANNA ROBLES Address I hereby umthat I'm exempt from the Contractor's License Law for the following reasonAddress 16257 VAN GOGH COURT 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 1 Phone 1 ext © compensation,will do the work,and the structure is not intended or offered for sale Phone (909)597-6422 I ext 1 I Lic# 1 1 I,as owner of the property,am exclusively contracting with licensed contractors to'(' I ill Bus Lie# City Bus Lic# construct the project I am exempt under Section i I BPC for this reason Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By LAURO BUGARIN I hereby affirm under penalty of perjury one of the following declarations Contractor BELL-AIRF I Date Issued 8/9/01 Address 112356 OLEANDER I have and will maintain a certificate of consent to self-insure for workers'compensation Finance Code C4-SM © as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code ICHINO,CA 91710 I Census Code / / 1 which thispermit is issued Phone or Pager (090)265-5962 ext I I Final Date �s ��oZd' �C A, r Bus Lic# 101-05589 Final Byi / I have and will maintain workers'compensation,as required by Section 3700 of the © Labor Code,for the performance of the work for which this permit is issued My Lie # 1354170 I Extension workers'compensation insurance carrier and policy number are Exp Date 12/28/02 Reviewed By LAURO BUGARIN INSURANCE INFORMATION Lie ss IB Approved By LAURO BUGARIN Insurance Company 1EXEMPT • I ( PROJECT INFORMATION Policy Number I I 1/ PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date I I I 1 I 1 Structure © Section need not be completed if permit is for one hundred dollars($100)or less Garage I I 1 I certify that in the performance of the work for which this permit is issued I shall not employ Patio I 1 I I I ny person in any manner so as to become subject to the Workers'Compensation Laws of Porch I I I alifomia and agree that if I should become subject to the workers'compensation provisions of Other 11CB0 PATIO 1REAR 1 371 Section 3700 of the Labor Code I shall comply with those provisions I — .7.. PROPOSED USE ICBG PATIO REAR 371 SF Date: pf ', 6/I Signature: i (-_,,,...",,7774,/,,,&%.,,, i I certify I have read this application and state that the above In/ JO VGl4 6�C � � formation is correct I a ree to comply with all City Ordinances and state laws and hereby authonze representativ s this City to COMMENTS enter upon the above mentioned property for inspection purposes —) ,C- '7 Date. p_G•f -.0/ i Signature V�,f- G /!fes — OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD 1 Front Yard 21 Over X 1 0 I Issuance I $29 00 I Electrical I $0 00 Land Use FR-1 I Side Yard 5/5 Cut 0 1 School I N Permit Fees: 1 $171.56 Development N Plan Check 1 $56 16 1 Plumbing 1 $0 00 I Plan 1 I Rear Yard 15 Fill 1 0 1 SMIP I $0 50 1 Occ 1R3 1 SSY Total 0 1 Sewer I N Mechanical 1 $0 00 1 Structural I $86 40 I Type 1VN I Water I N Geo Review 1 $0 00 1 Grading I. $0 00 I Total Fee Due 1 $172.06 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 Electric Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical , 0 U/G Conduit/Electncal Final Building/Construction 1/moo!/c50- Compaction Report /Water Meter Number 1' ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: ^^ ,� L- Slab Grade e JLf / �fu i -d/ F' ?/- 0 / DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED n Shear f er (!h' r 0_6P.r/- i//o?,t 4 Roof Nailing / 7 Extenor Walls Intenor Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Intenor/Extenor Lath Stucco Scratch Roof Covering 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 - a = Gr Conduit _ _ Ro Elect - = POOL NOT TO BE FILLED UNTIL FENCING I5 COMPLFTc n Fence,Gate&Alarm .-____ Final Pool Temp Power Pole Electric Release Gas Test