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Permit No. 30226 BUILDING ADDRESS: 15114 VIA LORETO PERMIT NUMBER: 30226 r--� ;4,____ BSG INFORMATION APPLICANT INFORMATION a! BUILDING PERMIT APPLICATION ° .N Address 115114 VIA LORETO Name IJOE FILKINS _ 11VCommunity Development APN 11032-481-29 Address 17567 MARMONDE PLACE '=''`,.% 2001 Grand Avenue venue Lot 18 / City,Zip Code 1RANCHO CUCAMONGA,CA 91730, ' •.. Chino Hills,CA 91709 , +1'':' Cross Streets Phone/Pager 1(909)627-7448 I ext 1 CITY , LICENSED CONTRACTOR DECLARATION ���� L,�J1 ,/,� ' Tract/Parcel 13906-3 /Ss�AcG+Gl►- City Bus Lic# 03-03181 I hereby affirm that Pm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$1,000 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 N/A OWNER BUILDER DECLARATION Name PERCY SEGURA Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 115114 VIA LORETO COURT City,Zip Code I,as the owner of the property,or my employees with wages as their whole City,Zip Code 1CHINO HILLS,CA 91709 Phone 1 ext 1 0 compensation,will do the work,and the structure is not intended or offered for sale Phone 1 ext Lie# ® I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# 1 City Bus Lic# construct the project I am exempt under Section I 1 BPC for this reason I Bus Exp APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION issued By HEATHER DAVIS I herebyaffirm under penaltyof perjury one of the followingdeclarations Contractor FILKINS MASONRY P J rY Date Issued 10/21/02 Address 7567 MARMONDE PLACE Finance Code f�4'y I have and will maintain a certificate of consent to self-insure for workers'compensation i_ Cs asprovided bySection 3700 of the Labor Code,for theperformance of the work for City,Zip Code RANCHO CUCAMONGA,CA 91730 0 Census Code ,,d- I --4,1 ___.) which this permit is issued Phone or Pager (909)627-7448 ext 1 Final Date I—C —o Lf Bus Lic# 03-03181 I have and will maintain workers'compensation,as required by Section 3700 of the Final By A vs*-O Labor Code,for the performance of the work for which this permit is issued My Lic 4 03-03181 _ Extension workers'compensation insurance earner and policy number are Exp Date 631963 Reviewed By Lic ss C29 Approved By INSURANCE INFORMATION Insurance Company 1State Fund PROJECT INFORMATION Policy Number 11578639 P 1,.....--- l' 11IIIOJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 107/06/03 A 1 1 1 1 1 Structure Section need not be completed if permit is for one hundred dollars($100)or less Garage I certify that in the performance of the work for which this permit is issued I shall not employ Patio • any person in any manner so as to become subject to the Workers'Compensation Laws of Porch California and agree that if I should become subject to the workers'compensation provisions of Other 1BBQ GAS LINE REAR Section 3700 of the Labor Code I shall comply with those provisions PROPOSED USE BBQ GAS LINE, 110V ELECTRICAL 2 OUTLETS,RELOCATE A/C Date: I I Signature. I I 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 mentioned property for inspection purposes Date: I/7)-09.Pad I Signature. r.Ld16/i OTHER TI PX FEES REQUIRED ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard Over X 0 1 Issuance $33 30 1 Electncal $35 25 Land Use 1FR-1 Side Yard 5/5 Cut 0 1 School 1 NO Permit Fees: $94.53 6 00 Plan Check $0 00 Plumbing $ 1 Plan 1 1 Rear Yard 15 Fill 1 0 1 Development 1 NO SMIP $0 00 1 Occ 1R3 SSYTotal 0 1 Sewer 1 NO Mechanical $19 98 Structural $0 00 1 Type 1VN Water 1 NO Geo Review $0 00 Grading $0 00 1 Total Fee Due $94.53 1 0111 I SPECTION 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 FinishvGrading- 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 .e4 4 — Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electrical$4Q/A/G. Final Building/Construction J----(0-041 T � Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION, Footings 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 Inte ridr Walls Hardware/Hold-Downs Rou ,ti Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED, Insulation Drywall Interior/Exterior Lath Stucco Scratch Roof Covenng Block Wall Inspections : ' Footing, ReBar -r r 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 /�1I Gas Test c:1 ,o-- i `