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Permit No. 2009-30190 I tS City of Chino Hills 0 BUILDING14000City Center DIVISIONDr,COFhino COMMHills,CA91UNITY DEVELOPMENT709 DEPARTMENT r, T...); -• r 1 :d-' Counter Phone (909)364-2780 ;1- Building Permit 24-Hour Inspection Line (909)364-2790 -�` (NOTE You must call before 3p m for a next business day inspection) ;11!,: :^til City Hall Main Number (909)364-2600 Ott NOTICE* THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR BELOW WHEN MAKING INQUIRIES MORE THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No PERMIT No CONVERT 9 5'X 14 5'(138 SF)TO STORAGE ROOM IN(E)GARAGE AREA-(4)OUTLETS(1)LIGHT FIXTURE 12009-22489 30190 B 31�DIISGA DELRSOS—( APT/UNIT NO I ISSUED 5/4n�9DATE I ISSUED BY 2Jenkins,Shelley APN ITTRACT139MAP#6-5 I90T 1FLOORS/UNITS 5 / Addition/Remodel PROJECT PERMITS IP TYPE 10E Res CODESr ICBNST TYPE (ZONING TYPE O3CUPANCYTYPE (VALUATION $7300 OOITOTALSOFT 0 (BLDG SQFT 434_ Add 00 Current Owners LEONICO RODRIGUEZ- Fees Address 2037 VISTA DEL SOL CHINO HILLS CA 91709 Fee Group/ Fee Description Fee Amount Payments Ph 909-393-7897 Transaction Type Email Addition/Remodel $266 84 _ Contractor OWNER/BUILDER-OWNER/BUILDER _ _ ',0",,„, b ; ” ,,, '_ Address N/A CHINO HILLS CA 91709 8001 Permit Issuance Fee $52 00 52 00 Ph N/A Email B39-B53 Residential Building Permit $123 50 123 50 Llc Information Exp Date LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION B003 Residential Plan Review Fee $75 16 75 16 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with B076 Electrical SF Residential $15 18 15 18 Sec 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect In secunng this permit I am acting with the knowledge of and on behalf of the owner of the property SB1473 $1 00 1 00 • TOTAL FEES $266 84 Date Contractor AMOUNT PAID $268 84 OWNER-BUILDER DECLARATION BALANCE DUE $0 00 hereby affirm under penalty of perjury that I am exempt from the Contractor's Licence Law for the followin reason,(Sec,7031 5,Business and Profesional Code Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,pnor to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption Any violation of Sec 7031 5 by any applicant for a permit subjects the applicant to a civil penalty of not more that five hundred dollars($500 00) I,• . ' er of the• ...,:rty,or my empl. with wages as their sole corn.: -..n,will do the w ,a •the s.'•,cture not i -nded or off: :•fo'..ale(Sec 71 •,.,usiness an,Profe ions Code e Contr: ors Lice ,:L: does n.'apply to• owner• prope o bg ds or im• .ves th+eon,and o doe••uch work h r se.or herself•;throu. his or he'•wn e•.loyees,• .vid:• hat such i,prove :nts are not intended o'.i=red for sale ; h.•'ever,the bui improvem-•t is.old within on, ear.f completion,the owner-builder will ha•••• e burden of pro •g that he she di• .t build or rmpro - -•r the purpose of sale) I,as owner• .re property,am exclusively • tracing wi ••.!sed contracto • rstruct the project(Sec 7r• ,Bu:,ess an. ' •., sions C•ie e Co actor's,.:nse La .oes no•:.ply to n owner of prope• who b .s o prove•; e:• ,and :o••ntracts for •ch pr.:cts with a•antra..r(s) license.- .- :nt to the C: :ctors Limn', aw) I am n e B s and P 1 Corry/ Date 1 —'1 °6? Owner 1. \ / V WORKERS COMPENSATION DECLAffATION I hereby affirm under penalty of perjury one of the following declarations _I have and will maintain a certificate of consent to self-insure for workers'compensation,as I certify that I have mad this application and state that the above information is correct I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is all city and county ordinances and state laws relating to building construction,and hereby authorize issued r presentatives of th��,city to enter upon the above-mentioned proptery for inspection purposes _I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor I /� , ///��� Code,for the performance of the work for which this permit is issued My worker's compensation ( / \ /� / C.- (L_O y insurance earner and policy number are 1_ \ 1 7 / Lamer Policy# 1 APPLICANT SIGNATURE / DATE _I certify that in the performance of the work for which this permit is issued,I shall not employ any Applicant LEONICO RODRIGUEZ-/ person in any manner so as to become subject to the workers compensation laws of California,and agree Address 2037 VISTA DEL SOL CHINO HILLS CA 91709 that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions Ph 909-393-7897 Email Llc Information Exp Date Date Applicant I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Hearth and WARNING Failure to secure workers compensation coverage is unlawful,and shall subject an employer Safety Code,which regulate the storage,handling and use of hazardous materials to cnminal penalities and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of compensation,damages as provided for in section 3706 of the Labor Code,interest,and attorney's fees CITY OF CHINO HILLS COMMUNITY DEVELOPMENT—BUILDING' & SAFETY DIVISION Call(909)364-2790 before 3:00 p.m.for next day inspection Post in a safe,conspicuous place at front of job Provide permit number when calling for inspection Have approved plans on job at time of inspection NO WORK SHALL BE COVERED WITHOUT