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Permit No. 30216 BUILDING ADDRESS: 15114 VIA LORETO I PERMIT NUMBER: 30216 � BUILDING INFORMATION APPLICANT INFORMATION y� apt` BUILDING PERMIT APPLICATION Address 15114 VIA LORETO Name (JOE FILKiNS CommunityDevelopment APN 1 1032.481-29 Address 17567 MARMONDE PLACE z... 2001 Grand Avenue Lot 18 Cit ZipCode RANCHO CUCAMONGA,CA 91730 4. ;: Chino Hills,CA 91709 y' Cross Streets Phone/Pager 1(909)627-7448 I ext cm or num mu— LICENSED CONTRACTOR DECLARATION Tract/Parcel 113906-3 ( City Bus Lic# 103-03181 •I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 152,352 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 1N/A i OWNER BUILDER DECLARATIONName IPERCY SEGURA I Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 115114 VIA LORETO COURT I City,Zip Code I,as the owner of the property,or my employees with wages as their whole City,Zip Code (CHINO HILLS,CA 91709 Phone ( I ext compensation,will do the work,and the structure is not intended or offered for sale Phone 1 I ext 1 Lic# I 0I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# ( City Bus Lic# construct the project I am exempt under Section BPC for this reason I I Bus Exp { APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION issued By (CARMEN FRUCTUOSO Contractor FILKNS MASONRY1 herebyaffirm under penaltyof perjuryone of the following declarations Date IssuedM 49/Address 7567 MARMONDE PLACE f, I have and will maintain a certificate of consent to self-insure for workers'compensation Finance Code SM as provided by Section 3700 of the Labor Code,for the performance of the work for Gry,Zip Code (RANG({O CUCAMONGA,CA 91730 Census Code \j .-/5(r t 7 which this permit is issued Phone or Pager 1(909)627-7448 I ext 1 Final Date I /1C.,---C)(i Bus Lic# 103-031810Final By p4-)O'llf7 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 Lic # 103-03 1 8 1 Extension workers'compensation insurance carrier and policy number are Exp Date 1631963 Reviewed By Lic Class 1C29 INSURANCE INFORMATION Approved By Insurance Company {State Fund PROJECT INFORMATION Policy Number 11578639 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 107/06/03 I Structure 11 © Section need not be completed if permit is for one hundred dollars($100)or less I I I Garage 1 i I ( y .1 certify that in the performance of the work for which this permit is issued 1 shall not employ Patio 1 ! 1 I ny person in any manner so as to become subject to the Workers'Compensation Laws of Porch I I 1 I California and agree that if I should become subject to the workers'compensation provisions of Other 1PATIO 1 (REAR 196 Section 3700 of the Labor Code I shall comply with those provisions (COVERED PATIO PROPOSED USE Date: I i Signature: I i t certify I have react this application and state that the above information is correct I agree to D t YvJs pa,,ra_ ac---1 x 3,41'X t-Li comply with all City Ordinances and state laws and hereby authorize representatives of this City to COMMENTS enter upon the above mentioned property for inspection pu se g145/41/ rrQ-Y /v / N va..S,to- 1110 v Date: vL/-/'7--u i Signature: /� �(L/�/,,, �'L j . -42.12+4) D ' OTHER FEES REQUIRED . •trU e C0h,2 -in 4P....._ ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning (PDd Yard ar 1 Over X 1 0 1 i Issuance 1 $29 00 1 Electrical 1 $0 00 Land Use. 1FR-1 Side Yard 5/5 School NO 1 1 __ Cut 0 Plan Check $42 12 Plumbing1 $0 00 1 Permit Fees: 1 $135.92 1 Ilan 1 Rear Yard l5 Fill 0 Development NO 1 1 SM IP { $0 50 't ice 1R3 SSY Sewer ( NO 1 Mechanical $0 00 1 Structural 1 $64 80 1 (� 1 _.._ Total 0 1 type (VN I Water 1 NO 1 Geo Review 1 $0 00 1 Grading 1 $0 00 1 TOtal Fee Due I $136.42 itISPECTION RECORt 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 U/G Conduit/Electrical Final Building/Construction kj,pc) Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings F.4.1) Piaci< /(9—dttsqe)-- ti TS CERTIFICATE OF OCCUPANCY • UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing • Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections : Footing, ReBar ("c 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