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Permit No. 19914 BUILDING ADDRESS: 1 2101 VISTA DEL SOL PERMIT NUMBER: 19914 BUILDING INFORMATION APPLICANT INFORMATION off'\ BUILDING PERMIT APPLICATION Address: 12101 VISTA DEL SOL Name: IA P MASONRY N«_ w'*Y N�+ Community Development APN: 11032-482-30 Address: 18692 LA VINE STREET .,:.-'1',4-� 2001 Grand Avenue Lot: 1116 City,Zip Code: (ALTA LOMA,CA 91701 ',. 'y Chino Hills,CA 91709 Cross Streets: 1 Phone/Pager: 1(909)481-9964 1 ext. 1 CITY °F°""°HILLS LICENSED CONTRACTOR DECLARATION Tract/Parcel: 113906-5 I City Bus Lic#: ITO PURCHASE I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation: 1$5,952.00 1 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: IHOSSEIN ZAND ASSOCIATES OWNER BUILDER DECLARATIONName: RICK GOLDBAUCH Address: 15175 CHAPALA DRIVE I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address: 2101 VISTA DEL SOL City,Zip Code:'RIVERSIDE,CA 92507 I,as the owner of theroe p p rty,or my employees with wages as their whole City,Zip Code: CHINO HILLS,CA 91709 Phone: (909)784-2424 1 ext. 1 • compensation,will do the work,and the structure is not intended or offered for sale. Phone: I ext. I Lic#: 1C035721 • I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: City Bus Lic#: 1 construct the project. I Bus Exp: APPROVAL INFORMATION I am exempt under Section I I BPC for this reason WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: DAWN FORSHA I hereby affirm under penalty of perjury one of the following declarations: Contractor: IA P MASONRY J Date Issued: 5/8/02 Address: 8692 LA VINE STREET I Finance Code: C4 I have and will maintain a certificate of consent to self-insure for workers'compensation Q as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code: ALTA LOMA,CA 91701 I Census Code: which this permit is issued. Phone or Pager: 1(909)481-9964 1 ext. I I Final Date: Bus.Lic.#: 103-06793 I Final By: I have and will maintain workers'compensation,as required by Section 3700 of the Lic.#: 1722673 Q Labor Code,for the performance of the work for which this permit is issued. My I Extension: workers'compensation insurance carrier and policy number are: Exp Date: 105/31/04 I Reviewed By: ROGER MOON Lic. IC29,HIC I Approved By: ROGER MOON I INSURANCE INFORMATION Insurance Company: 'EXEMPT I PROJECT INFORMATION Policy Number: I 1 PROJECT DESCRIPTION Structure: LOCATION SQUARE FT. Expiration Date: 1 J I I I I • Section need not be completed if permit is for one hundred dollars($100)or less Garage: 1 I certify that in the performance of the work for which this permit is issued. I shall not employ Patio: I I I 1 any person in any manner so as to become subject to the Workers'Compensation Laws of Porch: I I California and agree that if I should become subject to the workers'compensation provisions of Other: (RET.WALL I (SIDE 1 496 Section 3700 of the Labor Code. I shall comply with those provisions. PROPOSED USE RETAINING WALL Date: 1 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 authorize representatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes. Date: IS%/p`a— I Signature: I v ' ac OTHER FEES REQUIRED ZONING/ SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning: 1PD 1 Front Yard: 20 Over X: 1 0 1 Issuance: 1 $29.00 I Electrical: 1 $0.00 I Land Use: 1FR-1 I Side Yard: 5 Cut: 1 0 I School: I NO Permit Fees: I $133.22 Development: 1 NO Plan Check: 1 $7.02 I Plumbing: I $0.00 ' Plan: 'RET.WALL 1 Rear Yard: 15 Fill: 0 SMIP: 1 $0.00 I Occ: 1R3 SSY: 15 1 Sewer: NO Mechanical: 1 $0.00 I Structural: 1 $97.20 I 1 Total: 1 I Water: NO Total Fee Due I $133.22 I Type: VN Geo Review: I $0.00 I Grading: 1 $0.00 YP , INSPECTIONRECORD Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL! Terraces County Environmental Sub Drains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Building Sewer Final Grade U.G.:Waste Plumbing Final Electric Water Service Storm Drain/Catch Basins Final Plumbing Final Mechanical U/G Conduit/Electrical Final Building/Construction L -J'-,pa- Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Gyound(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing • Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections : Footing, ReBar ( 7—vD- 1st Lift Bond Beam 4-2.