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Permit No. 19496 BUILDING ADDRESS: 5569 VERONESE PERMIT NUMBER: 19496 BUILDING INFORMATION APPLICANT INFORMATION ,,. , BUILDING PERMIT APPLICATION Address 5569 VERONESE Name (SUNSET BUILDERS =' ,� Community Development APN 1017-693-15 Address 4672 BRENTWOOD AVEUNE " ''' 4Z` 2001 Grand Avenue .-4 Lot 15 City,Zip Code RIVERSIDE 92506 Chino Hills,CA 91709 z•+•,::::; Cross Streets Phone/Pager (909)687-1381 ( ext CTII Or 011NO "" LICENSED CONTRACTOR DECLARATION Tract/Parcel 14079-3 City Bus Lic# 02799 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation $2,000 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 OWNER BUILDER DECLARATION Name ZEMA KHAN Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason City,Zip Code Address 15569 VERONESE OI,as the owner of the property,or my employees with wages as their whole City,Zip Code (CHINO HILLS,CA 91709 Phone 1 ext compensation,will do the work,and the structure is not intended or offered for sale Phone 1(909)393-1296 ( ext I Lie# I,as owner of the property,am exclusively contracting with licensed contractors to0 Bus Lie# City Bus Lic 4 APPROVAL INFORMATION construct the project Bus Exp I am exempt under Section i I BPC for this reason iI WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By (CHRIS OBERLE I hereby affirm under penalty of perjury one of the following declarations Contractor SUNSET BUILDERS Date Issued 11/30/02 Address 14672 BRENTWOOD AVEUNEFinance Code C4 t. I have and will maintain a certificate of consent to self-insure for workers'compensation C) as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code RIVERSIDE 92506 Census Code which this permit is issued Phone or Pager (909)687-1381 ext ( Final Date ( CIAS/19 L (.A.+, - Bus Lie# (02799 Final By I have and will maintain workers'compensation,as required by Section 3700 of theFIA: ( 0 Labor Code,for the performance of the work for which this permit is issued My Lie 4 354164 ( Extension workers'compensation insurance tamer and policy number are Exp Date 8/31/03 ( Reviewed By CHRIS OBERLE INSURANCE INFORMATION Lic Class B Approved By CHRIS OBERLE Insurance Company (State Fund PROJECT INFORMATION Policy Number (229-02UN170022400 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 1/1/03 1 ( 1 Structure ® Section need not be completed if permit is for one hundred dollars($100)or less Garage I •I certify that in the performance of the work for which this permit is issued I shall not employ 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 of Other (ELETRICAL/GAS ( (REAR Section 3700 of the Labor Code I shall comply with those provisions PROPOSED USE LINES FOR BAR-BQ Date: i i Signature: I I TWO OUTLETS ONE GAS LINE 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 enter upon the ab�e men ned property for inspection purpos COMMENTS Date. / Signature. i OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard 17 Over X ( 0 Issuance $29 00 Electrical ( $45 00 Land Use FR-1 Side Yard 5/5 Cut 0 School N $134.00 Development N Plan Check ( $54 00 ( Plumbing 1 $6 00 ( Permit Fees: Plan BBQ Rear Yard 15 Fill ( 0 SMIP 1 $0 00 Occ R3 SSY Total ( 0 ( Sewer ( N ( Mechanical ( $0 00 ( Structural ( $0 00 ( type 1VN Water N Geo Review ( $0 00 ( Grading 1 $0 00 Total Fee Due 1 $134.00 • • INSPECTION RECORD Permit Number ispection Date Inspector Inspection Date Inspector grading: regrade Meeting FINAL INSPECTIONS(Inspector verify following) ,ough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL.I erraces County Environmental ,ub Drains Health Dept inish Grading Planning Dept oils Certification Public Works trading Certification Fire Rough Landscape .s Built Approved Inderground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG luilding Sewer Final Grade I / I I J.G.Waste Plumbing Final Electric o1lka//Lv /n ��✓/ �/ Nater Service -Frnal Plumbing ;term Drain/Catch Basins Final Mechanical C JIG Conduit/Electrical Final Building/Construction rq /176(,-- :ompaction ReportWater Meter Number - V - — %BOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION, =ootings CERTIFICATE OF OCCUPANCY JFER Ground(Rebar/Copper) iardware/Hold-Downs 'iers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing Exterior Walls Interior Walls Hardware/Hold-Downs �� zi 7. Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED, Insulation Drywall Interior/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 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 r 'tl .v A y