INSPECTION File this permit with your permanent records when job is complete INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR Grad'ng: Block Wall Inspections: Pregrade Meeting Footing,Rebar Rough Grade 1'1 Lift Bond Beam Terraces 2"'Lift Bond Beam Sub Drains 3"'Lift Bond Beam Finish Grading Drain I Seal Soils Certification Grading Certification Rough ReRoof: Tear-off,Existing Conditions Underground Site Inspections: Sheath Nailing Building Sewer Line Roof Final Water Supply Line UIG Electrical Service Conduit Swirming Pools: Storm Drain/Catch Basin Location I Rebar 1 Bonding 1 Light DO NOT BACKFILL UNTIL ABOVE IS APPROVED Gas Test Gr Conduit Verify Soils Engineering: Ro Elect Compaction,moisture,conditioning,etc POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence,Gate&Alarm UnderfloorrUnderslab Inspection: Final Pool UIF Waste Plumbing UIF Water Fire Protection Equipment: UIF Mechanical UG Pipe UiF Electrical Thrust Blocks UF Framing Hydro UIF Insulation - Flush Subfloor Weld Outlet Insp ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Overhead Hydro Foundation Inspection: Tennp Power Pole Setback/Footing—OK to Pour Electric Release UFER Ground(Rebar/Copper) Gas Test Hardware I Hold-Downs Piers/Caissons/Tendons FINAL INSPECTIONS Slab Grade—OK to Pour 110 OCCUPANCY PERMITTED WITHOUT FINAL DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED County Environmental Heath Dept (391-7570) Shear inspection(Wood): Planning Dept (364-2752) Roof Nailing Public Works (364-2774) Exterior Walls Fire (393-3888) Interior Walls Landscape (364-2766) Hardware 1 Hold-Downs ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG. Final Grade Condo inspection: Final Electric Framing Final Plumbing ^" \ X Rough Electric Final Mechanical ,`� •�` Rough Mechanical Final Building/Construction ••,�� Rough Plumbing/Topout Water Meter Number COVER 110 WORK UNTIL ABOVE IS APPROVED CERTIFICATE OF OCCUPANCY Insulation OK TO ISSUE Drywall Inspection: OTHER: Interior Exterior EXT LATH Stucco Scratch Miscellaneous Inspections: Masonry Fi-eplace Plate Ties,Fire Block Patio/Deck: Footing Frame Access/Light/SWtch NOTICE TO OWNER:Call for FINAL INSPECTION on emery job. Patio Final This pernnitwill expie if work is suspended or abandoned for a period of 180 days. f' r ;• / City of oF �o Chino Hills ,i PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner-Builders A plyin • for Construction Permits IMPORTANT! N PROPERTY OWNER =)' Dear Property eSwner An applicationn for a building permit has b en submitjd ur ame Ii ing yourself as the builder of the prope 1, improv ments specified at 3"1 V/4 774. J &0/ `Y'"v /i5, C4' 907 r We are viding you with an Owner-Builder Acknowledgment and Information Verification Form t6 mak: you aware of your r �nsibilities and possible risk you may incur by having this permit issued in your name - the Owner-Builder We Will-n�issue a building permit until you have read, initialed your u • • tanding of each provision, signed, and returned - - • m to us at our official address '. .'- : - '. An agent of the owner cannot execute this notice unless you, the prope y owner, o•tain the prior approval of the permitting authority OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION, DIRECTIONS Read and initial each statement below to signify you understand or verify this information UL 1 I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property My homeowner's insurance may not provide coverage for those injuries I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property 2 I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility 3 I understand as an "Owner-Builder" I am the responsible party of record on the permit I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own 4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts k 5 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law 6 I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee" I also understand my failure to abide by these laws may subject me to serious financial risk 7 I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor Building & Safety Division • 14000 City Center Drive • Chino Hills • CA • 91709 • (909) 364-2780 • Fax (909) 364-2795 1/, 8 I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials "\. 9 I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www cslb ca gov for more information about licensed contractors " . 10 I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address 11 I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers (N- 12 I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil court It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license or form nota "zation, 's required to be presented when the permit is issued to verify the property owner's signature I\ Signature of property owner i Date f— Y-0 "I \Note The following Authonzation Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project Scope of Construction Project(or Description of Work) Project Location or Address Name of Authorized Agent Tel No Address of Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy Note This form must be notanzed, to verify the property owner's signature pnor to permit issuance Property Owner's Signature Date