-O} a i41ef — --�- ' /1 2nd Lift Bond Beam / ' \ 3rd Lift Bond Beam Fiy M _ Drain/Seal SWIMMING POOLS: Location/Rebar/Bonding/Light Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence,Gate&Alarm Final Pool Temp Power Pole Electric Release Gas Test BUILDING ADDRESS: 2101 VISTA DEL SOL I PLAN CHECK NUMBER: 19914 • N _ BUILDING INFORMATION APPLICANT INFORMATION o$ BUILDING PLAN CHECK Address: 12101 VISTA DEL SOL I Name: IA P MASONRY ,•`#`"*y+ Community Development APN: 1032-482-30 I Address: 18692 LA VINE STREET •:::4).:4..7.'; j-: 2001 Grand Avenue Lot: 116 1' City,Zip Code: 'ALTA LOMA, O 9 64 CA 91701 ext. rs.. mo -• - . ' 19 �;;; $! Cross Streets: 1 1 Phone/Pager: I( ) CITY OF QONOIIILLS LICENSED CONTRACTOR DECLARATION Tract/Parcel: 113906-5 1 City Bus Lic#: ITO PURCHASE I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation: 1$4,896.00 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: IHOSSEIN ZAND ASSOCIATES OWNER BUILDER DECLARATIONAddress: 15175 CHAPALA DRIVE Name: RICK GOLDBAUCH I I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address: 2101 VISTA DEL SOL 1 City,Zip Code:1RIVERSIDE,CA 92507 property,or I,as the owner of themy employees with wages as their whole City,Zip Code: CHINO HILLS,CA 91709 Phone: 784-2424 1(909)1 I ext. © compensation,will do the work,and the structure is not intended or offered for sale. Phone: 1 ext. 1 Lic#: 1C035721 I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: City Bus Lic#: 1 construct the project. Bus Exp: APPROVAL INFORMATION I am exempt under Section I I BPC for this reason I I WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: YVETTE MARTINEZ 1� Contractor: A P MASONRY I Date Issued: 4/24/02 I hereby affirm under penalty of perjury one of the following declarations: Address: 8692 LA VINE STREET I Finance Code: C7 I have and will maintain a certificate of consent to self-insure for workers'compensation 1 Census Code: C) as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code: ALTA LOMA,CA 91701 which this permit is issued. Phone or Pager: (909)481-9964 1 ext. I I Final Date: Bus.Lic.#: TO PURCHASE3 Final By: I have and will maintain workers'compensation,as required by Section 3700 of the extension: C? Labor Code,for the performance of the work for which this permit is issued. My Lic.#: 722673 workers'compensation insurance carrier and policy number are: Exp Date: 05/31/04 Reviewed By: Lic.Class: C29,HIC Approved By: INSURANCE INFORMATION PROJECT INFORMATION Insurance Company: EXEMPT 1 Policy Number: 1 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date: 1 I Structure: 1 1 I I 4' Section need not be completed if permit is for one hundred dollars($100)or less Garage: 1 1 1 I Patio: 1 1 I �+ I certify that in the performance of the work for which this permit is issued. I shall not employ �t any person in any manner so as to become subject to the Workers'Compensation Laws of Porch: 1 I / Ifo California and agree that if I should become subject to the workers'compensation provisions of Other: 1RET.WALL (SIDE Section 3700 of the Labor Code. I shall comply with those provisions. PROPOSED USE 68'X 6'RETAINING WALL(INCLUDES 1'FOR FOOTING) Date: I I Signature: I I II with e read this cesian and state that the r bye information hize eis correct. I thigree to COMMENTS Wh �\n C a 1 V 1 V `comply with all City Ordinances and state laws and hereby authorize representatives of this City to V ` enter upon the above mentioned property for inspection purposes. Date: I t,L/JiG /D I Signature: I ,�_ OTHER FEES Uv t ZONING 1 SETBACKS GRADING REQUIRED PRIOR TO PLAN CHECK FEE INFORMATION ACTUAL PERMIT Zoning: 1PD 1 Front Yard: 1 20 Over X: 1 0 1 I Initial Plan Check: 1 $56.16 I Land Use: FR-1 Side Yard: 5 School: 1 I Cut: 0 Initial Structural: 1 $0.00 Total Fee Due I $56.16 I Plan: RET.WALL 1 Rear Yard: 1 15 Fill: 1 0 Development NO Initial Geo Review: 1 $0.00 1 Occ: 1R3 1 SSY: 1 15 1 Total: 1 0 1 S/Wter NO I Initial Grading: 1 $0.00 I Type: IVN 1